A case brought by a former detective with Scotland Yard's Flying Squad has opened the doors for more than 300,000 elderly people to have their long-term care paid for.
Torbay Care Trust has announced that it will repay £50,000 to Mike Pearce after it agreed that his mother, Ruby, had been wrongly required to pay for her own care. A dementia sufferer, she was deemed too well to have her care funded by the NHS despite, as the Alzheimer's Society put it, 'being incapable of doing anything but chewing and swallowing'. Her home in Torquay was sold to fund her nursing home fees.
The Alzheimer's Society, which assisted Mr Pearce in his six-year fight, and two other specialist charities, Age Concern and Counsel And Care, regard this as a landmark case. Only about 25,000 people currently have their care paid for by the NHS, but the society believes more than 10 times that number are now eligible, or soon could be.
Most elderly people in need of care are currently required to pay some or all of their own costs if they go into a care home and own a house or other assets. One exception to this rule allows for registered nursing care contributions to be paid by the state in one of three banded rates, subject to an assessment by the local health authority. The assessment determines how much of the person's care should be classified as 'nursing care' and therefore (under the principle that NHS services are free at the point of delivery) be paid for by the state. The assumption is that the primary need is not nursing care.
Mr Pearce argued that his mother's case met with a second exception to the rule: that her condition was so poor that her 'primary' need was to be nursed. In such cases, the costs of being in a care home are paid for by the NHS (as the home is seen almost as an alternative to hospitalisation).
Mr Pearce battled through various appeals hearings and finally convinced the Health Service Ombudsman. 'When I went to an appeal committee, the whole process was a shambles. I had far more accurate information about my mother than they did,' said Mr Pearce.
A crucial aspect of his case was that it was based on draft guidelines for funding NHS care, which are due to be formally issued by the Department of Health in the next few months. In the past, local health trusts have been able to set their own criteria, but the DoH accepts that this 'postcode lottery' is unfair. Mr Pearce's case was based on the draft guidelines because Torbay Care Trust did not have up-to-date criteria when he appealed. So it decided to use the new proposed framework.
The specialist charities are urging people who think they could be in the same position as Mr Pearce to ask for an assessment for NHS continuing care funding or - if they have already been turned down - to lodge an appeal. Both processes can be started by contacting the local primary care trust. People with very serious health problems - including dementia - should have a chance of getting the care paid for. Trusts which have local criteria in service may be able to avoid paying up because they have defined their own eligibility criteria. But when the new guidance - timetabled for the first half of this year - appears, they will have to pay.
Mr Pearce is helping 75 families with their claims. 'It was never about the money,' he says, 'it was the principle I was fighting for. I hope this will give many others the inspiration to fight for their rights.'
For more information, contact:
www.alzheimers.org.uk, 0845 300 0336; www.counselandcare.org.uk, 0845 300 7585.
