Failure to fund continuing care leads to huge surge in complaints

A record number of complaints was made to England’s health service
ombudsman last year, many of them against health authorities that
had refused to fund continuing care in nursing homes.

In her annual report, the health ombudsman Ann Abraham reveals that
she received 3,994 complaints in 2002 – a 50 per cent increase on
the previous year.

The increase was “almost entirely due” to complaints about the
funding of continuing care in the wake of her February report,
which criticised four health authorities for wrongly making
patients pay for their own care (news, page 10, 27 February).

“My investigations showed NHS organisations struggling, and
sometimes failing, to conform to the law and Department of Health
guidance on this issue,” Abraham says in the report. “The
indications were that the problems might be widespread.”

Abraham received 1,300 similar complaints in the six weeks after
publication of her report in February. She has since asked NHS
chief executive Nigel Crisp to work with health authorities to
ensure that local eligibility criteria meet the legal standard set
by the 1999 Coughlan judgement.

“In my view it is not for my office to embark on a series of
investigations into matters which should fall on the health service
to resolve,” Abraham writes in the report.

The report has details of three complaints on long-term care,
received since February, which Abraham has since upheld.

A complaint by Age Concern against the former Shropshire Health
Authority concerned a stroke patient who had no mobility and needed
all personal care needs attended to but had been refused NHS-funded

Abraham found that, under the authority’s eligibility criteria, no
nursing home patient qualified for funding because they had been
deemed “fit enough” to be discharged from hospital. Revisions to
the criteria made in 2001 were still “overly restrictive” and
assessment forms had not been updated, the ombudsman said.

A second complaint against the same health authority concerning a
woman with Alzheimer’s who was assessed as needing Elderly Mentally
Ill care but refused NHS-funded continuing care was also upheld.

The third case concerned another woman with Alzheimer’s who was
initially assessed by the former Suffolk Health Authority as
eligible for funding, but was later ruled ineligible following a
second assessment for a placement nearer her husband’s home. The
ombudsman criticised the authority for having inconsistent
procedures (news, page 10, 6 April).

– The Health Service Ombudsman for England, Annual Report

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