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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 28.06.07 - Continuing Care PRESENTER: WINIFRED ROBINSON |
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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Over the years on You and Yours we have reported on the patients who feel certain they must be entitled to free care when they go into a nursing home but are told that they are not. Thousands of seriously ill people have sold their houses to pay nursing home fees unjustly, they claim. Well this week in the face of long and sustained campaigns by charities and by individuals, some of them fought through the courts, the government has redrawn the rules on who qualifies for what is called continuing NHS care in England. In response the Alzheimer's Society is offering a new service to help people navigate their way through what remains a very complicated system. Carolyn Atkinson has been looking into the changes. Carolyn, is this an admission then that the old system was unjust? ATKINSON Yes it is. The old system failed a lot of people who were living in nursing homes who were very, very ill because the rules used to decide who got what's called this continuing NHS care when they left hospital and went into a home were decided regionally by each individual strategic health authority and then they were interpreted locally by each hospital trust, so it changed in different areas. Now the point about continuing NHS care is that it acknowledges that the person is very, very sick, they're sick enough to have all their costs, not just nursing care or personal care but also food and accommodation, met by the state, just as they would if they were still in hospital. Now there were huge variations in decisions over who qualified across England, so as Ivan Lewis, the care services minister, told me they've decided to scrap the old system and they've come up with one set of rules for everybody. LEWIS The postcode lottery has been a running sore for families, individuals and also the healthcare community. You can have the same level of need in one part of the country as another and yet find your primary care trust came to a very different decision about whether they're willing to provide the necessary NHS funding. We've decided that the appropriate response to that is to issue national guidance which will affect both the way that nurses and social workers and others make assessments but also ensure that we have national criteria which are applied by the decision makers, those people who make decisions ultimately in primary care trusts about who's eligible for continuing care funding. ROBINSON Ivan Lewis. So how many more people Carolyn may well qualify under this new system? ATKINSON Well the government's looked at this and they reckon between five and ten thousand more people will be assessed as qualifying for this free continuing NHS care once the new system kicks in, and that comes in in October this year. Now Age Concern, for example, agree with that figure and to put it all in context - at the moment the total number of people who get this continuing NHS care is around 31,000, so we're talking about a new total of about 40,000. But Age Concern and other charities believe that the number who should qualify is more like a 100,000 and some lawyers, who've been taking a look at the figures, suggest that it could be even as high as 200,000. So basically we're going to have to wait and see who's right on that. One thing that everyone does agree on is that the biggest losers under the old system were people with dementia because that wasn't really recognised as a physical disease and there was this assumption, arguably, amongst the people doing the assessments that a mental condition like dementia does not have a physical effect. Now under the new system, and the minister made this very clear, the assessors are being told they should set aside the diagnosis, not just look at the medical name, and they should look at individual need, what that person is actually like. ROBINSON Well one man who can talk with experience about the new rules and how they should work is Mike Pierce, he's a retired Scotland Yard detective, and he'll be helping to offer a new service through the Alzheimer's Society. He was first to test the new system when draft guidelines were published by the Department of Health last year and he won back £60,000 in fees for his mother. Mike Pierce is here. Tell us then what it is that you did. PIERCE Well basically I realised that Torbay's information and criteria were totally out of date. As they published the new framework it would have been of benefit to me because it took into account the psychological trauma that my mother was going through, she was totally incapable of doing anything for herself except eating food and swallowing it. So I forced basically Torbay to use the new system. They were out of date, I was up to date and I sent them a review of my mother's case, detailing all her conditions and correlating it with the guidance that had come from the Department of Health in November 2005 and from a High Court judgement in 2006. ROBINSON So can I just get this straight? Were you using these new rules, unveiled by the government this week, as they had appeared in draft form, or were you looking at previous rules and previous court judgements? PIERCE I was using the new draft judgement in its entirety. And in fact we sat around a table and we discussed my mother's condition from various notes, such as hospital, nursing home notes and we graded my mother under the new framework. And she finished up with a score of about three severes and many highs in the category. To a certain extent they were unable to refuse continuous care funding because of that. ROBINSON Now you've since been helping other people to challenge assessments, why have you now joined forces with the Alzheimer's Society? PIERCE Well I've been doing this for about two years, quietly by myself, now it's getting such a big issue that other people that have been through the system have also volunteered and we're going to form a network to give people good moral and also practical support on how to get through this enormous problem for people. ROBINSON Well Neil Hunt, the chief executive of the Alzheimer's Society is also with us. More people with dementia should qualify for NHS continuing care under these new guidelines, do you think that's going to happen in practice? HUNT Well we are very pleased that the sort of cognitive decline aspect has now been formally recognised. I've got to say whilst we can't help but be pleased to see this happen we're doubtful really that it's going to change things for most people. We are talking about hundreds of thousands of people with dementia and if the government's figures about who they think are going to benefit from this ... ROBINSON Yes, they're suggesting that from 30,000 it may go up to 40,000. HUNT Our sense is that sadly so many people making these assessments really do not understand dementia, they don't understand the fact that it's a physical illness of the brain, a deteriorating brain, these people are so dependent on the help they get, and they don't actually understand I think the pressures on families either, the very severe limitations that come with it. So we think that actually whilst this is a step forward what the government really needs to do is actually accept the fact that they are dealing here with a very, very substantial health and care issue and open up a bigger debate actually about who should be paying for what. ROBINSON This new service though are you confident that you can meet the demand, I mean it could be overwhelming couldn't it? HUNT In the first instance our advice has to be look please ask for an assessment and if you don't like the outcome then try and appeal it. What we're going to try and provide - and I do congratulate Mike on his work and thank him for his offer and others - is that we are going to try and build up this network so that people who are finding themselves completely confused or frustrated by the process can actually get some serious help, advice and practical input. ROBINSON Mike Pierce, advice for anyone entering this process for the first time. PIERCE It's a long process, you've really got to organise yourself for a battle. You've got to write letters, take notes and be prepared to spend an awful lot of time finding out your own information, the National Health Service are prone to lose documents and if you go and look at records yourself and take copies you will prevent that but what you'll also do is you will use National Health professionals to prove your case and it's very difficult for them to argue against that. ROBINSON Mike Pierce, Neil Hunt, thank you both. Well Carolyn Atkinson is still with us. Carolyn, the minister insists that there will be winners, as you said up to 10,000 of them, and maybe even more with a little help from the Alzheimer's Society, is anybody going to lose out here? ATKINSON Well quite possibly yes. The way the system works is that people who don't get continuing care, and of course people can be assessed and correctly told no you're not eligible, but they can get help with the costs of nursing, they have to pay for the bed and board in a home and for personal care but the nursing - so that's injections, wound care, all of that type of thing - is covered by payments called Registered Nursing Care Contributions. And they are paid direct to the nursing home. Now at the moment there are three bands: £40 a week, £89 or £139 and from October they're going to be scrapped in England, those three bands are going to be scrapped, and the most that anyone will get will be £101 a week. So we can see immediately there are going to be some people who are currently getting a £139 and that's going to go down to 101. So some people will lose out but the Department of Health is insisting that there won't be that many people moving - losing out because they're saying the bulk of the people who are currently on the high band, getting that £139 nursing care a week, will under the new rules qualify for this free continuing NHS care. ROBINSON Well Carolyn Atkinson thank you. And if you want more information about the Alzheimer's Society's new system and the help it's trying to offer then you can either go to our website and follow the links or telephone our helpline which is 0800 044 044. Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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