ServerOneCare - Providing Information on the Campaign on NHS Continuing Care Funding

ServerOneCare Case List of cases where NHS Continuing Care Funding

Year Case Started Year Case Finished Name of Party (Or other Abbreviation)
Local Authority Responsible
Primary Health Condition(s) Notes (limited to facts only) Link to Details

2009
Ongoing D Whitehouse Walsall PCT Alzheimer's/Gross Dementia, Arthritis Suffers with gross vascular dementia which has resulted in a severely impaired short-term memory and severely impaired long-term memory, combined disorientation in both time, place, and occasionally in person. Unable to consistently weight bear and behaviour care needs include random and unpredictable violence and agression towards others. Underwent a healthcare asssesment in 2007 prior to discharge from Walsall Manor Hospital. Told that could only be discharged to a care home that specialised in Elderley Mental Illness. Screening Tool indicated that she was entitled to CH funding, but was not referred internally as required. This report was sent by fax to social services, who then demanded the sale of her home to pay for her care. Retrospective assessment undertaken by Walsall PCT in Jan 2010 (ineligble), appeal to Local Panel in May 2010 also denied entitlement. Currently subject to appeal at Strategic Health Authroity level.
CLICK HERE

UPDATED

MAY

2010

2002 Jan 2007
Ruby Pearce

Torbay Primary Care Trust
Alzheimer's/Gross Dementia.
Ruby Pearce suffered from Alzheimer’s disease and was unable to do anything for herself except chew and swallow. She was awarded NHS-funded nursing care by Torbay Primary Care Trust but not full continuing care funding. Her son Mike had to sell the family home to pay for the cost of accommodating Ruby in a care home.

Mike campaigned for five years to obtain continuing care funding for his mother, insisting that her primary need was for nursing care rather than social care. Eventually his case was reviewed by the Health Services Ombudsman which ruled that Torbay Primary Care Trust should pay £50,000 to Mike in retrospective care fees.

The Pearce case is notable as it was based on draft guidelines for the National Framework which was not published until June 2007. At the time that Mike appealed, Torbay Primary Care Trust did not have up to date eligibility criteria in place, so it was decided to use the draft Framework’s new Decision Support Tool.

The case shows that the National Framework offers a fairer system of determining eligibility for continuing care funding than the previous system of local eligibility criteria.
Click Here

Nov 2002 Oct 2005 Evelyn Lovelock Wokingham District Council Alzheimer's, Fibrosis Alveolitis (lung desease), Deep Vein Thrombosis and Arthritis Click Here

2002 May 2008 Judith Roe NHS Worcestershire severe Alzheimer's and Parkinsons NHS funding because her condition was a "social" rather than "health" problem, even though she was so ill she could not make a cup of tea and regularly left the stove on.
The family has now been awarded £130,000 by the Health Service Ombudsman after being forced to sell her £200,000 home to pay for care home fees.
Click Here

2003 Jul 2009 Marjorie Eyton-Jones Powys Local Health Board, Anglesey Local Health Board and Wirral Primary Care Trust Alzheimer's (grossly cognitively impaired and having a multiple and high level needs reflecting an unpredictable/ unstable condition) The family of Marjorie Eyton-Jones, aged 88, who suffered from Alzheimer’s, were reimbursed £165,000 they had paid in nursing home fees after being forced to sell her home.The family had previously been told that Mrs Eyton-Jones required 24 hour nursing care, but because she had assets totalling at least £23,000, they had to fund the care themselves. Click Here

May 2005 Sep 2009 Rod Johnson Eastern Cheshire PCT Repaid £51,500 by Central and Eastern Cheshire PCT after a four-year battle to pay for his care after he suffered a brain haemorrhage which left him partly paralysed. Click Here

2001 Feb 2004 Mr Malcolm Pointon South Cambridgeshire PCT Dementia Case established that authorities also must contribute to home care. The Pointons will receive £1,000-worth of care a week to help towards care assistants. Click Here

1993 July 1999 Pamela Coughlan North and East Devon Health Authority Tetraplegic, Partial Paralysis, Incontinence
Established the two famous tests (below) that, in order to be eligible for NHS CH funding, that care should NOT be:

(i) Merely incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide; and

(ii) Of a nature which it could be expected that an authority whose primary responsibility is to provide social services could be expected to provide...."
Click Here

2004 2006
Maureen Grogan

Bexley Primary Care Trust

Multiple Sclerosis, Dependent Oedema , Cognitive Impairment

The Grogan Judgment brought back to the fore many of the issues that had been covered in the Coughlan Judgment seven years before, including:

Any person whose needs are the same as, or exceed, those of Pamela Coughlan should be entitled to continuing health care funding

Who provides a service should not be a factor in the decision-making process as nursing tasks are often carried out by non-nursing staff such as health care assistants

When assessing a patient for eligibility for continuing care, the assessor should look at the totality of a patient’s needs to see if they have a primary health need, and therefore meet the Coughlan test for fully-funded care

Social services should also examine the totality of a patient’s needs before agreeing to provide means-tested services, to check that the services they are planning to provide are not beyond the legal scope of the Local Authority.
Click Here

Year Case Started	Year Case Finished	Name of Party (Or other Abbreviation)	Local Authority Responsible	Primary Health Condition(s)	Notes (limited to facts only)	Link to Details
2009	Ongoing	D Whitehouse	Walsall PCT	Alzheimer's/Gross Dementia, Arthritis	Suffers with gross vascular dementia which has resulted in a severely impaired short-term memory and severely impaired long-term memory, combined disorientation in both time, place, and occasionally in person. Unable to consistently weight bear and behaviour care needs include random and unpredictable violence and agression towards others. Underwent a healthcare asssesment in 2007 prior to discharge from Walsall Manor Hospital. Told that could only be discharged to a care home that specialised in Elderley Mental Illness. Screening Tool indicated that she was entitled to CH funding, but was not referred internally as required. This report was sent by fax to social services, who then demanded the sale of her home to pay for her care. Retrospective assessment undertaken by Walsall PCT in Jan 2010 (ineligble), appeal to Local Panel in May 2010 also denied entitlement. Currently subject to appeal at Strategic Health Authroity level.	CLICK HERE UPDATED MAY 2010
2002	Jan 2007	Ruby Pearce	Torbay Primary Care Trust	Alzheimer's/Gross Dementia.	Ruby Pearce suffered from Alzheimer’s disease and was unable to do anything for herself except chew and swallow. She was awarded NHS-funded nursing care by Torbay Primary Care Trust but not full continuing care funding. Her son Mike had to sell the family home to pay for the cost of accommodating Ruby in a care home. Mike campaigned for five years to obtain continuing care funding for his mother, insisting that her primary need was for nursing care rather than social care. Eventually his case was reviewed by the Health Services Ombudsman which ruled that Torbay Primary Care Trust should pay £50,000 to Mike in retrospective care fees. The Pearce case is notable as it was based on draft guidelines for the National Framework which was not published until June 2007. At the time that Mike appealed, Torbay Primary Care Trust did not have up to date eligibility criteria in place, so it was decided to use the draft Framework’s new Decision Support Tool. The case shows that the National Framework offers a fairer system of determining eligibility for continuing care funding than the previous system of local eligibility criteria.	Click Here
Nov 2002	Oct 2005	Evelyn Lovelock	Wokingham District Council	Alzheimer's, Fibrosis Alveolitis (lung desease), Deep Vein Thrombosis and Arthritis		Click Here
2002	May 2008	Judith Roe	NHS Worcestershire	severe Alzheimer's and Parkinsons	NHS funding because her condition was a "social" rather than "health" problem, even though she was so ill she could not make a cup of tea and regularly left the stove on. The family has now been awarded £130,000 by the Health Service Ombudsman after being forced to sell her £200,000 home to pay for care home fees.	Click Here
2003	Jul 2009	Marjorie Eyton-Jones	Powys Local Health Board, Anglesey Local Health Board and Wirral Primary Care Trust	Alzheimer's (grossly cognitively impaired and having a multiple and high level needs reflecting an unpredictable/ unstable condition)	The family of Marjorie Eyton-Jones, aged 88, who suffered from Alzheimer’s, were reimbursed £165,000 they had paid in nursing home fees after being forced to sell her home.The family had previously been told that Mrs Eyton-Jones required 24 hour nursing care, but because she had assets totalling at least £23,000, they had to fund the care themselves.	Click Here
May 2005	Sep 2009	Rod Johnson	Eastern Cheshire PCT		Repaid £51,500 by Central and Eastern Cheshire PCT after a four-year battle to pay for his care after he suffered a brain haemorrhage which left him partly paralysed.	Click Here
2001	Feb 2004	Mr Malcolm Pointon	South Cambridgeshire PCT	Dementia	Case established that authorities also must contribute to home care. The Pointons will receive £1,000-worth of care a week to help towards care assistants.	Click Here
1993	July 1999	Pamela Coughlan	North and East Devon Health Authority	Tetraplegic, Partial Paralysis, Incontinence	Established the two famous tests (below) that, in order to be eligible for NHS CH funding, that care should NOT be: (i) Merely incidental or ancillary to the provision of the accommodation which a local authority is under a duty to provide; and (ii) Of a nature which it could be expected that an authority whose primary responsibility is to provide social services could be expected to provide...."	Click Here
2004	2006	Maureen Grogan	Bexley Primary Care Trust	Multiple Sclerosis, Dependent Oedema , Cognitive Impairment	The Grogan Judgment brought back to the fore many of the issues that had been covered in the Coughlan Judgment seven years before, including: Any person whose needs are the same as, or exceed, those of Pamela Coughlan should be entitled to continuing health care funding Who provides a service should not be a factor in the decision-making process as nursing tasks are often carried out by non-nursing staff such as health care assistants When assessing a patient for eligibility for continuing care, the assessor should look at the totality of a patient’s needs to see if they have a primary health need, and therefore meet the Coughlan test for fully-funded care Social services should also examine the totality of a patient’s needs before agreeing to provide means-tested services, to check that the services they are planning to provide are not beyond the legal scope of the Local Authority.	Click Here