Mrs S’s husband lives in a care home located in one primary care trust (PCT) area; but his GP is based some distance away in an area overseen by a different PCT - Kingston Primary Care Trust. The PCT for the area in which the care home is located assessed him as eligible to have all of his care paid for by the NHS. However, Kingston Primary Care Trust would have been responsible for paying Mr S’s NHS bills because Mr S’s GP surgery was on their patch.
Kingston Primary Care Trust said they wanted to assess Mr S themselves before they decided whether or not to pay for his care. This left Mrs S to pay her husband’s bills for several months, despite having been told her husband was eligible for NHS funding.
Mrs S rang the Ombudsman to ask for help. We rang Kingston Primary Care Trust. We asked them what was happening and when they would make a decision. We asked them to consider Mrs S’s request to fund her husband’s care based on the other PCT’s assessment. This prompted them to take another look at Mr S’s case. They decided that they would fund Mr S’s care without reassessing him. They also paid Mrs S over £13,000 for care she had wrongly had to fund.
Having received only one telephone call from Kingston Primary Care Trust in six months, Mrs S was pleased to be telephoned with an update and then, later the same day, with the news that the funding had been agreed.