Frail and elderly face care home lottery

By STEVE DOUGHTY

Last updated at 17:32 27 February 2007

The frail and elderly are facing a care home lottery with just one in 20,000 people qualifying for free nursing care in parts of the country, a damning report has revealed.

The NHS has virtually stopped paying care home bills in large areas of Britain, the alarming new figures showed.

In areas where help for patients in nursing homes is most heavily rationed, only a handful of people gets a care home bill paid by the health service.

There are 40 Primary Care Trusts where the NHS meets bills for those who need intensive nursing in care home places for only one in every 10,000 residents.

The near-withdrawal of the NHS in many areas from paying for elderly people who need health and medical care was revealed by the charity Age Concern.

It follows years of controversy over the reluctance of health chiefs to pay for people who need high levels of medical and nursing care but who live in care homes rather than in hospitals.

The NHS has a duty to pay for those who meet stringent tests on their level of medical need.

People in care homes who do not qualify and must pay their own bills unless they have few savings or assets and can pass a tough means test applied by social workers.

Charity chiefs said the large gap between areas of the country where the NHS is least willing to pay the bills and those where more people get help from the Health Service shows that many thousands of old people are being denied medical help they have paid for with taxes and national insurance throughout their lives.

Age Concern estimated 75,000 people who should have their bills paid are being forced to meet their own care home costs.

The charity's director Gordon Lishman said: "The scale of this problem is unbelievable.

"At present some older people, who are paying all the costs of their care, have higher needs than those who are fully funded in other areas. These figures indicate the ultimate post code lottery."

Opposition politicians said the Health Service is trying to save money at the expense of the elderly.

Tory shadow health secretary Andrew Lansley said: "I am deeply concerned that this is motivated by the financial crisis in the NHS. It cannot be right that people will be forced into selling their homes to plug the black hole in NHS finances."

Concern that the NHS has been denying 'continuing care' funding to elderly people with great medical need because of health chiefs' push to save money has been growing for a decade.

A series of test court cases and a highly critical report from the NHS ombudsman have failed to encourage health trusts to be more generous in their funding.

The Department of Health is now trying to establish new national standards for who qualifies for NHS aid to replace local assessments.

But critics fear national criteria will only mean the rules will be drawn even tighter and more elderly people will be denied help.

The Daily Mail has highlighted the difficulties that the very sick and old experience in trying to get NHS assistance in its Dignity for the Elderly campaign.

The latest figures, drawn by the charity from details supplied by the Health Department to MPs, show huge differences between numbers of people in care homes who have their bills paid by the NHS in different parts of the country.

They showed that five Primary Care Trusts fund care home bills for just one in 20,000 of their local populations.

These include Rotherham in Yorkshire, Newbury in Berkshire and Central Suffolk - all areas where people over 65 make up between a fifth and a quarter of the population.

In all, 40 trusts pay care home bills for one in 10,000 of their local population or fewer.

But the figures show that some areas apportion NHS money to support very ill old people in care homes much more readily.

In Easington in the North East, where more than one in five of the population are over 65, more than one adult in every 400 has their care home bill paid by the NHS. In Dudley and Hillingdon, with a similar elderly population, bills are paid for around one in 500.

The tally of how individual health trusts treat claims from care home residents shows astonishing disparities between neighbouring areas where numbers of people in care homes with severe medical needs could be expected to be similar.

In North East Lincolnshire, where one in five of the population is over 65, around one in every 17,000 people has a care home bill picked up by the NHS.

But just a few miles away in in Lincolnshire South West, with the same proportion of older people, the rate is over one in 600.

While Rotherham gives NHS-funded care home places to one adult in 20,000, nearby Doncaster Central trust, with a higher proportion of older people in the population, pays bills for nearly one in 1,000.

Mr Lishman said: "While local anomalies can explain some of the most extreme figures, they cannot fully account for the scale of the differences.

"The Government is now proposing a national framework for assessment of nursing needs. The fact that such large differences can be seen, even between areas that use the same criteria now, does not give much hope that decision making will become much more consistent around the country.

"We fear people will continue to miss out on their entitlement to continuing care.'

Mr Lansley added: "These figures show impossibly wide variation in access to NHS continuing care. It is clear that there is no coherent, consistent, access to NHS funded support.

"The Government talk about a single set of criteria. The risk is obvious; that there will be a levelling down of access."

Advice for paying for long-term care

A Department of Health spokesman said: "The national framework for continuing care has been developed to eliminate the so-called postcode lottery and to promote consistency in the way people are assessed for continuing healthcare eligibility all over the country."

He added that the Government would publish its final plans for the new system after considering the responses to a consultation.