Published: 15 March 2007
Redress for Late NHS Funding of Continuing Care
The Parliamentary and Health Service Ombudsman, Ann Abraham, has reported on the results of her investigation into complaints about the amount of redress received by some elderly and disabled people who had belatedly received NHS funding for their care.
Complainants alleged that the amount of recompense they had received from Primary Care Trusts (PCTs) did not compensate them fully for all the financial losses they had incurred while funding their own essential long term care.
PCTs said that in calculating the amounts payable they were following guidance from the Department of Health, which advised paying the care costs the NHS should have paid and took no account of other possible financial losses or the desirability of including an element of compensation for any distress & inconvenience suffered.
Also, the guidance had advised calculating interest based on the retail price index (RPI) rather than the higher County Court judgment debt rate.
The Ombudsman found that there was inconsistency in the way PCTs calculated the amount of redress due, saying:
“It was unfair that the geographical location of those belatedly receiving redress affected the amount of compensation they received.
Some people had been forced to make difficult decisions about how to fund their care.
Where the NHS later reviewed their cases and agreed that the initial decisions had been wrong, I would expect to see an appropriate level of interest paid on the reimbursed fees together with an element of compensation for the distress and inconvenience suffered”.
However, the Ombudsman said that those people who had received social security benefits during the period for which they later received retrospective NHS funding would usually not have suffered any injustice.
That was because the Department for Work and Pensions had agreed not to reclaim the benefits.
The total sum those people received - made up of reimbursed fees plus interest calculated by using the retail price index (RPI) - in most cases more than equalled the amount they would have received had interest been calculated using the County Court judgment debt rate and state retirement pension and benefits been reclaimed.
However, Ms Abraham was clear that PCTs should compensate any complainants who could provide evidence of financial loss, unless the amount of money involved was small in relation to the total amount due.
The Ombudsman recognised that PCTs were acting on advice from the Department of Health and she concluded the Department had been maladministrative in deciding on its formula for redress and in the way it communicated its approach to the Health Service.
Ms Abraham recommended that the Department should develop & distribute properly considered national guidance on continuing care redress, which should remind the Health Service that:
· where financial loss could be shown to be attributable to the wrongful denial of continuing care funding, compensation payments should be aimed at returning individuals to the financial position they would have been in had the maladministration not occurred
· payments should also be made in recognition of the inconvenience and distress caused to patients, and
· that local authorities can offer deferred payment agreements to those not eligible for NHS funding who might have to sell their houses to fund their own care
The guidance should also be clear about how to calculate interest payments.
The Ombudsman said she was pleased that the Department had agreed to produce such guidance and to issue it at the time her report was published.
In response to the report, Care Services Minister, Ivan Lewis said:
"We take the Ombudsman's recommendations very seriously and therefore, I am pleased that we are able to issue guidance in response to the recommendations made in her report and we hope that this will clarify issues raised by the investigation.
We understand that families do have to make difficult and emotional decisions when someone has to go into residential care and this can be compounded by the impact of funding decisions around continuing care.
We are easing some of these difficulties by helping people avoid having to sell their homes during their lifetime to pay for residential care.
In June, I intend to publish new national eligibility guidance around continuing care which will set out a clear framework to streamline matters and ensure that the NHS provides the same contribution to everyone receiving this type of care.
Further information
Retrospective continuing care funding and redress
Continuing care – Background papers (click on Continuing Care)
Single assessment process
National framework for NHS continuing healthcare and NHS funded nursing care in England: Closed consultation
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