On The Edge TV interview with Angela Sherman, founder of Care To be Different
In this clip, Angela Sherman talks about the NHS failing to carry out proper health needs assessments, how legal test cases for NHS Continuing Healthcare are ignored and how vital it is that elderly people have someone to fight for them. The interview was recorded before her parents died.
Duration: 00:09:56. Watch it here. [TV clip © Edge Media]
… or read the transcript below:
TC = Theo Chalmers (interviewer), On The Edge
AS = Angela Sherman, founder, Care To Be Different
SS = Simon Stone, lawyer, Kingsley David Solicitors
TC: So, just a round up on your mother, then we will move on to your father. So your mother had her victory, they paid some of the money back. Have you received that?
AS: I received that money. It took another three or four months to get the money.
TC: Did they pay you interest on it?
AS: They did pay interest on it. I also claimed for physiotherapy fees for my mother because physiotherapy is essential because her joints and her limbs are quite contracted. It took quite a long time – it took about another six or seven months to actually get the physio fees back, but I got them.
TC: So you have got the bit between your teeth now Angela, you have seen the glint of victory here, so let’s talk about your father. What was his situation?
AS: Well he had actually been in the care home for two years before I kind of thought actually his needs are getting quite serious.
TC: So he had had Parkinson’s for a long time and what other needs did he have?
AS: He was developing Parkinson’s dementia.
TC: It that a kind of dementia?
AS: It’s a different kind, but it’s essential dementia.
TC: Did he know you and that sort of thing?
AS: Yes, he still knew me. He needed more care than my mother because he had the more typical Parkinson’s systems – he was very shaky, very unsteady. He had a lot of very bad falls. He needed more care, more looking after, and the care home manager had told me he needed more care. I started to question why isn’t he being funded? Why is he still paying for himself? Then I discovered no assessments, at all, had been done on him.
TC: Didn’t you think to ask, when you were fighting for your mother who I suppose had a more obvious clinical need than you father to start with at least, did it not occur to you to ask for an assessment for your father?
AS: Actually, it didn’t. Because my father was better than my mother in that sense, I kind of left that… I knew I could come back to it if I wanted to. But the case for my mother took so much energy, so much time, I needed to focus on that at the time and then I moved on to my Dad.
TC: So, tell us about that then.
AS: So, when I realised he hadn’t actually been assessed at all, I wrote to the NHS and said what’s happening, what’s going on, why isn’t he being assessed? Could you send me any information on assessments that he has had. And he hadn’t had any.
TC: Is this the strategy then of the NHS because the longer they delay an assessment, there can be no decision about them paying, while he is un-assessed?
AS: Yes, that’s right, but I suspect if they had assessed him they would have found him ineligible. It would have been a formality.
TC: Because that was their policy or because he was ineligible?
AS: Because very few people win funding and his needs at the time were very much like a lot of other people in care homes – and they are deemed as social needs.
TC: So it seems to me – let’s talk about your mother again for a second – that if you hadn’t fought as hard as you did fight for your mother, she would still be paying.
TC: So if elderly people are in homes and they don’t have a son or a daughter fighting for them, there is no-one that’s going to volunteer.
AS: They have no chance.
TC: The care home doesn’t appoint a sort of champion for them?
AS: Care homes are supposed to flag up when somebody needs nursing care and they are supposed to flag up when the condition changes, but very often that doesn’t happen and its either because the care home just doesn’t have time or because the care home might be concerned that it won’t get paid one way or the other –
TC: Because it has to have a good relationship with the NHS?
AS: Yes, there is that need to have that relationship, or it could be that the care home staff are simply not aware that they need to flag it up.
TC: Poor training?
AS: Yes, or just not aware that there is a link there, so if you are in a care home and have no family, you are lost really.
TC: That’s incredibly sad.
AS: Incredibly sad, if you have no-one to fight for you, no-one else if going to do it.
TC: Obviously if you have dementia, you simply can’t do it for yourself.
AS: And you wouldn’t be aware of what is happening.
TC: So they take your money and they run.
AS: In a way.
TC: So, your father…
AS: Yes, so I asked for an assessment to be done. At that same time the government introduced a new procedure for assessments. There had been so many complaints that the Ombudsman had directed that a new procedure should be in place.
SS: Yes, it was as a result of that case, Coughlan and another one called Grogan – that was again a very important case. Maureen Grogan was a lady who suffered from multiple sclerosis. She had skin oedema problems and a whole host of other issues.
TC: Skin oedema – what’s that? A blood clot?
SS: It’s where the skin can break out into ulcers and she was a very poorly lady, again as with Pamela Coughlan, and yet again it had to be fought through the NHS systems and this one went up to the High Court, and again the High Court said yes this is right and it said to the health authority this is wrong, your interpretation of the guidelines here is wrong. But to be fair, the guidelines were all over the place. There needed to be some form of pulling together and as a result this National Framework came into being. The Ombudsman had criticised things, the judges had criticised it previously and there was a need for this National Framework. So this National Framework now says: this is how we go about assessing people’s needs. There is an initial assessment to establish whether there ought to be a further assessment, a sort of weeding out process. And if a further assessment is necessary then a nurse, doctor or other health care employee who is qualified and able to do this is meant to take this forward with these medical specialist needs. At least two of them have to do this.
TC: So the High Court has rapped the knuckles of the NHS, but it hasn’t had any effect has it?
SS: Well it has had some effect. It has tidied up a lot of what was going on, I am sure, but there is still the issue of interpretation of what these guidelines should be, and then a person’s [NHS employee] understanding of assessing this person against these needs and ‘where do I draw the line’ – and I believe that’s where we have the fundamental problems. Either because these people aren’t trained well enough, they are too busy and therefore making quick judgements – or there is a pressure on them to say make sure you are going to go down the right side of the fence here.
TC: I have got one NHS insider here who has texted before, Linda in Birmingham, and she says: “The whole system is the problem. This is why they [care homes] were privatised and people could make money out of elderly people. The NHS will do anything to get out of paying and well done for winning.” So it’s a bit like granny farming, these people open these centres [care homes] and they have to find the low hanging fruit with regard to being paid, if they can get the money off the patients…
AS: If they get money for fees from somebody who is paying for themselves, they get more money.
TC: So they get more money. So they have to give a discount to the NHS, well no wonder the assessments all go in favour of the NHS because… Is that actually the case? You know that as a fact?
AS: If somebody is being funded by Social Services, and I know this from when I had the emergency funding… Social Services paid the home less than we were paying.
TC: Were they getting a sort of bulk buy discount?
AS: Yes, they block booked the rooms, the beds, but I did notice that when we had then to pay everything back and start paying again after we had been able to sell the house, the fees were higher than the ones that Social Services had been paying.
TC: So the money that you paid back was the block booking rate wasn’t it?
AS: Yes, I paid that back at the block booking rate but then our subsequent fees that we were still paying for Dad were at the higher rate.
TC: Well we are getting ahead of ourselves again here aren’t we? So let’s quickly talk about your father, so you wrote to the NHS and you said he hasn’t been assessed.
AS: So they did an assessment and, as Simon was saying, it was the initial ‘filtering out’ or ‘filtering in’ assessment. [This filtering process is now done with a process known as ‘The Checklist’]
TC: Were you at this assessment this time?
AS: I was at the assessment.
TC: And were you able to bring in his medical records?
AS: Yes, the same process as before. They hadn’t considered all the things that were important. They hadn’t spoken to his neurologist, they hadn’t spoken to a GP, they hadn’t spoken to the psychiatrist that he had been seeing. All these physicians that you would think would be important had not been consulted and had not inputted into the assessment.
TC: Forgive me for asking but why was he seeing the psychiatrist?
AS: He was seeing the psychiatrist because his mental health was deteriorating.
TC: And he was making an assessment of that was he, the psychiatrist?
AS: Yes, so all these things need to come into the pot, but they weren’t. So, the filtering process took place and then the NHS decided rightly, in my view, that he needed another proper assessment. It’s a very long process. That then went to an internal PCT panel, at the local Primary Care Trust, and that came back to say ‘no’, not eligible.