A breath of fresh air

Once again the health service ombudsman has shone a light to
help service users and their carers who are forced to fumble their
way through the darkness that still too often lies at the border
between health and social care. Partnership may be the
government’s preferred buzzword – and there are many good
collaborations between health and social services across the
country – but boundary disputes of various sorts persist, whether
they concern the delayed discharge of patients from hospital or who
should pay for their care once they are out.

In striking her latest blow for service users, the ombudsman Ann
Abraham has cast aside the health service’s comforting
delusion that fully funded NHS care is necessarily delivered in
hospital or in a nursing home. Malcolm Pointon, diagnosed with
Alzheimer’s 13 years ago, is cared for at home by his wife
Barbara and has a range of pronounced physical and mental health
needs which result directly from the disease. Yet the primary care
trust initially concluded that his principal needs were for social
rather than health care and that it should be financed by
means-tested social services payments rather than fully funded from
NHS budgets. What seems to have driven the PCT to this perverse
decision is the false belief that health care in these
circumstances must be provided by trained nurses, though the
evidence given to the ombudsman showed that the patient’s
wife was in fact providing health care to a high standard.

The PCT’s decision to accept the ombudsman’s
recommendation and fund all of the care costs, by a £1,000
weekly direct payment via the local authority, is a victory for the
service user and his carer. But it also brings common sense to bear
on the debate about what is, and what is not, social care. As the
result of a previous intervention by the ombudsman, the NHS already
faces a £300m bill to compensate older people wrongly made to
pay for their long-term care. Then as now there were problems about
the way eligibility criteria were applied. In Malcolm
Pointon’s case it was plain from the outset that he passed
all the tests for health care, but the PCT could not see that the
patient’s situation called for some fresh thinking.
Belatedly, after a prolonged campaign by the carer and pressure
from the ombudsman, it has done just that. The ability to think
afresh will be indispensable as social care refashions itself in
partnership with health.