ADMIRAL LEADS CARE FIGHT
A RETIRED rear admiral is suing the Government in a bid to force the NHS to pay the health costs of pensioners in care homes.
If successful, the judicial review sought by Philip Mathias could force the health service to pay out £ 5billion in fees.
The case concerns the failure by NHS bosses to pay for the continuing healthcare ( CHC) of tens of thousands of pensioners every year.
If the NHS rules that help is needed simply because someone is frail or elderly, this falls under social care which is means- tested, leaving people to pay the costs down to their last £ 23,500.
A Daily Express crusade found that refusal to fund the costs was forcing people to sell their homes to pay massive health care bills.
National rules say those with significant health problems should have care and nursing fees paid in full, provided their condition is the main reason they need help.
But the process is complicated and local clinical commissioning groups ( CCG) have been accused of rationing applications so they do not have to pay out.
Eligibility
Research found a 20- fold variation in the chances of securing funding between different CCGs.
Admiral Mathias, now retired, a former Ministry of Defence director of nuclear policy, won a £ 200,000 refund from Wiltshire CCG for his mother’s CHC.
He said: “In terms of the sheer scale of this scandal, measured by the significant number of old, ill and vulnerable people adversely affected and the level of unlawful financial deprivation, this is very possibly one of the biggest government scandals of modern times.”
Charities and campaigners agreed, saying the system is “ripe for refinancing and reform”.
Dennis Reed, the Silver Voices campaign group, said: “The majority of those denied continuing healthcare are residents in care homes living with dementia. The bureaucratic barriers put in the way of eligibility are a scandalous means of rationing free healthcare for those living with an incapacitating disease.”
AgeUK’s Caroline Abrahams said: “The real underlying problem with CHC is that it is seriously underfunded.
“In a civilised society every older person who is ill and has high care costs would receive the help they need as of right, without the need to battle with the authorities at the most difficult time of their life, when their end may also be near.”
NHS officials are increasingly refusing to fund care, claiming that devastating diseases are not severe, or are not the primary reason help is needed.
Charities say they are exploiting the looseness of the definition as an excuse to reject applicants.
Last year the Equality and Human Rights Commission threatened legal action against 13 CCGs accused of setting “arbitrary” limits on costs covered.
Yesterday PM Boris Johnson pledged once more to “fix the injustice of care home funding”.
Admiral Mathias believes up to 10,000 people are unlawfully denied CHC each year. So 50,000 people denied CHC over the past five years had, on average, had to pay £ 100,000. The NHS could be liable for £ 5billion.
The father of two, based in Southsea, Hants, is seeking to raise £ 30,000 needed to fund the first stage of the judicial review. In four days, almost £ 20,000 has been raised.
An NHS spokesman said: “CHC funding is available to a minority of people whose eligibility is assessed on an individual level, while most people are instead covered by the rules on social care eligibility that Parliament has established.”
● ● To learn more and donate go to crowdjustice.com/case/the-nhs-continuing-healthcare-scandal