THIS TRANSCRIPT IS ISSUED ON THE UNDERSTANDING THAT IT IS TAKEN FROM A LIVE PROGRAMME AS IT WAS BROADCAST. THE NATURE OF LIVE BROADCASTING MEANS THAT NEITHER THE BBC NOR THE PARTICIPANTS IN THE PROGRAMME CAN GUARANTEE THE ACCURACY OF THE INFORMATION PRINTED HERE.

Tape Transcript by JANE TEMPLE

MONEY BOX LIVE

Presenter: Paul Lewis

Guests: Philip Spiers Pauline Thompson

TRANSMISSION 1st OCT 2001 1500 - 1530 RADIO 4

ANNOUNCER : It's two minutes past three and time for MONEY BOX LIVE with Paul Lewis:

LEWIS: Hello and today we answer your questions on paying for long term care. New rules start today which mean that people in nursing homes in England who pay their own fees should see them fall by up to �110 a week as the nursing costs are picked up by the National Health Service. But there are problems about the new system - many people have still not been assessed for the amount of nursing care they need, the money will be paid direct to the home who may not pass it on to the resident in full, and personal care such as help with dressing or eating will not be covered. And just to confuse things more, the new rules begin today in England only. Scotland, Wales and Northern Ireland will get their own scheme to pay for nursing care but not just yet. There are other changes which start today which should make it easier for people who go into any sort of care to hang on to their home without selling it immediately to pay for the fees and there were changes in April to the way the means test worked - you can still get help with your fees even if you have up to �18,500 in the bank. But of course even with these changes there'll be thousand of people still struggling to pay those fees. Many miss out on benefits that might help. Well many things to discuss in the next half hour. Whatever your question - call Money Box Live now - 08700 100 444 And with me today to answer your questions about paying for long term care are Philip Spiers of financial advisors The Nursing Home Fees Agency, and Pauline Thompson who's policy officer from Age Concern. And just before we take the first question Pauline, just explain briefly what the changes are that start today in England?

THOMPSON: Yes. In a nutshell for nursing care there's going to be three bands - as you say the NHS is going to pay for nursing care and they've set three bands at �35, �70 or �110, so your fees should go down by those amounts and also there is the deferred payment scheme for people who want to not sell their house or are going to have some difficulty in selling their house- they can enter into an agreement and there's one or two other changes that I'm sure will come out during the course of the programme.

LEWIS: Right, so eventually you have to pay the fees from the value of the house but you can put it off?

THOMPSON: Yes

LEWIS: For some considerable time. Well thanks for that and let's take the first question which is from Margaret in Coventry. Margaret your question for the panel?

MARGARET: Oh hello. I just wanted to ask who is actually going to carry out the assessments which determine the level of nursing care funding that's to be awarded?

SPIERS: The assessment will be carried out by a registered nurse employed by your health authority. It probably won't take place immediately and it'll probably be between now and December when the assessment will take place, so provisionally you may be placed on a lower band than you should actually be on in which case when you are finally assessed and that nurse places you on a higher band you will be rebated the difference.

LEWIS: And Pauline Thompson, we've known about this system for a while - why haven't people been assessed already?

THOMPSON: Well it was decided that the assessments couldn't actually start until 1st October which seemed rather peculiar because obviously how can you put somebody on a band from the 1st October if you haven't assessed them and so they've got to have a sort of interim band so this rather sort of confused period - I mean there's 42,000 people to assess. Nurses are in short supply and it is going to be very difficult to do this assessment in the time allowed.

LEWIS: And just to be clear these 42,000 are the ones who are already paying for their fees?

THOMPSON: Yes - self funders only

LEWIS: Self funders as we call them

THOMPSON: It's people who fund themselves. People who go in from the 1st October, they'll have the assessment done as part of their - the assessment of them going into a nursing home.

LEWIS: Right, so valuable nursing time taken up by doing assessments I suppose till December. Thank you for your call Margaret. Let's move on now to David in Derby. What's your question David?

DAVID: Yes my question concerns the division between care workers assistants and nursing assistants in terms of my father is in a nursing home - he can only walk a few steps so most of his day is taken up with help by care workers, so how to you apportion the difference in the costs?

LEWIS: Pauline Thompson?

THOMPSON: Right, there's been a very tight definition which is in the health and social care act which went through Parliament and got royal assent in May. How they're going to work it out - it's what a registered nurse does or the time it takes them to delegate supervised or manage the work done by the nursing assistant, but the actual task and the time that the nursing assistant is working with the person doesn't care as nursing care. It's just what the registered nurse does.

LEWIS: So Philip Spiers, this only applies then in nursing homes, not in care homes where there are no registered nurses?

SPIERS: No that's correct - the principle being that if you need nursing care in a registered residential care home then that will be provided by your district nurse. The sort of care which this gentlemen's receiving in the care assistants is what the government is calling personal care and that would be assistance in dealing with your activities of daily living like washing, dressing, toileting, feeding, and mobility.

LEWIS And it's obviously very hard to decide between them - and thanks for your call David, but I think on the line we have Robin Wendt who was actually on the Royal Commission that looked into this whole question. Robin, how did you - what conclusions did you come to about the difference between nursing care and personal care?

WENDT: We came to the conclusion that it's a very fine distinction indeed and it really is not viable in terms of the way in which social policy ought to be developed. What we're concerned with here are people who are so ill or frail or disabled that they can't look after themselves properly - they need to be helped with washing, feeding and so on - we took the view that for the State to meet the costs of all this is that they should be a basic human right along with all the other things that the State provides for its citizens who are in distress, and frankly what is happening now in England is a very limited correction of what after all is simply an anomaly in the health service under which if you're in hospital you don't have to pay for the services of a nurse - if you go to your GP's surgery, you don't have to pay for the services of a nurse -if you happen to be in a nursing home perversely you do. All that's happening is that that anomaly is being put right. In the meantime the big issue of real intimate personal care and the need for the State to help with the costs of that is being - in England at any rate - ignored, and it's a tragedy.

LEWIS: Robin Wendt thanks very much and just briefly Pauline, the reason for the government or the Westminster Parliament I should say not doing this in England is simply the cost - it was over a billion pounds and they thought they could spend the money better?

THOMPSON: Yes I mean what they did was that they've introduced - they're putting 900 million over the next four years into a system called intermediate care to try and get people intensive care for very short periods of time and so people will still be paying for their personal care.

LEWIS: Yes I mean I think roughly it's about 200 million to pay for nursing care and as I say over a billion to pay for the whole lot and that was the sticking point. Well very aptly we have a question from Scotland now - Mary's ringing from Ayr- Mary, your question?

MARY: Yes my question is - my husband is in nursing care - a nursing home at the moment having nursing care and it is paid for from his state pension and half of it occupational pension. Now from that there is a deduction for personal allowance and half of his occupational pension to me. Not to go into too much detail the client contribution is �111 and the council contribution's �224. Will the changes envisaged for Scotland make any difference to the amount I pay, or does it only affect people who are receiving no contribution from the council?

LEWIS: Right well we've heard about the changes in England - now this question of personal and nursing care Pauline has been dealt with differently in Scotland though not just yet?

THOMPSON: No. From April 2002 it looks as if - well the care development group has reported and the Scottish Parliament has still got to comment on the report, but they're recommending that both personal care and nursing care should be paid for. However what they've said is that people will get �90 for personal care and �65 for nursing care so

LEWIS: That's a flat rate?

THOMPSON: That's a flat rate yes and they're then saying oh well that's because people get attendance allowance, but of course obviously your husband because he's funded by social services doesn't get attendance allowance.

MARY: No he doesn't

THOMPSON: And I'm not quite sure how it will actually work in your particular case -whether or not you will find a reduction in the fees - so much depends on his - how much he's paying and if he's paying for part of his personal care then hopefully that will actually reduce the fees because from April 2002 all that will have to be paid for is the actual accommodation costs.

LEWIS: So Philip Spiers I mean this is a big difference in Scotland that they will be paying �90 towards personal care, �65 towards nursing care - no distinction there, but people in - in the position of Mary's husband they are partly funding themselves?

SPIERS: Yes I think Mary's husband will - will see no difference at all to his contribution. I mean the - if his contribution exceeded the amount of personal and nursing care then he might do but his contribution is �111 - the local authority contribution is �224 - and all that'll happen is the money will shift from the health authority - from local authority to the health authority and so Mary I don't think there will be any difference at all to your husband.

MARY: �I thought that might be the case

LEWIS: Although the system's better Mary it's probably not going to help you and I'm sorry for that. And now continuing our journey around the United Kingdom we have a call from Violet in Bangor. Violet, what's your question?

VIOLET: Well my husband is in a nursing home and is totally self funding. Now I understood - understand that in Wales there's going to be a flat rate fee paid for all nursing care and I also understood that this was due to commence today but I understand now that this isn't so. Could you perhaps clarify the situation for me?

LEWIS: Well we'll certainly try - We were actually on the phone just before the programme trying to clarify this because it is confused - Pauline?

THOMPSON: Yes. At the moment there's a consultation document out in Wales, and what they're suggesting - they've given Wales the option of either having the banded system that we're having in England or going for a flat rate system of �90 across the board, and they've made it quite clear that that's the one they prefer. However, the consultation period doesn't end till the 19th October so it's a bit difficult to actually bring something in before you finish consulting and we've been informed today that the start date will be as soon as possible after the 19th October, but bearing in mind you know you're going to get the -all the sort of consultation documents - they're going to have to be read and looked at, but they are obviously very concerned to bring it in as soon as possible. But it doesn't look as if it will be back dated to the 1st October.

VIOLET: It won't be backdated?

THOMPSON: We're not 100% sure about that, but that was the impression that we were given.

LEWIS: Yes I mean I think there is - there is an expectation isn't there Pauline in Wales that it will be backdated, but when we spoke to the National Assembly Office just before we went on air we were told it wouldn't, so we're slightly confused, but

VIOLET: I'm totally confused!

LEWIS: But at least it will - it will be a fairly simple system it seems when it comes in Philip Spiers?

SPIERS: Yes I think it's much simpler system - when you look at the costs of actually administrating the 3 bands, the assessments and distributing to the money to the homes and everything a single payment to that home to that individual makes far - far more sense.

VIOLET: Yes could I just make the point that with the 3 band system I think it's going to be totally unfair on people like my husband who suffer from dementia. I mean how on earth can you decide what his nursing care requires and what is personal care?

LEWIS: Well that's exactly - exactly the point that we were talking about. And just briefly to go back to the system in England as we understand it Pauline, if you are put in a band will you be reassessed? Can you appeal if things get worse?

THOMPSON: Yes well you can - you can ask to be reassessed at any time - so if your condition gets worse and you're say in the �70 band and you think you've gone up to the �110 band you know get - ask for a review quickly but also you - you are going to be reassessed after 3 months and then again every 12 months.

VIOLET; Right thank you very much for your help

LEWIS: Thank you for your call Violet and now it's not the only change happening today of course and I think Glyn in Kidderminster has a question about another change?

GLYN: I do good afternoon

LEWIS: Good afternoon - your question?

GLYN: Part of the costs for a nursing home for private patients is the incontinence products. I understood that these were to be made free of charge from 1st October, but the primary health care trust have informed us that these aren't available. Have you any idea when these will be available and what conditions they're going to apply?

THOMPSON: Well this is going to be a very interesting one because in fact it the guidance makes it quite clear that incontinence products are going to be available from 1st October. Anybody who is paying for their incontinence pads is not expected to pay for them from 1st October. Six million has been put in to this in order that the various health authorities or primary care trusts can undertake this and so I think if you're being told that they're not going to be free I think you should put in a complaint.

LEWIS: Yes I mean Philip Spiers, it's easy to say put in a complaint isn't it? - and I'm sure that Glyn will do so, but we often do this on Money Box Live - we say these are your rights and then people still run into a bureaucratic brick wall. What can be done?

SPIERS: Well you have to go through the complaints procedure - I mean every health authority, every social services must have a procedure for you to follow and you can get that in writing for them, but I would recommend any complaint should actually be dealt with in writing rather than by telephone because then you have got a record and it must be dealt with.

LEWIS: So Glyn you have it from us they should be available today and if they're not go out and complain - thanks very much for your call and now Bobby in Reading. Bobby, your question?

BOBBY: Yeah hello. My mother is in her 80s is the owner of a house. Now at the moment she's living at home. She wants to leave that house in trust to her grandson - my son who has special needs and isn't likely to have major - much earning capacity. Now there's currently a test case going on where a bloke left a house to his son and there's a row with the local authority because they say it should pay for his care costs and he didn't have the right to give it away. I want to know how she can secure that gift - how she can secure that for her grandson?

LEWIS: It is a tricky one isn't it? - Philip will take this first.

SPIERS: Yes it is a difficult one and it is something we never recommend to people normally to give their property to avoid accommodation costs. There is provision for the local authority to look at this very closely. Their means test form will actually say have you ever owned a property and if you tick that and you don't own it any longer they will treat you as if you still own that property and refuse to fund your care costs.

BOBBY: The thing is though I mean she - you know she may not actually need care - she may die quite happily at home

SPIERS: Well yeah absolutely. I mean there's nothing to stop her actually putting together her will now to leave it to her grandson - I mean that's quite fine.

LEWIS: Pauline it is worth pointing out isn't it - that the great majority of people never go into a home and you should organise your affairs with that belief and we've had an e-mail on a similar subject - Rebecca e-mailed us saying that her parents want "to 'sell' their house to myself, my brother and my sister for �10 each".

THOMPSON: I think the local authority would look at that very closely

LEWIS: So they have the right to do what if you do that?

THOMPSON: Well if they think you've done it with the intention of avoiding charges - I mean it has to be with the intention of avoiding the charges then they are quite within their rights to count you as still owning that property. I mean there have been two cases in Scotland where this has happened and there is another case at the moment, but that was more about the complaints procedure - the test case that's going through at the moment is whether or not the complaints procedure was actually conforming to the human rights act.

LEWIS: But there are problems about them actually recovering the money aren't there? - they can recover it from the person you've given it to but only

THOMPSON: Only if you've done that within 6 months before you actually needed local authority help with the funding. But what they can do otherwise is just - I mean what's happening in Scotland is that they're just saying well we refuse to actually make the arrangements for you in the first place because you've got notional capital - i.e. your house and so therefore you can avoid to pay for care yourself, so it could really put somebody in a very very difficult position.

LEWIS: Indeed yes so get advice and preferably don't try and avoid the law in this way though I can see the temptation for people because it's something that people really really don't want to do. Let's take a slightly different topic now - Stephen's calling us from Bristol - Stephen?

STEPHEN: Hello yes my elderly father is in a nursing home - an EMI nursing home which means elderly mentally infirm - he got there through having to be admitted to hospital because he couldn't simply - couldn't look after himself and he was a danger to everybody. Now he's in this nursing home now and he's self funded, but physically he's fairly well so in terms of what we would think of as classic nursing care - he doesn't need very much at all but there is no option for him not being there, so we seem to have fallen between the stools here that he's not on the face of it likely to be helped much by this scheme but he has to be involved in it?

LEWIS: Well I won't - I won't describe Pauline's expression - I'm not sure whether it's glee or horror at trying to explain this to you but she's going to have a go - Pauline?

THOMPSON: Right well the first thing is Stephen - do you know what section - when your father was in hospital was he sectioned

STEPHEN; Unfortunately I know now that if we had - the time when he was admitted he was sufficiently lucid to agree to be admitted, now at one point I was pleased about that but I know now that was a terrible mistake - he should have been sectioned. I know that now.

THOMPSON: Cos if he had been sectioned under certain sections of the mental health act then his care would have been free.

STEPHEN: I tell everybody now that that's what they should do

LEWIS: So just to be clear about this - if he was forced to go into a mental care - mental care home because of his mental condition Pauline they would have then had to pay the full costs of that but because he was compos mentis

THOMPSON: it's the going into hospital

LEWIS: Going into hospital I'm sorry - because he was compos mentis enough to say well okay I'd probably be better off there, it's not compulsory so he has to pay?

THOMPSON: Yes

LEWIS: That seems extraordinarily unfair?

THOMPSON: Yes it is - it's one of the many unfairnesses within the system. And you know it does actually mean that you've said that he's in a nursing home so the good news is that he'll be assessed for how much nursing he needs and that of course as you've said you know is the nub of the matter because many people with your father's type of illness you know they need an awful lot of personal care but they don't actually need very much nursing care but the fact that he's in a nursing home does show that he does need some nursing care.

LEWIS: So Philip Spiers we have to look at how much care from a registered nurse or organised by a registered nurse this gentleman needs to assess the band he will come in?

SPIERS: That's right yes and if you feel that he's been assessed and placed in perhaps a low band and you feel he should be in the middle band then you do have a right to actually review that. The assessments will be reviewed anyway 3 months after the initial assessment and then again every 12 months, but at any time in-between if you want a review of that assessment if you think the needs have increased then you can request that review.

LEWIS: It does sound as if some of these cases with mental illness as they often are are going to be more difficult to assess than the physical needs of other patients. Stephen thanks very much for your call. Let's move on to Ascot now where Peter's waiting to ask a question - Peter?

PETER: Oh good afternoon. My question relates to funding and what options there are where I can go and look for money if I don't - if I can't get access to all the money that I need say from the costs of the property that I'm trying to sell - you know where can I go - which - what financial products are there out there that can support me and help me out?

LEWIS: Philip Spiers?

SPIERS: Right one product we use quite often is called an immediate need care fees payment plan and very few people know about these, but basically they're based on a person being in a nursing home having a shorter life expectancy - you can purchase - it's like an annuity it will pay far greater income that you'll get with traditional annuities and it's based on somebody's medical state of health. Typically if you needed to raise �1000 a month income such a plan might cost around about �30,000.

PETER: Right. But that's the only thing - is there anything else?

SPIERS: Not really - I mean it's very difficult to find anything which is going to pay these levels of income that you need from your capital.

PETER: I mean I had an interesting scenario in that I went into a bank to ask if they - on the power of attorney that I've got - if they would through my father's bank account loan me short term enough money to get him started and they said no they won't do it because they won't do that for power of attorney - I'll have to go to my own bank and I found that rather frustrating -

SPIERS: Okay there is actually provision - under the new rules for the local authority to actually disregard the value of property and assist with the funding for the first 12 weeks of somebody's care

PETER: Oh there is?

SPIERS: After the 12 weeks then somebody is then entitled to what's called a deferred payment scheme whereby the local authority can actually lend you the cost of that care and place a charge against your value of the property

PETER: Oh fantastic that's really helpful - thank you

LEWIS: Just let me get a comment from Pauline on that because this change where the property was ignored for 12 weeks began in April but there's widespread ignorance of it?

THOMPSON: Yes I mean I think there's partly ignorance - we get many calls where people aren't told and so they're just told to go off and make their own arrangements, so in fact people are missing out quite a lot of money and in fact there's been new guidance issued today from the department of health, and although it was only brought in in April they're actually reminding local authorities that they can't avoid this - it's mandatory

LEWIS: So for the first 12 weeks in the home the value of the property is ignored completely, and then of course you can arrange to pay the bill out of the proceeds when the house is finally sold and meanwhile the bill is clocking up interest free or?

THOMPSON: It's interest free and it stays interest free if the resident dies for - for 56 days no interest will be charged

LEWIS: So that's quite a good deal in some areas because you could then rent out the property, use the income and then when the person in the home sadly does die sort it all out?

THOMPSON: I mean we certainly think that anybody who wants to do this really does need to seek independent financial advice -there's so many factors

LEWIS: And bully the local authority because a lot of them obviously don't know it's happening. Okay now we've got a call from Davies in Rockbourne - what's your question?

DAVIES: My question is in fact first, speaking on behalf of my mother in law who is an 80 year old suffering from dementia - she's in a nursing home - she is self funded. She had to go into the nursing home following the death of her husband who had been supporting her until his dying day. She's been in the nursing home - she pays �500 per week - this believe it or not has gone up by �50 this very week - coinciding with this so called improvement in the scheme. My question really is what right of appeal have we got and why isn't this money payable to the patients and not to the homes who are calling the tunes?

LEWIS: Philip Spiers - you're very worried about this aren't you?

SPIERS: Yes it's a very good question - I mean I would have liked to have seen this money actually paid to the patient and not direct to the homes. There is a real problem with care homes in the country at the moment whereby because local authorities have not been paying a full market rate to them for fees then a lot of homes have closed. This has caused a problem of capacity and therefore the fewer homes then the more they can actually charge, and there is a fear that any extra money coming in to pay for free nursing care is going to be absorbed in fee increases. I will say that once somebody actually is assessed by the NHS for their part of nursing care, they will be informed by NHS as to how much they will be getting so they can tackle the home and I think most homes will be rebating that to the - to the patient.

LEWIS: But there is a danger Pauline, and there's no law to stop it, that homes will put home fees as indeed this home appears to have done to recover the money. And in a sense although it obviously seems wrong a lot of these homes are in great financial difficulties and it maybe the only way they think anyway they can survive as a business?

THOMPSON: And it is a great concern - and I was rather horrified to find that in fact the nursing bands aren't going up next year. Now fees always go up in April or invariably go up in April and so therefore you're - they're still going to have the same banding next year.

LEWIS: So we're stuck with �36, �70 and �110 till when?

THOMPSON: Till April 2003 it looks like

LEWIS: So even if the home fees haven't gone up today they could well go up in April and absorb more of that. Well thanks for your call Davies - that's an interesting, very relevant question. Let's talk to John in Workington next?

JOHN: Hello there.

LEWIS: John, your question?

JOHN: Yes I'm here. Yes, I'd like to refer to the Coughlan case in l999

LEWIS: Oh dear - you're going to tell us what that is - or Pauline will tell us what

THOMPSON: Forty six pages of it

JOHN: Which rules I believe to sum it up as quick as I can that if the primary need was for person going into a nursing home was for nursing care then the full care should be paid for by the health authority - my particular interest in this is for some of the younger disabled people - I'm chairman of the local MS society.

LEWIS: Right so why are they only paying bands if some people can get all the care paid - this is the complexity Pauline?

THOMPSON: Yes this is - the - the difference between the highest band of nursing care and the criteria for the highest band and the criteria for actually getting your full nursing home fees paid are very very gray to say the least. And we would certainly recommend anybody who's put on the highest band to actually look at very closely at whether or not they shouldn't be getting the full costs paid. Currently there are 10.9% of people in nursing homes now get the full funding from the NHS. That did go up - it used to be about 8% for years - it's gone up to 10.9 - and we suspect as a result of the Coughlan case where health authorities have been reviewing their continuing care criteria. But I think - I was very worried when I saw the example given in the nurses' textbook - it was so similar to somebody who needed fully funded care.

JOHN: Yes the Coughlan case - the lady had to be hoisted and fed and dressed and so on and a lot of people with MS are in this situation?

THOMPSON: Yeah I mean I think you need to be very careful and really check very carefully that you shouldn't get the full fees paid

LEWIS: So there are some people who can get the full fees paid and people - if the primary need to go in was nursing they get the whole lot paid by the NHS. Now we've been talking about England -we've mentioned Scotland and Wales - Northern Ireland of course the other part of the United Kingdom has slightly more amorphous plans than any of the other 3 nations?

THOMPSON: Yes I mean at the moment we can't really say what's happening in Northern Ireland. I mean certainly nursing will be free but I think there are some sort of rumours as to whether or not they're going to be looking at personal care being free as well, but those plans are still very much in the pipeline.

LEWIS: Yes we did have an email from somebody in the Northern Ireland assembly who says that they do have a policy on it but of course we have checked and we don't quite know the details of when it will happen, or what will happen, but some suggestion it might even happen by next April and it will be nursing care, and I think you were saying earlier that they were looking at perhaps including personal care as they did in Scotland?

THOMPSON: Certainly, when I've spoken to Age Concern Northern Ireland, you know there does seem to be some sort of feeling that they might try and get it wider.

LEWIS: Okay let's move on to another point now - Pauline is calling from London - Pauline your question?

PAULINE: Oh good afternoon. Elderly care - I'm investigating it and if I pay �16,000 - Age Concern affiliated with Norwich Union fund - should I need care later on they would pay up to �13,000 annually

LEWIS: Pauline I'm going to take that as your question cos we've literally got 5 seconds - Philip Spiers?

SPIERS: Well yes I mean that's a long term care insurance and my recommendation would be to look at all the insurers - get some independent advice and compare the quotes but they do - they are useful to enable you to have the control over your future care needs.

LEWIS: Philip Spiers, thanks for that and thanks for your question Pauline. Thanks also to Pauline Thompson of Age Concern. More details on anything raised in the programme on our action line - 0800 044 044 Our e-mail address: [email protected]. I'm back on Saturday with MONEY BOX and next Monday with MONEY BOX LIVE.

BACK ANNO That was Paul Lewis and the producer was Jennifer Clarke.