Ombudsman reports on problems with NHS funding for long term care

16 December 2004

Press release 11/04

The problems faced by disabled and elderly people in accessing NHS funding for long term care are highlighted in a new report from the Health Service Ombudsman, Ann Abraham, published today.

The report is based on the evidence gathered from almost 4,000 complaints received since the publication of the Ombudsman's first report on the subject, in February 2003. It highlights how the creation of national minimum eligibility criteria, a national set of assessment tools and the right skills and capacity at local level should help patients to get the funding to which they are entitled.

Ms Abraham said, 'From the patient's point of view applying for funding for long term care has been a lengthy hit and miss process. My main concern is for the future. I want to be assured that no-one has been wrongfully denied NHS funding for their long term care and that the lessons learned from the current review of cases are used to make sure that open and fair procedures are put in place across the country.

'I am pleased that last week's Ministerial statement opens the way to improving how funding decisions are made and it means that the Department of Health is giving the leadership and guidance so badly needed by the health service locally. In terms of next steps, there is a need for clear and consistent national guidelines about who is eligible for funding; robust approaches to assessing need and enough people in place with the right skills to undertake that assessment at local level."

After setting out the shortcomings in the current review of continuing care cases back to 1996, the Ombudsman's report makes six key recommendations to the Department:

  • Establish clear, national, minimum eligibility criteria which are understandable to health professionals and patients and carers alike;
  • Develop a set of accredited assessment tools and good practice guidance to support the criteria;
  • Support training and development to expand local capacity and ensure that new continuing care cases are assessed and decided properly and promptly;
  • Clarify standards for record keeping and documentation both by health care providers and those involved in the review process;
  • Seek assurance that the retrospective reviews have covered all those who might be affected; and
  • Monitor the situation in relation to retrospective reviews and use the lessons learned to inform the handling of continuing care assessments in the future.

The Ombudsman adds, 'Our report highlights that the only way to make the system transparent and fair, is to have national minimum eligibility criteria, with a national set of assessment tools and guidance on how to conduct and report on the reviews. It is clear from our work that there are examples of good practice and systems in some strategic health authorities which can form the basis for this work. We would be delighted to work with the Department of Health and the strategic health authorities in helping to develop national guidance.'

For more information, or copies of the report contact the OPHSO Press Office. Telephone: 0300 061 4996 or email: press@ombudsman.org.uk

Notes to Editors

  1. The Report - NHS funding for long term care: follow up report will be available from 1230 hours on Thursday, 16 December on the OPHSO website: www.ombudsman.org.uk
  2. The Report includes a number of case studies - information on the identities of the individuals involved in these cases is confidential.
  3. About the Ombudsman - The Health Service Ombudsman looks into complaints made by or on behalf of people who have suffered because of unsatisfactory treatment or service by the National Health Service (NHS). The service is free and the Ombudsman is completely independent of the NHS and the government. For further information see the website
  4. Continuing care - NHS continuing care is a package of care arranged and funded solely by the NHS for people who need it because of disability, accident or illness. Continuing care can be provided in a range of settings - care homes, patients' homes or hospitals.
  5. Continuing care complaints - The bulk of continuing care cases received by the Ombudsman have included complaints about delays in carrying out reviews and about appeals, once reviews have been carried out. Most complaints are about the decision not to fund, the process by which the decision was made and about delays in the payment of restitution.