'Medical opinions ignored' by NHS payment assessor, workers say

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  • Medical opinions have been ignored in the assessment of NHS payments to patients receiving care, it is claimed.


    Three health workers said an assessor organisation discounted medical views so some patients were denied NHS care.

    Norman Lamb MP said England-wide data obtained by the BBC showed a "regional disparity" and was "an injustice".

    However the assessor organisation, Arden and Greater East Midlands CSU, says it follows national guidelines to decide on payments.


    Under national criteria, the NHS pays for long-term support and care if a patient's condition is severe enough.


    http://www.bbc.co.uk/news/uk-england-41187615


    It seems the NHS assessors are following the same devious procedures to disqualify residents from NHS funding for care home fees as the DWP do with welfare claimants and ignoring medical advice. When one relative was in a home and funding was applied for, her daughter went to the care home and was told by the assessor 'I've already done the assessment and signed the form. She doesn't qualify for NHS care.' Being unaware of the system they didn't get the funding and had to pay for the care by other means.


    A few years later when her father was admitted to a care home, the NHS assessor told her that he'd done the assessment, interviewed the staff which included two qualified nurses and her father didn't qualify for NHS funding. However she said she had all the details of how the assessments worked, what the qualifications for NHS funding were, and in her opinion he qualified so she would be appealing the decision. He said he would be consulting care home GP. This was over a year ago and she still hasn't heard anything about her having to fund the care and assumes the NHS is paying it.


    Another case showing how important it is to know your rights.

  • Under national criteria, the NHS pays for long-term support and care if a patient's condition is severe enough

    No they do not, not in the majority of cases.


    The BBC article is wrong, as proven by the government supposedly imposing caps on what people could expect to pay for their care, but then they've gone all quiet on the issue of care costs. This was one of the reasons why May lost votes.


    The assessment is done on the ability to pay, not medical need. Also, the assessment is done by local authorities, not the NHS.


    Although, I had already accepted redundancy for my job prior to the official diagnosis of dementia for my dad, when we were eventually assessed, because my parents had over £25k savings, they were deemed too rich and all care had to be paid for by themselves. Which actually meant I had to provide all the care, so couldn't work and earn money and that was the case up until my dad's death last year.


    The financial burden on me has been devastating, but it was either that, or buy in care and ultimately lose our house. I am still doing the care, but this time for my mother. All that I am entitled to (which I've paid for in taxes many times over) is Carer's Allowance which is just over £60 a week. That's what I've lived on for the last five years. I used to have a well paid City job...


    Officially, you are meant to get NHS continuing care if you are very ill, but as everyone knows and it's been widely reported, if everyone who got the care that was needed and this was funded by the NHS, the NHS would go bankrupt. To gain access to NHS continuing care is almost impossible if you have £25k or more in savings, it does not happen, certainly not in London anyway.


    Knowing your rights is one thing, but getting what you are "officially" entitled to, is something entirely different.

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  • Sorry but that's not the whole issue. It's complicated but basically the ability to pay is a different assessment to the NHS one. If a person in a care home needs continuing medical treatment then the NHS should pay for all or part of the care needed depending on the level of nursing care as opposed to ordinary care. Social care needs are funded depending on income and savings.


    http://www.nhs.uk/Conditions/s…/nhs-continuing-care.aspx

  • Sorry but that's not the whole issue. It's complicated but basically the ability to pay is a different assessment to the NHS one. If a person in a care home needs continuing medical treatment then the NHS should pay for all or part of the care needed depending on the level of nursing care as opposed to ordinary care. Social care needs are funded depending on income and savings.


    It is complicated, you are right.

    If my post is in this colour, it is a moderator decision. Please abide by it.


  • It is complicated, you are right.

    I would assume that the reason the NHS pay for the care home if the patient needs some sort of continuous medical treatment is partly because it's cheaper than keeping the patient in hospital at a cost of about £600 a night. Plus the problem of bed blocking of course.