• NHS Continuing Care? 17 May 2016 | View comments

  • 17th May 2016 | By David Jolley

    Amongst the lessons to be learned this week came (yet another) report from the Ombudsman’s office which describes failings in the care of older people in hospital and at the point of discharge.

    http://www.ombudsman.org.uk/__data/assets/pdf_file/0006/36483/Selected-summaries-of-investigations-by-PHSO-Apr-to-June-2015-2.pdf

    http://www.theguardian.com/commentisfree/2016/may/12/hospital-policy-older-people-dying-ombudsman

    http://www.theguardian.com/society/2016/may/10/nhs-discharge-system-failing-elderly-patients-says-nhs-ombudsman-report-vulnerable-hospital

    There is no doubt that most people receive good or excellent care from our statutory services, but these stories of failure and inhumanity toward the vulnerable and their families are not unique and many of us hear similar or worse week by week from friends who will not proceed to formal complaints which would reach the ombudsman.

    But I was planning to share something of my bewilderment, anger and frustration about the iniquity of NHS Continuing Care Funding – or lack of it.

    It is now two weeks since I was involved in an Independent Review of a judgement concerning who should pay for the long-term care of an individual with advanced, severe dementia. This is not the first occasion I have supported a family in trying to right wrongs – They have all been hurt and outraged that someone, clearly damaged and rendered dependent on others for care by illness, has been declared to have only social needs. The situations I have detailed knowledge of include a woman who had been an active and trusted carer for her grandchildren until struck down by a stroke which rendered her instantly incapable and unable to comprehend or communicate. She is declared (incorrectly) to have capacity, though her close family have been unable to have any meaningful exchanges with her since the stroke. Despite obvious neurological evidence of illness and a brain scan showing a massive infarction, her needs are said to be social in origin.

    But much more commonly, people with progressive and advanced dementia and their families find themselves misused in this way.

    Professor Luke Clements has written clearly and compassionately about this – tracing the history and comparing the charade of assessment against a checklist with the rulings of courts for those few cases which have got to court:

    www.rcpsych.ac.uk/pdf/OA-11-35%20NHS_Funding_for_CC_revised_Guidance.pdf

    In this matter, the courts have made reasonable judgements – their criteria for responsibility resting with the NHS are far lower than those demanded by the checklist. The checklist is said to be there only as a guide and to be interpreted by the assessing panel based on their knowledge of the individual and the full history of the situation. In practice, as I have seen it, people on panels often have little or no clinical knowledge of the individual. They use the checklist slavishly and as the absolute determinant of their decision and rate each component as meanly as can be – often beyond belief and evidence. In this most recent case, my evidence as the senior responsible clinician had been set aside as inadmissible. The family were advised that it would be inappropriate to involve a legal representative as the panel would not be addressing matters of law.

    In a personal note, even Luke Clements admits he does not know how this institutionalised injustice can be corrected.

    Day after day people who have been laid low by illness are being ‘assessed’ to be social problems by people who otherwise use the English language correctly. It would seem that in this the Law is of no consequence. Humpty Dumpty rules http://www.goodreads.com/quotes/12608-when-i-use-a-word-humpty-dumpty-said-in-rather

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