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NHS long term care - Elderly and disabled in care wrongly assessed

Elderly and disabled patients who need continuing care are often wrongly assessed and charged for treatment by health authorities according to a  report by the independent Health Service Ombudsman.

The report ,"NHS funding for long term care of older and disabled people" has found evidence to suggest officials are wrongly making people meet the costs of nursing home care. In fact thousands of elderly and disabled people may be able to claim compensation because they have been wrongly charged for long term care.

The report highlighted and upheld four complaints concerning individuals who were billed for their care. Each was required to pay nursing home fees despite Department of Health guidance and a 1999 court ruling - the Coughlan judgment - which stated that the costs of long term care must be met by the NHS if the needs of the patient are primarily health-related. The relevant health authorities have been ordered to reimburse those costs.

The report recommended health authorities and primary care trusts should:

• review the criteria used by their and the way those criteria were applied, since 1996, taking into account the Coughlan judgment, guidance issued by the Department of Health and my findings;
• make efforts to remedy any consequent financial injustice to patients, where the criteria, or the way they were applied, were not clearly appropriate or fair. This will include attempting to identify any patients in their area who may wrongly have been made to pay for their care in a home and making appropriate recompense to them or their estates.

The Department of Health should also:

• consider how they can support and monitor the performance of authorities and primary care trusts in this work. That might involve the Department assessing whether, from 1996 to date, criteria being used were in line with the law and guidance. 
• review the national guidance on eligibility for continuing NHS healthcare, making it much clearer in new guidance the situations when the NHS must provide funding and those where it is left to the discretion of NHS bodies locally. 
• consider being more proactive in checking that criteria used in the future follow that guidance;
• consider how to link assessment of eligibility for continuing NHS healthcare into the single assessment process and whether the Department should provide further support to the development of reliable assessment methods.

You can also access the following:

• back to policy documents page
• nhs funding for long term care of older and disabled people
• nhs funding for long term care: follow up report
• summary of the coughlan judgment

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