Red tape delays could force huge care bills on public

Dated:

Bureaucratic failings by the NHS could lead to the wastage of millions in tax payer’s money following claim assessment delays related to incorrectly charged care fees.

Care Home Fees

A contingency of £90m has been put aside by the health service in Yorkshire in respect of nursing home costs – fees which were mistakenly charged to families of the care recipients instead of being met by the NHS.

Alleged delays in claims assessments by health officials have added further to the current average total of £45,000, a figure already inflated by up to 8% in yearly interest attached to each bill.

2 years needed to deal with claims, says NHS


South Yorkshire NHS staff, who are reportedly battling to cope with an excessive caseload, have forecast that 2 more years will be needed to settle outstanding claims.

In Essex we are told that claims are on hold because of the lack of specialist staff to deal with the applications.

The holdups have been attributed to April's change to clinical commissioning groups (CCGs) from primary care trusts (PCTs), with officials having to wade through details previously examined ahead of ministers' reordering of the NHS.

Errors


When patients have long-term needs, NHS continuing healthcare is normally free, with the health service also picking up the tab for care home fees. However, previous errors in conducting proper assessments have led to cases of up to 9 years old being reviewed retrospectively.

Nationally it is believed some 60,000 claims have been received, with over 5,000 from the cash-strapped Yorkshire area. £12m has been earmarked for claims in Doncaster, with Barnsley and Sheffield each putting aside £7m and Wakefield £6m.

'Postcode lottery'


There are concerns that Department of Health guidance is not being applied consistently by Clinical Commissioning Groups and different regions seem to be applying different procedures in order to tackle the backlogs of work created by the imposition of Department of Health deadlines and this in turn is creating a post code lottery.

The Yorkshire Post reported that in Rotherham, Jacqueline Atkin is waiting for her £66,000 refund claim for the care of her late parents to be assessed. From 2008 to 2011, Ms Atkin's mother and father required intensive nursing after developing dementia.

Frustration


But following delays in dealing with the case by the NHS South Yorkshire and Bassetlaw Retrospective Close Down Project, Ms Atkin said she was becoming increasingly frustrated.

"My parents were in care for about 1 and a half years as their needs were so demanding," Ms Atkin said. "They were told that, as they had savings and a house, they would have to pay for their own nursing home fees."

Ms Atkin added that to cover costs her parents had to sell the family home originally intended as a bequest.

"All their savings were eaten by care home costs. The process is now so long and complex it's like it's been designed to deter people from trying to secure refunds."

Confusion between health and social care


Noting current confusion in what distinguishes health care from social care, Janet Cooper, Simpson Millar's Head of Care Home Claims, said: “This distinction is the source of most disputes as to whether the local authority or the NHS should foot the bill for long term care."

"The difference is that NHS care is free, while a local authority will always apply a means test."

Janet added that, while legally a local authority can only provide low-level nursing care, historically the NHS has always tried to shift the burden.

"The DoH has been criticised by both the courts and the Health Service Ombudsman for setting the 'policy bar' too high, and many people are funding care costs that ought to be met by the NHS from their own pockets."

Complicated process


The NHS West and South Yorkshire and Bassetlaw Commissioning Support Unit insists that DoH guidelines control how case reviews are managed.

"The process is complicated, but is built on a strong foundation of partnership working between the claimant and their care providers to ensure each year of claim is assessed against criteria established under the national framework," integrated care service lead Debbie Morton said.

"We are aware that in a small number of cases concerns have been raised as to the length of time the process will take but we would like to reassure all clients that our process is in line with Department of Health expectations."

According to NHS officials in North Yorkshire, specialist staff are presently looking into clinical management options for this process.

Whilst the NHS may claim that only a small number of cases are affected this is not our experience and little if any progress has been made in many cases which have already been outstanding for more than 12 months.

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