NHS faces financial time bomb over care: Long-term nursing 'must be provided'

THE National Health Service Ombudsman yesterday placed what health authorities described as a 'financial time bomb' under the NHS by ruling that it still had a duty to provide long-term nursing care to a profoundly brain-damaged man.

In a finding which will cost Leeds Health Authority thousands of pounds a year, William Reid, the Health Service Commissioner, found it and Leeds General Infirmary guilty of 'a failure in service' for discharging the neurologically damaged, immobile and doubly incontinent man, who needed full nursing care, to a private nursing home for which his wife had to find pounds 6,000 a year to top-up the fees - even though the family was on income support.

So serious are the implications for the NHS that Mr Reid took the unprecedented step of issuing a special report on the case because of 'the issues of general public interest it raises'.

The man, aged 55 at time of discharge, had spent 20 months in hospital after a brain haemorrhage which, despite surgery, had left him unable to communicate or feed himself. His condition was, however, stable and he was discharged because no more could be done to improve his condition and Leeds had adopted a policy of making no provision for the continuing care of neurological patients.

The man was sent to the private home despite his wife's objections, and Department of Health guidance, which NHS researchers say is widely ignored, that 'no NHS patient should be placed in a private nursing or residential care home against his/her wishes if it means that he/she or a relative will be personally responsible for the home's charges'. Mr Reid ruled that the authority should pick up the bill and review its policy - a ruling the authority has accepted.

Baroness Cumberlege, a health minister, yesterday acknowledged there was 'a clear obligation on health authorities to pay for continuing health care of seriously ill patients', but added that ministers were closely studying the Ombudsman's finding 'for any further implications it may hold for the health service'.

Philip Hunt, director of the National Association of Health Authorities and Trusts, acknowledged that many health authorities had been bailing out of long-term care and discharging people to private nursing homes. That had partly been made possible, until last April, by social security picking up the bill for those poor enough, although others have had to meet the full fees. Under community care, social services now decide who gets such care.

Most people, Mr Hunt said, 'are not aware of what the NHS rules are. This finding will draw them to their attention and could prove a financial time bomb for health authorities and the Government. If health authorities are to have a duty to provide or pay for continuing care the potential costs, depending on the numbers, are absolutely enormous'.

Mr Reid said yesterday that the present case was clear-cut. After that there would be 'gradations' of how dependent patients were. But the consultant at Leeds told him that five or six other long-stay patients on the neurological ward at that time had also been discharged to private homes. Bill Swan, the chief executive of Leeds Health Authority, also emphasised that in not providing any long-stay medical beds, or contracting for them in private nursing homes, Leeds was 'no different in that respect from most other health authorities . . . if Leeds Health Authority were expected to pay nursing home fees it would soon become financially overstretched', he told Mr Reid. The issues 'needed to be addressed nationally', Mr Swan said.