Elderly care: Millions of pounds refunded in mistaken charges

Multi-million pound mistakes in charging sick, elderly people for nursing care they should have had free have been revealed by BBC Wales.

Health boards have already refunded £3.6m to patients who were originally told they were not entitled to NHS Continuing Healthcare Funding.

Millions of pounds in further refunds are anticipated as a backlog of almost 2,000 cases are determined.

The Welsh government has ordered a review of free care assessments.

Last October, BBC Wales' Week In Week Out programme revealed that many elderly people had sold their homes to pay for care the NHS should have provided free of charge.

Belongings sold

Helen Jones from Porthcawl spoke to BBC Wales again of her struggle to care for her mother, 83-year-old Cynthia Molkner, who died in March.

The former businesswoman and model was diagnosed with advanced vascular dementia in 2009.

Mrs Molkner was bedridden, doubly incontinent and unable to communicate or feed herself.

But Abertawe Bro Morgannwg University Health Board twice ruled she was not ill enough to qualify for free care.

Mrs Jones said she had to resort to selling some of their belongings to help pay for council carers to call twice daily to help wash and dress her mother.

The board decided Mrs Molkner was eligible for free care a few hours before she died.

"She was persuaded by successive governments that the thing to do was to get a pension for your old age," said Mrs Jones.

"She paid a full national health insurance stamp, paid all of her taxes and this is how she gets repaid - am I going to fight for her? Yes!"

Mrs Jones has begun a campaign "This Could Happen To You" in memory of her mother to get the funding rules changed and to help other carers challenge health boards' decisions in Wales.

Critics say the Welsh government's assessment guidelines amended in 2010 have made it harder for some patients in Wales to get funding, while in England the forms remained the same.

'Tick-box' assessment

Tina Donnelly, director of the Royal College of Nursing (RCN) in Wales, said the union was concerned about the tick-box style tools nurses had to use to assess eligibility for free care.

"If you've got nurses telling you it isn't right, you've got patients telling you it's not right, and/or their relatives, then I think it's time the government listened and changed the tool," she said.

"The tools themselves do not enable much discretion - it reminds me of when you've got a tick-in-a-box questionnaire being sent in about your likes and dislikes.

"You know that's not the answer you want to give but it's the closest to the one you are being asked."

Lisa Morgan of Hugh James solicitors, acting for Helen Jones, said she believed assessors got it wrong in Mrs Molkner's case, and spoke of a "clear postcode lottery".

"The assessment is very subjective - it's based on opinion and therefore one person's view of who is eligible for continuing care differs to another," she said.

"So I can see that there are families who will get funding in one area, but if they were living twenty miles elsewhere they wouldn't get funding."

Mrs Jones decided not to have a further assessment of her mother because she was disillusioned with the system.

Abertawe Bro Morgannwg University Health Board said in the circumstances it would not be appropriate to comment.

Legal expense

The Welsh government has asked the Wales Audit Office to review the assessment system, with a report on its findings expected in spring 2013.

Health Minister Lesley Griffiths declined to be interviewed for the programme, but the Conservatives' shadow health spokesman Darren Millar called for a shorter appeals process to limit the expense of legal proceedings.

"Every pound that we're spending on solicitor's fees and legal fees is a pound that's not being spent on care of those people who deserve it," he said.

"Every one of the appeals which is successful is a tragedy because of course people will have been through the mill in order to provide care and support that the state ought to have been funding.

"It is heartbreaking when people have to sell the family home, which may have been in the family for generations, simply in order to meet costs of caring for loved one.

"What we have to do is make sure there's a much shorter appeals process so that when there's a disagreement, those disagreements can be resolved quickly."

Week In Week Out: Helen's Story is on BBC One Wales at 22:35 BST on Tuesday