Tuesday, July 25, 2006

Home is where the heart is...

Panorama on BBC1 on Sunday night was a follow-up programme to the one shown earlier in March 2006 about the national home swindle – basically the sick and elderly having to sell their homes to fund their NHS care, when they need to go into a nursing home.

The follow-up programme came about due to the high emails and letters that they received (over 5,000) about this scandal. Most of them came from relatives or friends that seen loved ones having to lie to their parents, aunts, uncles etc rather than tell them that they have sold their house to fund their care.

To think that the majority of these people worked hard all their lives, scrimped and saved to better themselves brought their own houses and then at their most vulnerable are denied the basic care needs by beaurcracy and assessments is outrageous. And lets face it when I think of my grandparents they did save if they wanted something they saved up to get it they did not go out and purchase it on a credit card and pay for it later, they made do until they could afford it. They were encouraged to save for the future, they thought that buying a house would be an investment for the future and something of value to leave the family.

The whole issue around this home swindle is the assessment that is carried out to see if a person is entitled to fully funded NHS care or whether they will have to pay the service.

There are two issues about health or social care

Services that are provided by the NHS are free at the point of delivery because NHS pays for them
Services, which are provided or arranged via social services departments or local authorities, are means tested
If care is provided via social services all or some of the cost can be passed onto the person receiving the services depending on their finances. They are charged for their care, in some cased even if they receive benefits.
If care is provided via the NHS then there should be no means test or charge

Since 1996 all health authorities have had to have eligibility criteria that specify who is eligible for fully funded NHS care and who is not (who must pay via the Social Services means test.)

Many elderly people have been placed into homes by social services think the state is paying for their care because social services are paying their care costs but the reality is they are paying towards their costs by being charged out of their income – including benefits and pensions.

In 1999 a disabled woman Pamela Couglan challenged the NHS via the court of appeal and argued that the NHS were responsible for her care. This was due to her condition and the type and level of nursing care that she required. Her local health authority challenged saying that she did not meet their criteria because she only needed general nursing and not specialist nursing. Mrs Couglan challenged the authority by saying that the NHS had wrongly transferred responsibility for health services including general nursing onto social services and that meant that people were being charged for health care which should have been paid for by the NHS.

The Court of Appeal agreed with Mrs Couglan and laid down a new test for deciding who was responsible for funding a care package in a nursing home. This was to become the `couglan test` which said that

The NHS were responsible if the persons reason for the placement in a home was primarily a health need

The local authority social services department can only be responsible for nursing care if the quality and quantity of nursing care is `merely incidental to the provision of the accommodation` The court said that social services can only be responsible for services which are of a nature which a social services can provide.

In 2001 the government introduced a new system called `free nursing care for all` however this is not the same as fully funded NHS care.

This system is a three-tier system, which involves the NHS making a small contribution towards the overall care package. It is for care that is provided by registered nurses employed in nursing homes. It does not pay for care provided by nursing assistants. The NHS bases the banding on High Medium or Low, which results in different levels of contributions.

The government pointed out that this would not replace the `couglan test` which was the one to be used for eligibility although there are concerns that in practice people are being assessed as being entitled under this system instead of the `couglan` way there they may be entitled to full funding.

The system is a mine field of who is and who is not eligible, and because of this many do not question or challenge the decisions that have been made by the powers that be.

More and more people are encouraged and helped to stay in their homes when they have high health needs and palliative care and many receive free help from the local nursing services but the NHS should also pay for the social care side of their package. They should have all parts of their care paid for them not just the district nurses.


For more information check out the Panorama website where you will find lots of useful information and comments.

`Guide to fully funded NHS care` booklet March 2006
Age Concern www.ageconcern.org.uk
Alzheimer’s Society www.alzheimers.org.uk
Help the Aged www.helptheaged.org.uk
Royal College of Nursing www.rcn.org.uk

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