Following the Health Service Ombudsman’s report “NHS Funding for Long Term Care of Older and Disabled People”, the national health service has carried out retrospective reviews of over 12,000 cases where fully funded NHS care was denied, dating back to 1996. The case of Mr. Pearce’s mother was one of these retrospective reviews of her eligibility for continuing care. This retrospective review found that Mrs. Pearce was wrongly denied NHS funding for her care, and so Torbay Care Trust reimbursed care home fees for the period of time when they considered they should have been paying for her care.
The care trust will continue to take the same approach to any other retrospective reviews they have to conduct, but no national precedent has been set.
In 2004, primary care trusts (PCTs) estimated that they would pay approximately £180 million in repayment as a consequence of the retrospective reviews of cases following the Ombudsman’s report.
Torbay Care Trust used the strategic health authority’s (SHA) eligibility criteria, which have been reviewed in accordance with guidance issued by the Department since the Coughlan and Grogan judgments. In their consideration of Mrs. Pearce’s case, they used the draft decision support tool, published as part of the Department’s consultation in 2006 , to help them gather information about Mrs. Pearce’s needs. This information was then tested against the criteria already in place in the SHA.
Further clarification for PCTs about redress, in cases where it has been found that NHS funding was wrongly withheld, was contained in guidance published by the Department in response to the publication of the joint report by the Parliamentary Commissioner for Administration (Parliamentary Ombudsman) and the Health Service Ombudsman for England, Retrospective continuing care funding and redress, on 14 March 2007.
The information requested on NHS expenditure on care home and care home places is not held centrally.