27 February 2003: The Health Service Commissioner for England, Ann Abraham, recently presented her first report to Parliament entitled “NHS funding for long term care of older and disabled people” based on some 16 complaints about NHS funding for long term care considered over the last 18 months.
She said that in four of the investigations, involving different health authorities that had refused to pay care bills of a person moved from hospital to a care home, the complaints concerned were largely justified. Those health authorities were using over-restrictive local criteria which were not properly in line with Department of Health guidance or with a crucial judgement in the Coughlan case. The effect was that in at least one case a patient had to pay for their own care when the NHS should have paid for it.
The complaints seen also raise other concerns, detailed in the report, about how the system for assessing eligibility for NHS funding has been working.
The test case involving Pam Coughlan did much to shape the current system. The judgement in that case made it clear that if the needs of the patient were primarily health needs, the health authority was responsible. But the judgement also said that some care could be provided by social services, which can charge patients after means-testing. This led to some confusion about which patients were eligible for NHS-funded care.
There is evidence that the revised guidance issued in 2001 by the Department of Health following Coughlan, in the view of the Commissioner, “has been misinterpreted by some health authorities and trusts”.
As a consequence of the above criticism, the Government is to review its guidance on who should receive free long term nursing care – but it has played down speculation that the problems relating to existing guidance are widespread. The Health Minister, Lord Hunt, said he believed the advice was sound and he did not think confusion was common.