Summary
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The Parliamentary Ombudsman found that there was maladministration in the Department of Health’s decision making and communication of its approach to recompense for wrongly denied continuing care funding. The Department had advised the NHS to pay recompense based on the principle of restitution for only those monies paid out in care fees. Their approach discouraged PCTs from considering full redress, including, for example, redress for claimed financial loss for premature sale of a property or inconvenience and distress that individuals had suffered in making unnecessary difficult decisions about how to fund care. The Health Service Ombudsman concluded that Greenwich Teaching Primary Care Trust had not acted with maladministration and it was not responsible for the consequences of its attempts to implement the Department’s unclear and inconsistent guidance to the NHS.
The Department’s maladministration resulted in inconsistency in payments. However, for most people this is unlikely to have resulted in significant unremedied injustice.
The Parliamentary Ombudsman recommended that the Department should develop and distribute properly considered national guidance for the NHS on continuing care redress which aims to return individuals to the position they would have been in but for the maladministration which wrongly denied them continuing care funding. The guidance should:
- include a reminder to the NHS that PCTs can make compensation payments for:
- financial loss, including interest, which is demonstrably attributable to the wrongful denial of continuing care funding and is aimed at returning the individual to the financial position he or she would have been in but for the maladministration; and,
- inconvenience and distress caused by having to make difficult financial decisions at a challenging time which were unnecessary because continuing care should have been funded. Such payments should recognise the degree of inconvenience and distress that was suffered by complainants. In some cases this may be a significant sum of money, in others a smaller sum. There will be cases where any such payments will be accounted for by the financial gain from unreclaimed state benefits and/or state pension payments;
- give clear guidance to the NHS about how to calculate interest payments; and make it clear that, where inconsistencies in using the Retail Price Index have resulted in significant financial injustice, adequate remedy should be made;
- include information for PCTs about the responsibilities of local authorities to offer deferred payment agreements from October 2001, so that complaints can be promptly considered by all the relevant bodies;.
- where, in the light of this guidance on continuing care redress, PCTs identify systemic unremedied injustice, the Department should support them in taking action to remedy the injustice.
The Department accepted the recommendation and agreed to publish such guidance.
