Foreword
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In February 2003 and December 2004 in my role as Health Service Ombudsman for England, I laid before Parliament two reports about my investigations into complaints about funding for the continuing care of elderly and disabled people. The first of those, NHS funding for long term care (HC 399) made a number of recommendations to strategic health authorities (SHAs) and primary care trusts (PCTs). They included the recommendations that SHAs and PCTs should:
- review the continuing care eligibility criteria used by their predecessor bodies, and the way those criteria had been applied, since 1996, taking into account the Coughlan judgment, guidance issued by the Department of Health and my findings; and
- 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 would 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.
As a consequence of the retrospective review of continuing care cases undertaken by the NHS when following these recommendations, some people have now been granted retrospective NHS funding for continuing care. While I am pleased that some people who had been wrongfully denied funding have now received redress for the maladministration I identified, I have received a number of complaints about the amount of redress paid by primary care trusts.
The complainants have alleged that the redress they received failed to compensate them or their relatives fully for all the financial losses they suffered while having to fund essential long term care.
Primary care trusts have said that, in deciding on the amount of compensation for those who had been wrongly denied funding for their continuing care, they were following Department of Health guidance.
One of the complaints to me was made by Ms T following the refusal of Greenwich Teaching PCT to provide financial redress for the premature sale of her uncle’s property. Ms T also complained to me, via her MP, about the role of the Department’s guidance in the PCT’s decision.
PCTs are within my jurisdiction as Health Service Ombudsman for England and the Department of Health is within my jurisdiction as Parliamentary Ombudsman. Therefore, unusually, I issued a single investigation report in relation to Ms T’s complaint. As I consider that the issues raised will be of interest to Members generally, as well as professionals working in the fields of health and social care, voluntary organisations and advisers, I am laying this report before Parliament under section 10(4) of the Parliamentary Commissioner Act 1967 and section 14(4) of the Health Service Commissioners Act 1993.
Ann Abraham
Parliamentary and Health Service Ombudsman
March 2007
