NHS Ombudsman Report on Long Term Care

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2003 Retired Members' Conference
26 June 2003

In February 2003 the Health Service Ombudsman published the report NHS Funding for Long Term Care which contained the results of four investigations into complaints about the way in which health authorities set and applied their eligibility criteria for NHS funding for the continuing care of older and disabled people. The report stated “There is evidence that the Department of Health’s guidance has been misinterpreted and misapplied by some health authorities and trusts, leading to hardship and injustice for some individuals. But there are also more fundamental problems with the system. The Department of Health’s guidance and support has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding to be operated across the country”.

The four cases highlight the problems of applying the eligibility criteria to identify those who are entitled to free nursing care but have to pay for their social care.

The Ombudsman’s Report recommends that health authorities should review the eligibility criteria and the way they were applied since 1996 and reimburse any patients who suffered financial injustice.

It also recommends that the Department of Health should:

1)consider how it can support and monitor the performance of health authorities in applying the eligibility criteria;

2)review the national guidance on eligibility for continuing NHS health care, making it much clearer in new guidance the situations when the NHS must provide funding and those where it is left to the discretion of NHS bodies locally;

3)consider being more proactive in checking that the criteria used in future follow the national guidance.

Therefore Conference asks that the National Executive Council request that appropriate action be taken to implement the recommendations of the Health Service Ombudsman report on NHS Funding of Long Term Care.