Criticism of long-term care charges prompts thousands to seek redress

Nearly 2,500 people have contacted the health service ombudsman
after she criticised four health authorities for failing to pay for
individuals’ continuing care in nursing homes.

In February, Ann Abraham criticised Dorset, Wigan and Bolton,
Berkshire and Birmingham strategic health authorities for wrongly
making patients with long-term conditions pay for their own care.
She invited relatives of other patients to contact her with similar
concerns (news, page 10, 27 February).

Abraham’s office has since had 2,481 inquiries from relatives
seeking to challenge funding decisions. She has forwarded 300 to
the relevant health authorities.

In her latest report, Abraham has criticised a fifth authority for
its “over restrictive” eligibility criteria for continuing care,
and ordered it to pay £20,000 compensation.

The case concerned Marjorie Baxter, 82, who has Alzheimer’s but was
refused funding by the former Suffolk Health Authority.

Although initially assessed as eligible, this was overruled by a
second assessment for a placement closer to her husband’s home. The
ombudsman criticised Suffolk for having inconsistent assessment
procedures.

Moreover, the criteria were not in keeping with the 1999 Coughlan
judgement on eligibility criteria for NHS-funded long-term care,
which prompted new Department of Health guidance in 2001.

Baxter’s son, Andrew, said nursing home fees over five years had
cost his elderly father £100,000.

The Alzheimer’s Society said thousands of people were probably in a
similar position, but the jargon confused relatives. “Most have no
idea of the difference between NHS continuing care and free nursing
care,” a spokesperson said.

“It is amazing that people in an advanced state of dementia are
still paying because they are told their care is personal and not
health care.”

After Abraham’s report, the Department of Health asked all
strategic health authorities to estimate the number of people who
might have been wrongly assessed under criteria not consistent with
the Coughlan judgement.

A DoH spokesperson refused to say whether the information would be
published, or what action might be taken.