Examination of Witnesses (Questions 192-199)
17 MARCH 2005
MS TRISH
LONGDON AND
MR COLIN
HOUGHTON
Q192 Chairman: Good morning colleagues.
May I welcome you to this session of the Committee, and particularly
welcome our witnesses. Could I place on record the Committee's
thanks to you both for coming before the Committee and for your
cooperation with our inquiry, noting that we have met informally
and we appreciate the time you have given the Committee on this
issue. Would you mind briefly introducing yourselves to the Committee,
starting with you Ms Longdon.
Ms Longdon: I am Trish Longdon.
I am the Deputy Parliamentary and Health Service Ombudsman. I
should say, in introducing myself, that Ann Abraham would really
have liked to have been here herself—this is a very important
issue and something in which, as you know, she has a very real
interest—but, sadly, she had a prior engagement which involved
a large number of people that it would have been very difficult
for her to cancel. So, her apologies, and also she has asked me
to say that if there is anything she can do subsequently to help,
she would very much like to.
Mr Houghton: Good morning. I am
Colin Houghton, Head of the Ombudsman's Continuing Care Team.
Q193 Chairman: Thank you. I think it
is worth saying that I did speak to Ms Abraham and I understand
the circumstances. We are grateful for her help in this inquiry.
Could I begin by an opening question along the lines I asked with
the witnesses last week. At the heart of this issue is something
that has dogged our discussions on policy for many, many years,
which is how we establish the dividing line between health and
social care and if there really is a dividing line. Do you have
any thoughts on this? In policy terms, what might we as politicians
do to address an issue that really is at the heart of the problem
we are talking about today?
Ms Longdon: I think we are probably
not best placed to answer that question from the evidence that
we have from the complaints that come to us, other than perhaps
to reinforce the point that actually the complainants who come
to us come to us very confused about the whole issue: confused
about what health care is; confused about the terms that are used;
and confused about the distinctions that many people as providers
make but which of course are meaningless to the users of those
services. We have a very large amount of evidence to demonstrate
that there is a real issue. In terms of solutions, I am not sure
we are well placed to suggest that. I am sure there are others
who are far better placed to suggest how that might be addressed.
Q194 Chairman: You wrote to the Department
recently—and I think it was Mr Houghton who signed the letter—with
regard to continuing care funding and registered nursing care
contribution, expressing concerns about the confusion between
these two areas and free nursing care, especially at the higher
band. I gather that you may have received a reply to your letter.
Is it possible for that to be made available to the Committee?
Or could you indicate whether the concerns you have expressed,
which are quite strong concerns, have been picked up in the reply
from the Department?
Ms Longdon: You obviously will
have an opportunity to talk to the Department directly.
Q195 Chairman: Of course.
Ms Longdon: And I am sure they
will want to answer for themselves. But, yes, we have had a reply,
and the Department have said that they too understand there is
some ambiguity that they will want to address as part of the new
National Framework. We are content with their statement that it
is actually difficult to address the ambiguity, and that it will
take time to do that—although we would hope it will be done
as quickly as possible—but that it is clear that people
should be assessed for continuing care funding first before they
are assessed for the RNCC band. Certainly, from the complaints
to us, that has not always happened, so, in the meantime, while
the clarification is going on, the view the Department have expressed
to us is that they would expect a continuing care assessment to
take place before an RNCC assessment has taken place, so that
the individual and the family can be clear that they do not qualify
for the full continuing care funding before they go on to look
at the RNCC.
Q196 Chairman: While I accept this is
to some extent a holding file, that the issues are being looked
at in more detail, do you get the impression from what they have
said to you that the procedures to which you referred just now
will in fact take place? Are they taking action to direct SHAs
to ensure that action is taken along these lines? Is there some
directive that has gone out, do we know?
Ms Longdon: In principle our understanding
is that there is. Colin may have some details.
Mr Houghton: I am very pleased
with the reply actually. It is very positive. It agrees with us
on the nature and the manner in which these two streams of funding
came about. They agree there is confusion and difficulties interpreting
these. We are hoping to meet with my counterparts in the Department
of Health next week, as soon as possible, to try to address this.
We recognise that there is the forward look for the National Framework,
but obviously our concern with the Ombudsman at the moment is
that we have a lot of complaints at the moment solely about this
issue of having higher band. People are saying, "Look, they
should have continuing care. What is the difference?" I am
looking forward to meeting very soon to try to work on this and
to address this issue, and to see how we go about ensuring that,
as I understand it, the 15,000 to 20,000 higher band cases have
been looked at properly: continuing care first and then, if they
are not eligible for continuing care, moving on to the RNCC bands.
Q197 Chairman: In your letter there was
reference to the RNCC being more restrictive within National Health
Service continuing care. Has there been a response from the Department
on that particular point? Or is that something you are going to
discuss with them?
Mr Houghton: I think that is something
we are going to be discussing.
Q198 Mr Burns: I think I am right in
saying that the problems which led to you receiving complaints
started from 1996. Do you have a breakdown of the number of complaints
you have had for, say 1996/7, and 1997/8, and 1998/9? Is there
any way of finding out when the most critical time was for the
most complaints?
Ms Longdon: No, we do not have
that information. In fact, the issues that we looked at were looking
backwards. Most of our complaints have come in since the Ombudsman
issued her report in February 2003 drawing attention to this issue.
Before that, we did not have large numbers of complaints coming
in, so we were not in a position to identify the volume. I think
everybody was surprised by the volume of people who were affected.
Q199 Mr Burns: When the Ombudsman's report
drew attention to a wider audience that there was a problem, presumably
a lot of families would have thought, "Ah, that must have
been a problem we suffered from in . . ."—whenever
it was. When they started complaining, you would know about which
time period they were talking, because they would say, "Mother
went into a home in 1996"—or 1997 or whenever. Would
you not have the statistics as to when the problems were occurring?
Ms Longdon: When we got the really
large number of complaints which have come to us since that report—normally
we do not have large numbers of complaints and we have received
over 4,000 complaints since then—in the first instance,
because of the Department's response to the Ombudsman's report—which
was to say that there would be a retrospective review of those
cases—we passed the complaints we received to the Strategic
Health Authorities and said, "You have undertaken to review
these properly." Therefore we did not retain that information;
we sent it to them. That information is something you would probably
need to look somewhere else for, I am afraid.
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