Thackray Williams

There has been some media coverage in August 2009 in relation to the family of an Alzheimer’s sufferer who challenged the decision of their local NHS Trust who had refused to provide free nursing care (NHS Continuing Care).  After persisting with their challenge for five years, the family were awarded a refund of over £100,000 by the Parliamentary and Health Service Ombudsman for money that they had paid out personally that should have been provided by the NHS Trust.

Decisions about who should receive free nursing care are complex. In this case, the family was forced to sell the home that their mother had lived in for 30 years to privately pay the care home fees of £600 per week.  When asking for an assessment to see if a patient is eligible for Continuing Care, there is a set framework that the NHS Trust has to follow.  They also have to provide clear reasons for their decision.

The decision should be based on the particular characteristics of the patient’s physical and psychological needs; the steps that are required to manage these needs; the level of support required to manage these; the level of skill required by the carer to treat, monitor and manage these needs; the risk to the patient if someone without necessary experience cares for them incorrectly.

There is a ‘Decision Support Tool’ that sets out certain topics that should be considered in making the assessment and these are to be rated either ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’.  This is an aid to deciding whether someone is eligible, so is not a scoring system.  The guidance gives situations where the score is likely to be sufficient to receive Continuing Care but this is only guidance so not set in stone. If you are not satisfied with their decision or if you believe that the framework has not been followed, you can seek a   review from the Primary Care Trust who have power to refer the matter to an Independent Review Panel of the Strategic Health Authority.  If you are still not satisfied, you can make a referral to the Health Service Ombudsman.

Although this recent case was in relation to an Alzheimer’s sufferer, each case is judged on its own merits so no two decisions are the same.

For more advice about NHS continuing care funding email: mark.stubberfield@thackraywilliams.com