Most complaints related to long-term care of the elderly

The ombudsman, Ann Abraham, said she received 3,994 complaints in the 12 months up to April 2003 - up 50% on the previous year.

Many of these were from people dissatisfied with NHS decisions on funding for long-term care.

The ombudsman's report suggests there are still wide variations in the way the NHS decides who is and who is not entitled to free long-term care.

Wrongly-charged

Mrs Abraham published a report into long-term care in February. It identified four cases where people had been wrongly charged for nursing home care.

Charities said these were just the tip of the iceberg and that thousands more may be entitled to money back.

The guidance about who qualifies for funding is hugely complex and baffles health care professionals, advisers and older people alike Gordon Lishman, Age Concern

Disabled and elderly patients in England and Wales are only entitled to free nursing home care if they have an underlying medical condition.

The government has so far refused to pay for personal care, such as help washing, dressing and eating, where people do not have an underlying medical condition.

This is despite the fact that personal and nursing care is available free to elderly and disabled patients in Scotland.

In her annual report, Mrs Abraham said her office received 1,300 complaints in the weeks after her investigation into long-term care had been published

She said she had investigated a further three cases where people had been denied free long-term care. All three complaints were upheld.

"The cases highlighted serious deficiencies in eligibility criteria and assessments, which had resulted in severe financial hardship in some cases and had widespread implications for other people in similar position," she said.

Mrs Abrahams highlighted the case of one woman, known only as Mrs T, who had suffered several strokes.

She could no longer speak or comprehend what was being said to her. She had to be fed through a tube, was doubly incontinent and was paralysed on her right hand side.

Nevertheless, the woman, who has since died, was denied free care. Her family were forced to pay for her care.

The local primary care trust has since agreed to reimburse the family.

The Department of Health said it did not know how many people have been wrongly charged for long-term care.

"We expect to have a better picture of the overall impact of the report later this year," said a spokeswoman.

"Strategic Health Authorities and Primary Care Trusts are working hard to deal with local enquiries arising from the Ombudsman's report.

"Any individual who feels that they have been affected by this should contact their local strategic health authority."

Clearer guidelines

Age Concern England urged the government to issue new, clearer guidelines on when the NHS will pay for long-term care.

"The guidance about who qualifies for funding is hugely complex and baffles health care professionals, advisers and older people alike," said its director general Gordon Lishman.

"The Department of Health must provide straightforward guidance and make clear what the state will provide and to whom as a matter of urgency."

Barry Hassell, chief executive of the Independent Healthcare Association, said: "The ombudsman's report highlights the difficulties facing people requiring long-term care.

"Complex and confusing rules mean that people are often denied access to the choice of care to which they are entitled."

Liberal Democrat spokesman on older people Paul Burstow said: "It is time the Department of Health owned up for years of injustice to older people, apologised and put in place a compensation scheme for its victims."

The ombudsman's report also reveals that just one in three complaints were investigated last year.

This is because many had not been through the NHS complaints system as required by law or did not fall under her jurisdiction.

Overall, she issued 179 investigation reports and upheld around 75% of those complaints which were investigated.

The vast majority of these related to the care and treatment provided to patients.