Daily Express - 30.07.2019

8 Daily Express Tuesday, July 30, 2019

DX1ST

Scandal of families hit

By Sarah O’Grady

Social Affairs Correspondent

CRISIS IN

DEMENTIA sufferers hit with

unfair care bills face years battling

an “incredibly complex and

opaque” appeals system to recoup

their money, it can be revealed.

In many cases, seriously ill pen-

sioners are forced to sell family

homes to pay spiralling care costs.

But the appeals process they and

their relatives are forced to

navigate means many die before

they discover that they were

wrongly billed for their care.

Evidence uncovered by the Daily

Express revealed a case where two

sisters fought for eight years to get

back some of the £200,000 their

mother spent on care home fees.

In another, a sister and brother

whose mother spent £211,000 on

her care found health chiefs

changed the funding criteria

behind closed doors.

Sofia Tayton, of Solicitors for the

Elderly, said: “The system isn’t

working fairly for any of the people

involved.

“Even in cases where you are

successful and obtain a refund of

care fees, there will have been a lot

of stress and disruption caused in

accessing money tied up in prop-

erty and investments, and related

costs in terms of tax and legal fees.

“The process is complicated and

this isn’t helped by a lack of

clarity about which Clinical

Commissioning Group [CCG] is

dealing with cases.

“Assessments should be carried

out as a matter of course, but staff-

ing issues are hitting the assess-

ment process, and they need to be

pressed for.”

Under the current system, the

NHS can fund “continuing health-

care” for the sickest in society at a

local level through CCGs.

If patients fail to get their care

funded and are forced to pay for it

themselves, they can appeal the

decision.

But a confusing lack of guide-

lines means CCGs conduct appeal

hearings in very different ways

across the country.

There are five levels of appeal

and it can take many months and

even years.

The latest official figures show

that in the last financial year, there

were 15,461 “local resolution

requests” or appeals to CCGs. Of

these, 3,297 were completed to the

satisfaction of the person or family

involved.

But an astonishing 12,164 were

dubbed “incomplete resolutions”.

In the first three months of this

year, the total number of appeals

completed by CCGs was 778. Of

these, just 137 went in favour of

the patient.

There are currently 454,

people in England diagnosed with

dementia, but very few are granted

NHS-funded care.

Dementia is not a qualifying

criteria for continuing healthcare

despite sufferers having complex,

long-term health needs and other

health conditions.

It means that sufferers pick up

the bill for all their care in a way

someone with cancer would not.

Two years ago, the Government

promised a reform on the way

dementia care was funded to stop

sufferers being forced to use their

savings and homes to pay for care

instead of leaving them as inherit-

ances to their families. In a recent

study by the pressure group CHC

Alliance, 55 per cent of profession-

als said they did not feel confident

enough in their own knowledge to

advise people about the appeal

process.

The Alliance also found many

people decided against appealing

“because they are too distressed

and exhausted to go through the

complex appeals process”.

Experts and charities yesterday

told the Daily Express why the

Department of Health and Social

Care must reform the system.

Caroline Abrahams, charity

director at Age UK, said: “It’s quite

common for appeals against a

refusal to qualify for Continuing

Healthcare funding to be resolved

only after a person’s death.

“This is incredibly distressing for

loved ones and can prevent them

from achieving ‘closure’.

“However, the sums of money at

stake are so enormous in many

cases that it would be foolhardy

not to exhaust the appeals process

and give up before all options have

been tried.

“It’s tragic that in this country

families so often have to battle for

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Q

Is Britain’s social

care system a

national disgrace?

SUFFERERS BATTLE

BUREAUCRACY

APPLYING for NHS

Continuing Healthcare

funding is increasingly hard

in the UK’s cash-strapped,

crisis-ridden care system.

Clinical Commission

Groups in England follow

certain guidelines, but there

is no easy-to-understand

application process for all.

The first step is an

inspection by a social worker,

an employee of the care home

and a nurse assessor from

the local CCG.

A family member should be

present, but that is not always

allowed. Information should

be easily available with no

“closed door meetings”.

Criteria the applicant is

assessed by include mental

function, mobility and

continence.

If a “local resolution” is not

agreed and funding refused,

the complex appeals process

includes a local review, an

independent review, an

Ombudsman’s investigation

and finally, a judicial review.

HOW OTHER NATIONS

SETTLE THE BILL

FRANCE has a mandatory

long-term care insurance

scheme. For home care those

on high incomes pay 90 per

cent of costs – people in the

lowest bracket are paid for.

Germany has public health

insurance but people can opt

out for a private scheme.

Basic needs are covered but

not costs such as

accommodation. However,

benefits can be claimed.

In Italy, care is delivered

through overlapping national,

regional and local institutions

with close to half of spending

dedicated to a cash benefit.

Funding comes from taxation.

In Japan national care

insurance is compulsory for

everyone aged over 40. Care

users contribute 10 per cent

of costs with a capping

system for low earners.

In Spain long-term care is a

legal entitlement. Residential

or home care requires a

contribution, which is

calculated by income up to 90

per cent of the total cost.

Yet only days ago her children,

Eleanor London, Deborah

Snookes and Jonathan Cook,

were told by NHS England that

their final appeal for retrospec-

tive payments had been rejected.

Mrs London, 65, of Penarth,

Glamorgan, said: “The system is

a shambles. We have been

absolutely appalled by what we

have discovered. After our

mother died, we discussed

whether or not we should carry

on fighting the system.

“It was too late for our mother

but we vowed to carry on to raise

awareness to warn other families.

“She and the family had to pay

for every penny of her care, total-

ling over £200,000 and necessi-

tating the sale of her home.”

She added: “The appeals

process itself is intensely

bureaucratic, unwieldy and is

heavily weighted against the

appellants, to the extent that

we believe many give up at the

first hurdle.

“When will our representatives

in Parliament wake up to this

national scandal, whereby if you

have the misfortune to develop

dementia and cannot care for

yourself, you or your family will

have to pay for your entire care

costs until you die?”

By Sarah O’Grady

Shambolic system is

weighted against us

ELIZABETH COOK’S three chil-

dren have fought tooth and nail

for more than eight years for a

fair deal for their mother.

Mrs Cook, who died aged 85 in

2011, spent more than £200,

on care costs – money she raised

by selling her house.

She had Alzheimer’s and vascu-

lar dementia among other health

problems, and was cared for in a

residential home in Alvechurch,

Worcs, for four years.

Mrs Cook was refused health-

care funding by the Midlands and

Lancashire Commissioning

Support Unit and other NHS

groups, despite social workers

and medical staff stating she qual-

ified in eight care categories.

In three of these her needs

were classified as “high” and five

as “moderate”.

But the panel looking at her

case decided these were “inciden-

tal or ancillary to the provision of

accommodation” and therefore

she didn’t have a “primary health

need”.

As well as having dementia,

widow Mrs Cook was immobile,

incontinent, at risk of pressure

sores and could not feed herself.

Sold... Elizabeth Cook’s home

Elizabeth Cook, in pink, at

daughter Eleanor’s wedding

Exhausted