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Information About Getting Continuing Care Compensation
I have over the last four years been challenging Ministers about the Government's approach to NHS continuing care criteria (rules) which appear to flout the law and deny elderly people their right to free healthcare regardless of setting.
Last year I published a report entitled "Who Cares, Who Pays"? which took a critical look at the rules being used by the NHS finding them at best unfair and at worst unlawful. I called on the Health Service Ombudsman to report to Parliament on complaints she was investigating. In February 2003 the Ombudsman reported her findings to Parliament in a highly critical report.
I can offer advice on the stages you can go through yourself to obtain redress, and below is a step by step guide To obtain assistance in any of the processes mentioned, you may wish to consider contacting one of the free advice lines and websites such as Age Concern (0800 009966) HelptheAged (0500 767476) or the Alzheimers' Society (0845 3000336), or write instead to your local Councillor or MP. Alternatively you can seek legal advice from your solicitor.
There are several different levels of complaint; you can, off course, pursue them simultaneously:
1. Assessment: It may be that you/your relative have never been assessed for continuing care needs. You are entitled to ask for a ''comprehensive single assessment''. Your GP or hospital doctor should be able to arrange this.
2. Review Panel: Ask for a review of your case. By law the relevant authority must establish an review panel, if requested to do so, to check that the proper procedures have been followed in reaching decisions about the need for continuing care and to ensure that the health authority's eligibility criteria are applied properly and consistently. The panel should be independent; that is to say not involving staff, mangers or specialists party to the original assessment, and chaired by independently recruited chair (not on the staff or management of either the Social Services or Health Authority).
3. Official Complaint: If you are think that the health authority's eligibility criteria are overly restrictive, or that the type and location of the NHS continuing care services are inappropriate, you should make an official complaint. All NHS authorities have a formal complaint procedure, so you should DEMAND a copy of the 'Complaints Procedure.' Mark your letters 'Official Complaint' and address them to the Complaints Manager. If rejected, asked for an 'External Enquiry' or 'Independent Review' of the Complaint
4. Starting legal proceedings: Although it is possible to commence legal proceedings as an unrepresented 'litigant in person' you should not consider this step without at least consulting a solicitor, who will probably instruct a barrister if you want to proceed with your case. Legal proceedings can be a very costly and time-consuming business. However, if you have a well- grounded case, starting legal proceedings may force the Health Authority to offer you a settlement. There are two types of proceedings:- • Judicial Review - To challenge the validity of decisions taken under unlawful eligibility criteria - in effect you are challenging the criteria themselves. This type of action must be commenced within six months of the unlawful decision. • Civil Action - To challenge the Health Authority for breach of statutory and duty of care. These cases are very hard to establish in the context of continuing care, and should be brought within three years.
4. - If after these steps you still feel you have a legitimate grievance then the Health Service Ombudsman may well take up your case. Print off and complete the forms from the weblink below and send them the the HSO. They will then offer adjudication on your case.
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