February 3, 2021

Ombudsman calls for end to uncertainty and confusion over responsibility for care home fees

The Northern Ireland Public Services Ombudsman, Margaret Kelly, has called for clarity over who is responsible for paying the care fees of adults who have a combination of health and social care needs, including those in residential or nursing homes.

The Ombudsman’s call was made following the publication of three reports into complaints from families who said that their Health and Social Care Trust had failed to carry out assessments to decide whether they could obtain Continuing Healthcare.  Continuing Healthcare (CHC) is the term used for the practice of the health service meeting the cost of any adult social care need which is driven primarily by a health need.

Under the current guidance Trusts are responsible for carrying out assessments of need.  If an assessment finds someone has primarily a health care need rather than social care then the Trust is responsible for paying for that care regardless of setting.  If the primary need is identified as social care then Trusts are entitled to recover the costs of that care.

However, the investigations carried out by the Ombudsman found that Trusts were unsure of their responsibilities around CHC, even to the point of stating that it was not available in Northern Ireland. The Ombudsman upheld the complaints, finding not only that Trusts failed to carry out the assessments but also that they did not have the proper tools in place to carry them out.

Ms Kelly said, “The concerns over the improper application of Continuing Healthcare have been around since they were highlighted in a report by AgeNI in 2014.  Since then we have investigated a number of complaints about these issues. 

The three reports we have just published are the latest to find that Trusts are reluctant to apply the existing Department of Health guidance because they are awaiting the results of a consultation it carried out in 2017.

The failures to carry out the assessments caused the families who complained to us real distress and frustration. It’s vital that other families who may be facing a decision over whether to use life savings or sell the family home to fund the care of a loved one are given clarity over whether they are entitled to CHC.”

I believe the current system is unsustainable, which is why I am calling on the Trusts, together with the Department of Health and others to agree a uniform approach for assessing all future applications for Continuing Healthcare in Northern Ireland, and to make this information available to those in care and their families.”

The full reports can be found here.