| |
Home > Publications > Selected Cases > Selected Investigations Completed December 2002March 2003 > Case no. E.5/02-03
Complaint against The former Shropshire Health Authority (the Authority)
Summary of Case
In June 2000, Mrs H’s mother, Mrs F, who has Alzheimer’s Disease, was assessed by a consultant psychiatrist as needing specialist elderly mentally ill (EMI) care. A nursing assessment on 3 July confirmed that. On 7 October, because of the severity of her symptoms, Mrs F had to move from her residential home to a nursing home. On 28 November, Mrs H’s Solicitor requested that, as Mrs F’s primary need was now EMI nursing, her care should be funded by the NHS, in line with a precedent set in a Court of Appeal hearing in 1999 (the Coughlan judgment). A nursing assessment of Mrs F’s needs noted that Mrs F required full assistance with all her personal tasks including washing, dressing, feeding and toiletting. She was also doubly incontinent, was dependent upon others for her safety, and could only mobilise with assistance. The Authority (which was responsible at that time for funding patients with continuing health care needs in the community) decided, on 11 January 2001, that Mrs F did not meet their criteria for funding. On 20 February, Mrs H’s Solicitor complained to the Authority about that decision. A request for an independent review was refused on 20 November.
Findings
The matter investigated was whether the Authority gave proper consideration to Mrs F’s eligibility for NHS funded continuing care and whether their eligibility criteria complied with relevant Department of Health guidance. The Ombudsman found that the Authority’s 1997 eligibility criteria, against which Mrs F was assessed, left no scope for the NHS to fund the full cost of care in a nursing home: only for patients in hospital. That meant that if a person was deemed fit to be discharged from a hospital, it might also be deemed that they were then not eligible for full NHS funding. The Ombudsman was uneasy about that: although some authorities might have had enough provision in NHS facilities to meet all those with continuing care needs, many others might not. The criteria was over-restrictive. Although the Authority had reviewed its criteria following the Coughlan judgment, and the new criteria allowed for full NHS funding outside of a hospital, it was not clear when the new criteria were implemented. Nor was it clear how assessments were to be judged and confusion was inevitable because the eligibility assessment forms had not been updated with the new criteria. The Ombudsman was advised by her independent clinical assessor that Mrs F required significant nursing care and it was debatable whether that could properly be regarded as merely incidental or ancillary to the accommodation which Mrs F also needed. The Ombudsman upheld the complaint.
Remedy
From 1 April 2002, the Authority was abolished and responsibility for funding continuing health care needs transferred to a new body, the Shropshire County Primary Care Trust, while responsibility for setting eligibility criteria moved to Shropshire and Staffordshire Strategic Health Authority (the new Authority). The Ombudsman recommended that the new Authority should, with the Primary Care Trust and local authority colleagues, review the eligibility criteria for funding continuing care to ensure that they were in line with the Coughlan judgment and other relevant guidance. They should also review their assessment procedures and documentation to ensure they were clear and consistent. It was also recommended that the new Authority should, with colleague organisations, then determine whether Mrs F (and any other patients) was wrongly refused continuing care funding and, if that was the case, make the necessary arrangements for reimbursing the costs. The new Authority agreed to implement these recommendations, and apologised to Mrs H for the shortcomings identified.
Previous < Contents > Next
Back to top
|
 |
