Panorama Covers the Free Nursing Care Scandal
by Robert Campbell        March 2006

The BBC’s flagship documentary series, Panorama, has screened a hard hitting programme attacking the government’s refusal to set up a lawful process for assessing eligibility for NHS funded (free) Continuing Care.

The programme highlighted the ruling in the Coughlan case way back in 1999 complaining that, even today, guidance documents drawn up by NHS Trusts based upon guidelines from the Department of Health do not comply with that ruling.

The programme’s presenter, Vivian White, began the programme by announcing:

"Tonight we reveal that thousands of people who are very ill have had to sell their family home because the NHS in England and Wales has unlawfully denied them the free care they were entitled to."

Launching into a reconstruction of a case going back to August 2004 the illustration went on as follows:

White:" Free care from the cradle to the grave, and there for you, especially in a crisis. Those are the values the NHS is supposed to stand for, and when Rose Fulcher was taken ill in a street in Sidcup, the NHS was there to help."

Ambulance Man: "This lady looks like she’s had a stroke, right sided weakness".

White: "Rose Fulcher was rushed to hospital and free medical care. Yet the same NHS that cares so well for people who are actually ill seems to display different values to many patients will long-term illnesses".

Ambulance Man: "Rose, this is oxygen, it’s good for you. It’ll help you. We’re almost at the hospital."

White: "And Rose Fulcher was soon at Queen Mary’s Hospital in Sidcup in Kent. But there she encountered a Health Service which apparently wanted to check out her finances first. A question on the admission form surprised her family. "Was she a home owner?"."

Kate Meager: "It’s a standard question they said. It’s on every form. Do you own your own property. It’s one of the very first questions that they ask after your name, address and date of birth. It’s wrong. What difference does that make to you being sick? None at all."

White: "Why do you think the patient is being asked then?"

Kate:" I think it gives them the opportunity to decide who will be paying for their long-term care and who won’t."

White: "Aunt Rose survived her stroke and began to recuperate in hospital, but it was obvious that she’d never be able to return home. She’d need a great deal of care for the rest of her life. Nowadays that’s unlikely to be in a hospital. Thousands of long stay hospital beds have been closed in the last 20 years. Rose Fulcher’s niece runs her own business in Essex. She had power of attorney, responsibility for her aunt’s financial affairs. It wasn’t long before the hospital contacted her."

Kate: "He told me his name, said he was a social worker and said I had to sell my auntie’s house because she needed to go into a home, and as I had power of attorney, I would have to do that on her behalf."

White: "And what was your reaction to this call?"

Kate: "Well I was shocked, I was totally dumbfounded really. I asked him to repeat who he was because I thought I wasn’t really hearing what I was hearing."

White: "From that point on this house, her aunt’s home in Sidcup, was under threat of being sold to pay for her care. All over the country houses have had to be sold because someone has a serious illness."

Hilary:" I go twice a week to see him and Saturday he seemed okay, just the normal, just very quiet. But yesterday he seemed very poorly."

White: "William Hancock is 91 and terminally ill with bone and prostate cancer. He’s from Cambridge, both of his daughters live there too and before he was diagnosed Hilary had nursed him at home for 4 years. Now he’s too ill for that."

Janice: "Who’s that ? [showing photographs to William]"

William:" It could be me. [laughter]"

White: "William Hancock was an electrical engineer. He was married for over 60 years. He nursed his wife, who had Alzheimer’s for the last five years of her life at home."

William:" [from hospital bed] I’d like to be able to get out and run."

Janice: "Would you? Ohh… those legs won’t work."

White: "The NHS, under pressure to cut waiting lists, wants beds freed up fast. They want William Hancock out and into a private nursing home where he’ll have to pay hundreds of pounds a week for his own care."

Hilary Elcock: "They’re saying he’s a bed blocker. They want the bed because there’s nothing more they can do for him."

White: "Janice, you say they’re saying he’s a bed blocker."

Janice Turton: "I was told that when I was having a conversation with one of the nursing staff there and they said to me that: "he’s blocking the bed, we have other people wanting to come here." I thought it was appalling. I thought the NHS looked after you when you were terminally ill. I had no idea they didn’t. It’s been a huge shock to me to find this out."

White: "It’s an NHS they’ve never known before. Because the National health Service want him to go to a nursing home the sister’s had to put their father’s house, their family home, up for sale".

White went on to say that the BBC had specially commissioned research on homes sold for care and:

"Panorama’s researches show that the NHS had been denying seriously ill people the free health care to which they’re entitled, and as a result thousands of people have unlawfully been forced to sell their homes. It wasn’t meant to be like this. Tony Blair said he didn’t want children to grow up in a country like that".

The programme quoted Tony Blair in an address to the labour Party Conference in 1997 as saying:

"I don’t want them brought up in a country where the only way pensioners can get long-term care is by selling their home".

Nonetheless said Panorama:

"But under this government, house sales to pay for the care of the long-term sick have continued. A modest bungalow in Essex, sold for £59,000. A terraced family home in Lancashire sold for £42,000. A former council house in West Yorkshire, sold for £51,000. Whether people can properly be forced to pay for nursing home care depends on where the line is drawn between health care, which the NHS must provide free, and what’s called social care. Local authorities provide that and it’s means tested. And the legal test for where this line still ought to drawn comes down to a young art teacher who set off to school one day in 1971".

Moving through a number of cases including Pam Coughlan’s case itself, Panorama demonstrated that, far from clarifying or easing the burden of qualification for NHS funded Continuing Care, the government’s response to the Coughlan ruling was to further complicate the decision making progress and, if anything, draw the line above which qualification would be achieved higher than the Court of Appeal ruled should be the case.

A particular highlight of the programme was Pam Coughlan herself appearing to say that, under the new guidelines, even she would not now qualify for free nursing care despite the fact that she was the subject of the initial test case!

One thing that came across loud and clear was that, even the professionals in the field who are supposed to be operating the system and carrying out the Continuing Care assessments do not understand it and that is a point that may well have been made by the Judge in Grogan the most recent case on the continuing care issue. Many guidelines developed by NHS Trusts following Coughlan simply fail properly to do what they are intended to do: guide.

All in all the government came out of the programme badly. Their corner was "defended" by Liam Byrne MP, Health Minister. He essentially sought to place the blame for the Grogan situation upon the local NHS Trust whose application of guidelines was criticised and to distance the government from being in the losing corner, a tactic that was fairly transparent and less than successful. NHS Trust guidelines are drafted on the basis of central government guidance and the government has had more than enough time since Coughlan in 1999 to ensure they were lawful.