Conclusions and recommendations from the Ombudsman's report, February 2003
The findings in the cases reported today and the themes emerging from those still under investigation lead me to conclude that:
- The Department of Health's guidance and support to date has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding for long term care to be operated across the country;
- What guidance there is has been misinterpreted and mis-applied by some health authorities when developing and reviewing their own eligibility criteria;
- Further problems have arisen in the application of local criteria to individuals;
- The effect has been to cause injustice and hardship to some people.
I therefore recommend that strategic health authorities and primary care trusts should:
- Review the criteria used by their predecessor bodies, and the way those criteria were applied, since 1996. They will need to take 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.
I also recommend that the Department of Health should:
- 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. Where they were not, the Department might need to coordinate effort to remedy any financial injustice to patients affected;
- Review the national guidance on eligibility for continuing NHS health care, 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. This guidance may need to include detailed definitions of terms used and case examples of patterns of need likely to mean NHS funding should be provided;
- 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 health care into the single assessment process and whether the Department should provide further support to the development of reliable assessment methods.
Source: NHS funding for long term care, the Health Service Ombudsman, 2nd report - session 2002-2003, HC399