Nurses are being offered the equivalent of more than £100,000 a year to evaluate whether terminally ill cancer patients and dementia sufferers should be stripped of NHS funding for their care.
A Money Mail investigation today reveals precisely how health authorities are depriving nursing home residents of this money.
Four weeks ago, we revealed that soaring numbers of people suffering from degenerative conditions are having care payouts removed after reassessments.
We have since been inundated with letters from families whose loved ones face being turfed out of nursing homes or draining their bank accounts to pay for help.
Victim: Ethel Roberts with husband Ted on their wedding day. Ethel, who suffers from dementia, had her funding refused on the grounds her needs were only ‘high’
Now, we can publish details of how these seemingly heartless decisions are being made. Our findings include that:
- A staffing shortage has forced local health authorities to pay nurses huge sums — just as officials try to slash care spending.
- Crucial decisions on funding are being made by panels of people who have never even met those in need of help.
- Vital reports on care needs are littered with mistakes, such as repeatedly confusing the sex of a patient.
- One nurse described, in an internal health authority document, how the purpose of her work is to ‘screen out’ funding, rather than to check on a nursing home resident’s health.
Cash-strapped local health authorities have been ordered to save £855 million from their care budgets, while staff shortages mean Clinical Commissioning Groups (CCGs) are shelling out huge sums for temporary nurses to carry out care assessments.
Supreme Hill Care Limited, a London-based recruitment firm which supplies nurses to fulfil these checks — known as continuing healthcare (CHC) assessments — is offering assessors up to £480 a day, the equivalent of £110,000 a year.
The CHC payment to patients is typically worth around £1,000 a week and is awarded to people with severe or unpredictable health needs. Crucially, their needs must be mainly health-related, rather than social, such as requiring help to dress and wash.
When funding is granted, the care recipient is reviewed by a nurse annually. If their needs are judged to have changed, a full reassessment is carried out by a team of nurses and social workers.
The Supreme Hill Care website says it has recruited assessors for five local health authorities, including Aylesbury Vale CCG and Chiltern CCG. An advert from another agency, this time recruiting for an NHS organisation in the Midlands, offers £380 a day — equal to £87,400 a year — for a mid-ranking mental health nurse to deal with older adults.
‘This is an enormous waste of resources at a time when elderly people are being forced to sell their homes to pay for care,’ says Tory peer and care campaigner Baroness Ros Altmann.
Reassessments are supposed to ensure that a person’s needs are being properly met.
A full reassessment must consider this over 12 areas, ranging from mobility and continence to feeding and cognition. But families say they feel as though staff are looking for any reason to axe funding.
Bob Birchmore’s 81-year-old mother-in-law, who suffers from dementia with Lewy bodies, which worsens over time, was stripped of funding in June last year by Salford CCG.
Bob, 65, from Bury, used Freedom of Information laws to obtain documents detailing how the decision was made.
In one report, a nurse says she carried out an assessment to ‘screen [her] out of continuing healthcare’.
Another report painted a misleading image of Bob’s mother-in-law’s needs, stating that she ‘has enjoyed dancing’ when she had merely been watching it on the television. Salford CCG says it cannot comment on the case.
NHS guidelines state that at a full reassessment, a team of professionals should try to see the care recipient in person. Family members should also be invited to attend and given ‘sufficient’ notice.
However, some families say only one nurse attended their meetings, which means some funding decisions are being made by people who have never even met the patient concerned.
‘I now rarely attend assessments where a full multi-disciplinary team is present,’ says Fiona Lower, a former nurse who now helps families at reassessments.
‘The nurse is unable to make a recommendation on their own; a recommendation is made following a team meeting at an office. This therefore denies the patient, the family and advocates the right to comment prior to a decision being made.’
When funding is granted, the care recipient is reviewed by a nurse annually. If their needs are judged to have changed, a reassessment is carried out by a team of nurses and social workers
When local health authorities write to families to inform them of their decisions, they enclose a report. In one document seen by Money Mail, a CCG recommends a male dementia sufferer is stripped of his funding — yet repeatedly refers to him using the female pronouns ‘she’ and ‘her’.
The man’s wife, who successfully appealed the decision, says: ‘How can these documents be used to make crucial decisions if even basic facts are wrong?’
In each of the 12 areas covered by the reassessment a person’s needs must be ranked from ‘no needs’ to ‘priority’. Generally, to qualify you must receive one ‘priority’ or at least two ‘severes’.
But the scoring process is a grey area, experts say. For instance, someone could score ‘severe’ in the mobility category if ‘on movement or transfer there is a high risk of serious physical harm and where the positioning is critical’.
But if they were judged to ‘need careful positioning due to risk of physical harm’ they might get only a ‘high’. This lower score could jeopardise their funding.
Stephen Roberts, 66, won back funding for his mother, who suffers from dementia, after recording the October 2016 meeting in which her needs were discussed.
Assessors said his mother, Ethel, 92, who stayed in London through the Blitz to continue her war service making military uniforms, had ‘severe’ needs.
But weeks later, Stephen, from Bromley, received a report stating that in some crucial areas her needs were only ‘high’, so her funding had been refused.
Stephen sent his recording to Lewisham CCG and funding was reinstated. The CCG said it would not comment on the ‘specifics of any case’, but added that it acted ‘in line with the national framework for NHS continuing healthcare and NHS-funded nursing care’.
A spokesman for Aylesbury Vale and Chiltern CCGs says ‘recruitment and retention of qualified CHC nurses was a national challenge’ in expensive areas such as Buckinghamshire.
‘The use of agency staff in Bucks is kept to a minimum and is closely monitored,’ he adds.