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You and Yours聽- Transcript 大象传媒 Radio 4 |
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TX: 16.12.04 - Long Term Care PRESENTER: SHEILA MCCLENNON and PETER WHITE |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 大象传媒 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. MCCLENNON Anyone who's tried to get financial help for an elderly relative who needs care in a nursing home will know how confusing the present system is. There have been complaints for a long time that it's a lottery as to whether the NHS, the local authority or the individual pays for it. And for the things like washing your hair and cutting toe nails count as personal or healthcare and who pays for that? The problem is that the decision is still made at a local level and decisions can vary depending on where you live. Last September we spoke to one listener about her mother and brother - both suffered from the same progressive genetic brain disorder. But while her brother was getting his nursing care paid for in full by one health authority, her mother, who was due to leave hospital and move to a care home covered by a different authority, was told she wouldn't get her nursing care paid for in full. LISTENER They say that she's only in the level 2 band, that she doesn't come into the top band, she doesn't require NHS continuing care. I understand that they are applying the national guidelines set out by the Department of Health but with a local twist, so they've set their own sort of criteria. Because the guidelines are so vague people are left to their own devices and I've got immense sympathy for the area health authorities - they're trying to do the best they can with a bad deal. MCCLENNON And at the time we spoke to Stephen Ladyman, the Health Minister, and he acknowledged that national guidelines might be a good idea. LADYMAN Once we've gone through the backlog and we've sorted out all the cases for compensation, for people who've been wrongly assessed in the past, maybe it would then be appropriate to go forward and have a single set of guidance everywhere but that has significant implications, not least for budgets, and it would be a very big step. But it is something I'm thinking about - whether we need to take that step. MCCLENNON Well last week Stephen Ladyman announced that he was commissioning a national framework to assess continuing care, care that the NHS pays for in full. WHITE And indeed in the last few minutes the Health Service ombudsman - Ann Abraham - has published her latest report into long term care. Back in February 2003 she identified widespread errors by health authorities which resulted in thousands of people paying for nursing care they should have received free of charge. Now based on evidence gathered from the 4,000 complaints she received she's now published a follow up report and she doesn't mince her words. She describes the system of applying for funding for long term care as: "a lengthy hit and miss process". Well Colin Haughton [phon.] is part of the Health Ombudsman's team. HAUGHTON There are slightly different systems across the country, for example there's one authority that interprets the Department of Health guidance we think more restrictively than was intended and for example requires someone to have healthcare needs that require the intervention of a specialist. We have concerns about - about that. Another example would be where the ideal situation would be a multidisciplinary team looking at someone's healthcare needs and I've seen some very good examples of that and have sat in and observed a panel where that's been fine. But I've seen other ones - we've had complaints put to us where the relative has got, for example, psychological healthcare needs and yet they've been assessed by a nurse without any mental health qualifications or experience. Another example would be where - there's one particular authority that uses a sort of scoring tool for deciding who was eligible for full funding or not and we've made comments on that, that that appeared to be too mechanistic, if it's just going to be applied that if you get one point over the top you get full funding, if you're one under you'll get high band nursing. WHITE So you're saying that really they need to look at the person's whole needs, rather than do some kind of arithmetical process? HAUGHTON No, we're not asking for the earth here. We've seen some very good examples but unfortunately there are others where that hasn't been done and sadly there have been some cases where people have been dismissed out of hand because they've been in residential care and it's not where you are it's what your individual healthcare needs are. WHITE Now your report applies specifically to England but England, Wales and Scotland all have different methods of assessing these needs don't they. HAUGHTON Yes they do. As you say our report is just covering England but obviously the Health Service Ombudsman is aware of what's happening in Scotland and Wales and is following very closely the situations there. WHITE Now you've made six key recommendations for the Department of Health to follow, what are the main points these address? HAUGHTON What we've said is rather than having 28 different criteria and various numbers of assessment tools this is a national health service why don't we have a national minimum eligibility criteria which applies across the whole of the country, it ends any prospect of postcode lottery accusations and a single set of assessment tools which would be clear and understandable to everybody. WHITE Now the Health Minister, Stephen Ladyman, actually made a statement last week and to some people's surprise he said he'd commissioned a national framework on continuing care, is this going to solve the problem? HAUGHTON It could do because I've looked at the statement and it says that he's commissioning the development of a national consistent approach with a national set of assessment tools and guidance on how to conduct it, I really hope that that's what's going to happen because the country's crying out for it. WHITE I'm also joined by Pauline Thompson, who's policy officer for community care finance with Age Concern. Age Concern's been very critical of these thousands of people who've had their cases fudged, so what do you want the government to do? THOMPSON What needs to happen is we do need to have national eligibility criteria, the same assessment tools being used throughout the country, but above all we really do need some training of staff as well. I mean Colin was talking about the retrospective reviews, now since last February there's been a direction of the NHS that they have to do a continuing care assessment before somebody leaves hospital and before they get in touch with Social Services, yet we're still finding that people are being - leaving hospital and they haven't had a review of their continuing care or one that they would recognise and that is written down on their case notes and they've been told that they've got the right to review this - this still isn't happening. So it's a training issue as much as anything else. WHITE But is it really possible to make a distinction between nursing and personal care? THOMPSON Oh it's - I mean I would agree with Colin - it is incredibly difficult, I mean one of the reasons we're saying well really we'd like to see free personal care is - let's get rid of this crazy distinction. But even within the distinction of healthcare the government's added to the really murky waters and well put a red herring in it as well I would say, in that they now have this other distinction about who gets nursing - their nursing care paid for in a nursing home. And they have a criteria for the highest band which says that a person has to have complex needs that require frequent mechanical and technical and therapeutic interventions by a registered nurse throughout a 24 hour period and their physical and mental health will be unstable and/or unpredictable. So to get - you have to meet that to get 拢125 worth of nursing. Now wouldn't you say - and wouldn't anybody say - that if you actually meet that level of care your primary need for being in the care home is because you've got health needs? WHITE Clearly I think people would say that but obviously if you provide nursing and personal care for everyone who needs it that is an extremely expensive item on your budget. THOMPSON It is indeed and you know it's up to the government to make decisions about whether they want to go that route and we've been pushing for that route because obviously we feel that these days it's so difficult to sort out what is personal care and what is health care because so much of what used to be nursing care has over the years stopped being nursing care and it's been given to other people to provide it. Many of the people that are in nursing homes these days would have been long term in hospital, so it's very difficult to actually work out what is nursing care and what is personal care. WHITE Pauline Thompson from Age Concern and before that you heard Colin Haughton, who's head of the continuing care team in the Health Service Ombudsman's Office. And we've heard from the Department of Health who tell us that they will be working with strategic health authorities and other stakeholders in the New Year to make the continuing care assessment process easier to understand and operate and to reduce inconsistencies across the country. Back to the You and Yours homepage The 大象传媒 is not responsible for external websites |
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