Welsh family welcome ombudsman report on care fees
15I06I08
Cardiff LHB 'Seriously
Flawed' says health ombudsman
The Public Services
Ombudsman for Wales has described Cardiff Local Health Board’s
decision that 75 year old Eileen Puc was not eligible for NHS
Continuing Healthcare as ‘seriously flawed’.
Eileen Puc has been a
resident in a Nursing Home since June 2005, she has suffered three
strokes and as a result is immobile. She suffers with diabetes
which is described as unstable and is administered insulin three
times a day. She is partially sighted and needs a pureed diet as
she is at risk of choking, yet her family, helped by the specialist
Nursing Care Team at Hugh James, is having to prove she has ‘health
needs’ which mean she is entitled to Continuing Healthcare and
won’t have to pay £1,825 every month needed for her own long-term
nursing care.
Continuing healthcare is
where the NHS is responsible for, and fully funds, care - it mainly
affects very ill patients, often elderly, in nursing homes; but can
also apply if a person is in hospital long term or needs nursing
care at home.
Lisa Morgan, Solicitor
with the Specialist Nursing Care Team at Welsh law firm Hugh James
acts for Eileen Puc and argues that the case is just the tip of the
iceberg: “Thousands of people across Wales are being wrongly
charged for nursing care and in many cases, they are forced to sell
their family home to pay. To date, we have recovered over
three million pounds in nursing home fees on behalf of our
clients.”
Lisa Morgan adds: “Hugh
James currently represents over 400 people claiming they have been
wrongly charged nursing care fees in Wales. Under current
government policy, there should be a comprehensive assessment for
people as soon as they are deemed as needing long-term care, which
determines whether they are entitled to have their fees paid.
That is not happening in many cases and families are losing
out.
“Mrs Puc’s family were
forced to sell her home to fund the nursing home fees. They have
already paid out over £60,000 and are continuing to pay. If
the Local Health Board had undertaken a full assessment in
compliance with correct guidance, this could have been avoided.
Under current policy a person should be the responsibility of
the NHS if their primary need is health. However, in many cases,
Local Health Boards in Wales are not applying the correct legal
test.
“Cardiff Local Health
Board have accepted that Ombudsman’s recommendations and will now
undertake a fresh assessment of Mrs Puc’s health and nursing care
needs, however in the meantime, she will continue to be responsible
for her ongoing nursing home fees. The family are committed to this
case and will consider court proceedings if the Local Health Board
continue to deny continuing healthcare.”
Key Facts:
- If you are
eligible for NHS Continuing Healthcare, you do not make any
contribution towards the long term care fees. The NHS pays the
whole cost and it applies if a person is in hospital, care home or
in their own home.
- In Wales,
if a person is not assessed as eligible for NHS Continuing Health
care and has capital over £22,000, they have to pay for all the
care fees.
- If you have
capital between £19,000 and £22,000 you will have to contribute
towards the cost of care.
- When you
fall below £19,000 you do not have to pay fees from your assets,
but income from pensions and benefits must be paid towards the care
fees.
- The average
weekly cost for care, per person, is £500. As an example, if
500 people have been incorrectly paying for care for one year, then
they are owed approximately £13m in total.
- Hugh James
currently represents over 650 people claiming they have been
wrongly charged nursing care fees in England and Wales.
- There are
currently over 12,000 people in nursing homes across Wales and many
people are looked after for a number of years.
Read the full case history
Notes:
.
- If you are eligible for NHS Continuing
Healthcare, you do not make any contribution towards the long term
care fees. The NHS pays the whole cost and it applies if a person
is in hospital, care home or in their own home.
- The average weekly cost for care, per person,
is £627