04 November 2005
Trusts are passing their responsibility for free health care to means-testing social services departments
Cutbacks in primary care trusts are leading to patients being charged for health care that is free in other areas, Public Finance has learnt.
The director of adult and community services at Wiltshire County Council,
Ray Jones, told PF that his local PCT was redefining what counts as a 'health care' need to make urgent savings. It is doing so by passing responsibility for paying for the care of people with long-term medical conditions on to the social services department, whose services are means-tested.
'There is a narrowing definition of what is an NHS responsibility,' said Jones. He cited the example of brain injury patients: 'Cases are now being reviewed by the PCT with the intention of making savings by taking the view that there is no longer a continuing health care responsibility.'
Jones said the situation had arisen as a result of the £13.8m cut West Wiltshire PCT has had to make this year to fund its historical deficit. The money is being saved by closing two community hospitals.
'Community hospitals, wards and beds are being closed, so we find ourselves [in social services] needing to provide more intensive home care services. Because we means-test for people's ability to pay, if someone is assessed as needing to make a contribution, then we charge them a proportion of the cost.'
Wiltshire County Council leader Jane Scott has written to Health Secretary Patricia Hewitt expressing 'grave concerns' about the situation. 'The PCTS are withdrawing services without any measures to deal with the resulting gap in provision,' writes Scott. 'The demand for intensive home care services is increasing, with home carers undertaking tasks that would have been undertaken by the NHS (eg, supervision of medication).'
A spokeswoman for West Wiltshire PCT said: 'Many hospital services in Wiltshire are out of date and no longer fit to provide modern, high quality services. We have been working closely with the community to explore how services may be provided in the future.' She declined to respond directly to the suggestion that the trust was redefining care to save money.
In 2003, the parliamentary and health service ombudsman drew attention to a postcode lottery of local interpretations of the definitions of free NHS 'continuing health care' needs and means-tested 'social care' needs. Charities campaigning on behalf of older and disabled people say that lottery continues and the situation seems to be worsening.
PF has been told of six other councils whose PCTs are shifting their definitions of health care to save money.
Dr Peter Skolar, chair of Oxfordshire County Council's joint health overview and scrutiny committee, told PF that his local PCTs and hospital trusts had a £34m deficit and appeared to be addressing the problem in a similar way to Wiltshire. 'They are moving the goal posts,' he said.
Skolar said that Oxfordshire social services had been presented with a fait accompli to provide care for patients whose hospital beds had been closed. He said such patients were faced with a 'double whammy' as not only were they being moved into inappropriate care homes, but many were now also being charged.
A Department of Health spokeswoman said: 'PCTs should not refuse to provide services where the refusal means that councils have to exceed their powers and provide health care. If councils suspect this is happening, they should be raising it with the PCT concerned. We expect PCTs and councils to work together to ensure that the care needs of their local population are met.'
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