Introduction
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The Pointon case
We are departing from our usual practice and publishing the full text of this investigation earlier than planned in order to amplify the edited version published by the Alzheimer’s Society on their website, which may have led to some confusion about the Ombudsman’s findings.
As always, the findings relate to the unique set of circumstances surrounding the case and do not set a precedent for a class of cases. The Ombudsman looks at each case on its merits.
Complaint as put by Mrs Pointon
- The account of the complaint provided by Mrs Pointon was that when he was 52 years old, her husband Mr Pointon, was diagnosed with early onset dementia. Mr Pointon’s physical and mental state deteriorated steadily and in 1998 he was admitted to a nursing home. Initially, he settled in well but by early 2000 he had become less mobile and was suffering from regular falls. MrsPointon decided to bring her husband home and care for him herself with the aid of two full-time carers working alternate weeks. This care was financed by Direct Payments from Social Services (monies paid directly to Mr Pointon) and contributions from Mr and Mrs Pointon.
- Between April 2000 and June 2001 Mr Pointon received NHS funded respite care in a psychiatric unit for up to five days every five weeks. However, this had to be discontinued when he began to suffer from car sickness and panic attacks during the journey to and from the ward. In August 2001 Mrs Pointon asked the former Cambridgeshire Health Authority (the Health Authority) to fund either Mr Pointon’s continuing health care costs, or the cost of two fulltimecarers every fifth week, in order to provide her with a break similar to that formerly provided when Mr Pointon was in the hospital ward. After a care assessment and a multi-disciplinary meeting a suggestion was made for possible funding of one extra carer for three and a half hours a day, for six days, every five weeks.
- Mrs Pointon complained to the Chief Executive of the Health Authority in January 2002. She was dissatisfied with the amount of funding that had been suggested and challenged the Health Authority’s interpretation of their eligibility criteria for funding continuing care. On 1 April 2002 the Health Authority ceased to exist. The budget for funding such care passed to South Cambridgeshire Primary Care Trust (the PCT). On 20 May, after a nursing assessment of Mr Pointon’s needs and further meetings between the PCT and Social Services it was decided that all Mr Pointon’s health care needs were already being met by the NHS, that the respite care required was social care and therefore he was not eligible for any extra NHS funding. Mrs Pointon remained dissatisfied.
- The matters investigated were that:
- the Health Authority misapplied their local eligibility criteria and relevant Department of Health guidance; and
- the PCT also misapplied the local eligibility criteria and relevant Department of Health guidance, and in particular they relied on inaccurate or inadequate information, failed to take account of relevant facts in their assessment and took account of irrelevant factors;
