Some people have to pay for care

A report by the independent Health Service Ombudsman has found evidence to suggest officials are wrongly making people meet the costs of nursing home care.

The ombudsman has upheld four complaints from the families of individuals who were billed for their care. Health authorities have since been ordered to reimburse those costs.

Case History Soon he'll have nothing left and this money could have been spent on a house or a car Click here to read the case of a man whose care has cost �40,000

But charities and opposition politicians say the report is just the "tip of the iceberg" and that thousands more could be entitled to money back.

The ombudsman, Ann Abraham, examined four cases involving people in Berkshire, Birmingham, Bolton and Dorset.

In each case, the individual had an underlying medical condition that required them to have round-the-clock care.

Government guidelines

All were required to pay nursing home fees despite Department of Health guidance and a 1999 court ruling stating that the costs of long term care must be met by the NHS if the needs of the patient are primarily health-related.

In her report, Ms Abraham said health authorities were failing to follow the government's guidelines.

The four cases reported by the ombudsman we suspect are just the tip of the iceberg Gordon Lishman, Age Concern

"My office has dealt with a cluster of complaints about the funding of continuing care.

"We have now completed the first four investigations and in each case have found the complaints to be largely justified.

"There is evidence that the Department of Health's guidance has been misinterpreted and misapplied by some health authorities and trusts, leading to hardship and injustice for some individuals."

Ms Abraham suggested the government's guidelines were flawed. "The Department of Health's guidance and support has not provided the secure foundation needed to enable a fair and transparent system of eligibility for funding to be operated across the country."

The Department of Health said it had ordered health authorities to review the criteria they use to decide who receives free care last year. A spokeswoman said further guidance will be published shortly.

"In August 2002, in response to one of the cases featured in the report, the Department of Health instructed strategic health authorities to review previous continuing care criteria and agree new criteria.

"The department will re-iterate to strategic health authorities their responsibility to review continuing care criteria, and agree with local councils one set of criteria within their area."

Policy under fire

The Liberal Democrats, which brought the cases to the attention of the ombudsman, welcomed the report.

Paul Burstow, its spokesman for older people, said: "The health ombudsman is rightly damning in her criticism of the NHS and the Department of Health.

"The implications are stark. Tens of thousands of people have been illegally forced to pay for long term care that should have been free."

Conservative Party spokesman Simon Burns added: "It is unforgivable that the government has let down some of the most frail, vulnerable and elderly in society, and their families. There is no excuse for what the Health Service Ombudsman has uncovered."

Director General Gordon Lishman told BBC News there were "hundreds, certainly, and probably thousands of people" who had been wrongly charged between �400 and �600 a week.

And some would have died since they started paying, in which case their relatives could be entitled to re-claim the cash.

"If this problem is not rectified quickly there will be large numbers of people who will need to be re-funded for the care they have wrongly paid for."