Sick woman must pay for long-term care: Nicholas Timmins reports on a dispute over who should pay for a patient's continuing care

A 62-year-old woman suffering from a rare incurable brain disease and the effects of a stroke is having to pay for her own nursing care in Leeds at a cost of about pounds 1,000 a month.

Jean Gittins is doubly incontinent, unable to walk, feed or dress herself, and needs 24-hour nursing care. She was discharged from St James's Hospital in December to a private nursing home where her savings of pounds 15,000 are being docked down to pounds 8,000 for the first 24 weeks of her care. Her husband Fred is now set to face his own financial assessment to see if he should contribute towards the cost.

The case has come to light as Leeds Healthcare, which was fiercely criticised by the Ombudsman three months ago for its failure to provide long-term care to a profoundly brain-damaged man, has yet to complete the review of its policy that was promised when the Ombudsman found against it.

Three other cases all pre-dating the Ombudsman's ruling have been forwarded to the authority by the local Community Health Council, but Leeds Healthcare has yet to decide whether it will pay the nursing home fees for Mrs Gittins and the other cases.

Health ministers have repeatedly said that there is 'a clear obligation on health authorities to pay for continuing health care of seriously ill patients'.

Mr Gittins, whose wife's case is featured on BBC 2's Public Eye tonight, said yesterday she had gone into hospital in July 1993 for a brain biopsy needed to diagnose her condition. After the operation she had a brain haemorrhage, followed by memory loss, double incontinence, chest and urine infections. 'They decided there was nothing else they could do for her and that they wanted her bed. They were pressurising me to get her out and into a private nursing home.' He was handed a financial assessment form by social workers and told his wife would have to pay the fees for the first 24 weeks because she had pounds 15,000 in savings. 'This was money she had worked for and saved, and had already willed for the grandchildren,' Mr Gittins said.

'But they said she wasn't dead, so the money was hers.'

In fact his wife was briefly discharged home where Mr Gittins tore his shoulder attempting to shift her 11-stone weight before his GP insisted she be readmitted to St James's. Several weeks later she was discharged to the nursing home. Mr Gittins said: 'I feel that the NHS should have picked up the tab from the word go.'

His wife's case, he said, was 'not identical to the one the Ombudsman criticised the health authority for, but it is similar to it.

'There was pressure put on me to move her out of hospital and there appears to be nowhere in Leeds for the longer-term care on the NHS of brain-damaged patients. They have closed all the facilities down.' Jean Townsend, secretary of the Leeds Community Health Council, said the health authority had sent a holding letter saying it could not take a decision yet on Mrs Gittins's case because of the complexity of the issues. Effective national guidance was desperately needed, she said, for the sake of staff who were faced with the task of telling patients that they had to leave hospital, as well as for patients. 'At the moment, different health authorities interpret things differently.'

Leeds Healthcare said: 'We must emphasise that this is a national issue and we are taking advice from the NHS Executive and exploring other district health authorities' policies across the country.' It could not yet say how many cases it would have to provide for, 'or what services will be necessary to care for them. However, once the review has been completed, appropriate contracts will be placed for the provision of these services.'

The authority told the Ombudsman last year that if it had to pay nursing home fees 'it would soon become financially overstretched'. The National Association of Health Authorities warned then that an insistence that the NHS pay for continuing health care could prove 'a financial time- bomb' for the Government.

Leading article, page 17

(Photographs omitted)

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