Daily Telegraph: “NHS officials selling care grant advice”

Daily Telegraph: “NHS officials selling care grant advice”

People Discussing Important MattersOn the front page of the Daily Telegraph on Monday, 30 December 2019, there was an article entitled, “NHS workers charge for advice on securing dementia care cash.”

Undercover reporters from the Daily Telegraph revealed that two senior health managers, Mr Ogunseye and Mr Aldridge, were working simultaneously as private consultants alongside their NHS roles – offering to help desperate families through the complex and confusing NHS funding system in return for a cash payment for their private consultancy services.

NHS Continuing Healthcare Funding (‘CHC’) is a fully-funded package of free care paid by the NHS for an individual’s healthcare needs, including accommodation, regardless of where the care takes place (eg in their own home or in a care/nursing home) and irrespective of wealth (i.e. is not means-tested).

The bar to achieving CHC Funding is set very high, and with toughening austerity measures, it is becoming more difficult to achieve as the NHS tightens its belt. Despite an ageing population, the number of people being awarded CHC Funding has reportedly declined since 2015. Families also face a ‘postcode lottery’, where Clinical Commissioning Groups in some areas of the country are known to be more inclined to grant CHC Funding than others.

We know from experience, and from what our readers have contributed to the Care To Be Different website over many years, that families face an uphill battle when trying to fight the NHS to secure CHC Funding for their relative. One of our contributors, retired Admiral Philip Mathias, who worked as a policy director on Britain’s nuclear deterrent, told the Daily Telegraph in an article on 28th February 2019: “In terms of complexity, the mental capacity required and the analysis skills needed, applying for CHC funding was as complex as some of the nuclear deterrent policy I worked on.”

The Daily Telegraph’s “cash for advice exposé”, highlighted the fact that this is a complex area where families often require help. An individual who has saved all their life and paid their taxes, can be refused CHC Funding and at the point in their life when they most need help from the NHS. It is estimated that millions of people over the years have been forced to sell their home or use up hard-earned savings to pay for their own care. It is enshrined in our heritage and in the National Framework For NHS Continuing Healthcare Funding and NHS–funded Nursing Care, that NHS care should be free at the point of need, from cradle to grave. So why has it become so difficult to obtain this entitlement to free care?

The crux of the Daily Telegraph article is that these two managers, Ogunseye and Aldridge, working for two different Clinical Commissioning Groups, were in senior positions of responsibility. They were being paid by the NHS to administer and oversee applications/assessments for NHS Continuing Healthcare Funding. Yet at the same time, according to the Daily Telegraph, they were offering private consultancy services, advising families how to navigate through the “labyrinthine rules” of the CHC Funding system. The selling point was that, although they could not guarantee success, they had inside knowledge and expertise on how to effectively ‘play’ the complex NHS system and secure CHC Funding – reportedly worth up to £100,000 a year.

Mr Ogunseye apparently told the reporter, “I mean, I am working this job, so I know where to look, and where not to look.”

The Daily Telegraph reported that, “This newspaper was alerted to the issue by the real family of the man whose claim had been rejected for CHC funding. They noticed that one of those working for the CCG which had rejected their application – Mr Ogunseye – was also advertising his services on Facebook to help people secure the very same grant. In other words, for a fee he would use what he knew to help them access the money his department had just denied them.”

If true, it is a clear conflict of interest – acting against the same CCG who employed him to refuse the application for CHC Funding!

Mr Aldridge told the Telegraph’s undercover reporters, “The cost of care is astronomical. Kids are looking at their inheritance going down… I can be in a meeting and I can support you, and I can argue [with] what they’re saying, so you know, around the CHC process.”

Mr Aldridge told the undercover reporters that he could not help families who are based in the area covered by his day job, but if people were based elsewhere he felt there was no conflict of interest.

Mr Aldridge is reported to have told The Daily Telegraph that, as an independent consultant, he would make a “recommendation” about whether funding should be approved and that his report would have ‘weight’ coming from him, and as such, the assessors would be more likely to look at it more favourably.

Nevertheless, in our opinion, he is still conflicted, as he is using knowledge gained from his employment with the NHS to help families seek funding from those budgets he is supposed to ‘protect’.

Don’t fight this battle alone – your entitlement to advocacy support

It doesn’t seem appropriate for NHS officials to be acting in a dual capacity – as NHS assessors and budget ‘gatekeepers’ – and at the same time using inside knowledge as private consultants to help individuals circumvent the CHC system. However, the National Framework (and Practice Guidance Notes) permit advocacy support. Here are some key references that will assist you, if the CCG’s assessors tell you that you can’t have an advocate to support you at an assessment for CHC Funding or an appeal:

PG 4 What are the key elements of a ‘person-centred’ approach in NHS Continuing Healthcare?

The provision of advocacy, where appropriate, is an important means of achieving meaningful participation (refer to Practice Guidance note 9 and 57 below). `All reasonable efforts should be made to involve the individual and/or their representative in the assessment process.

PG 20 What is the role of the NHS Continuing Healthcare coordinator(s)?

  • supporting the person (and those who may be representing them) to play a full role in the eligibility consideration process, including ensuring that they understand the process, they have access to advocacy or other support where required, and organising the overall process in a manner that maximises their ability to participate.

PG 57 Whose responsibility is it to provide advocacy for individuals going through the eligibility decision-making process?

57.1 Any individual is entitled to nominate a person to represent their views or speak on their behalf and this could be a family member, friend or peer, a local advocacy service or someone independent who is willing to undertake an advocacy role. It is not appropriate for either a local authority or NHS member of staff to act as a formal advocate in this sense as there could be a conflict of interest, although staff should always seek to explain the individual’s views alongside their own. Local authorities and CCGs may have varying arrangements to fund advocacy services in their locality, some being jointly funded whereas others are funded by a single agency or rely on voluntary contributions. 

PG 58 Do individuals need to have legal representation during the NHS Continuing Healthcare eligibility process?

 58.1 No, although individuals are free to choose whether they wish to have an advocate present, and to choose who this advocate is. This National Framework (supported by Standing Rules Regulations and Care Act 2014 Regulations) sets out a national system for determining eligibility for NHS Continuing Healthcare. The eligibility process is focused around assessing an individual’s needs in the context of the National Framework rather than being a legal or adversarial process.

58.2 If the individual chooses to have a legally qualified person to act as their advocate, that person would be acting with the same status as any other advocate nominated by the individual concerned.

Conclusion

If the CHC assessment process was fair and robust, and assessments were uniformly undertaken throughout the country in a consistent and transparent manner, with individuals being granted CHC Funding at the outset when they were clearly eligible – instead of being wrongly turned down and forced to endure the stress of a lengthy appeal process (and having to fund their relative’s care in the meantime!) – then there would be no need for such consultancy services!

But most families are overwhelmed by the whole CHC eligibility process and need help to navigate their way through the National Framework and in order to give their relative the best chance of securing free CHC Funding. The stakes are high and a successful application could save your relative from having to sell their home or pay many thousands of pounds per annum in expensive care home fees.

If you need personalised specialist help, visit our one-to-one page for more information.

6 Comments

  1. Jenny 3 weeks ago

    Thanks for your concern, and I’m glad you’re recovering. I’m out the other side thanks. I eventually secured CHC for relative during their lifetime, and recovered unassessed periods of care plus expenses retrospectively. I never ventured into the IRP or appeals process – it seems a quick route to madness.
    I secured CHC and a Review alone, but it’s essential to be very well prepared and informed. The book and this site were invaluable. I had help with the retrospective case from a specialist who was recommended on this site years ago. She helped me with process, specialist areas of law and drafting, and she was an immense source of informed support. I have a background in law and a tenacious nature. It’s difficult to imagine how anyone can get through the whole process this alone.
    I continue to post my experiences in the hope that unlawful and unfair practices are exposed, and that others are forewarned of them.
    I’m glad to be out of it, but happy to help where I can.

  2. pauline hardinges 3 weeks ago

    I wish THE TRIANGLE OF CARE was taken up by every GP surgery care home and hospital in the country. If someone with dementia or anyone without capacity would benefit if the professionals took this on board.

  3. Michelle Wetherall 1 month ago

    This doesn’t surprise me in the least. This is bigger than a conflict of interest.
    They are abusing their positions of authority as CHC Managers to acquire money for personal gain! This is dishonesty!
    Is there a case of corruption/fraud?
    To be employed by the very same CCG that has denied eligibility and then be privately paid to advise on how
    to overturn that decision is not only immoral but surely a criminal offence? I would be looking at how many cases they have been involved in, where decisions have been overturned. Would love to scrutinize their bank accounts!
    These two should hold their heads in shame!
    For those of us who have spent years fighting for CHC and for those now embroiled in the appeal process, it just goes to prove that this process is not only flawed but administered by unscrupulous individuals who don’t give a damn about the patient or their relatives, but are purely interested in profiting from the misery of others.
    There has to be a thorough investigation into both individuals and the CCG’s they work for.

    • Jenny 1 month ago

      Shocking, but not surprising. A great opportunity for The Telegraph to do a follow up article and campaign to enlighten their readers about CHC. The Mail’s campaign was confused and confusing; it conflated social care with Health Needs and focused on those who deserved CHC because they fought in the war – entirely useless and lazy research and reporting.
      At the start of my relative’s case, around 9 years ago, we tried for CHC in the area in which he was then based. It was a then PCT that has often been mentioned on this site. A former senior nurse employed by that PCT advertised as a CHC advocate and had a website explaining his many successes based on his work based knowledge. Imagine our surprise when, at the third attempt to convene a lawful MDT (because we’d stopped or complained about previous ones due to blatant breaches of process) he appeared as the lead assessor. The PCT had hired him in to lead a “crack team” for the occasion. He decided I had no right (as appointed Attorney) to see a psych report marked “For patient and not for third parties” although he read it and shared it with his colleagues, declined to explain process, dismissed us whilst they discussed scoring recommendations made on evidence presented, and then failed to ensure the rationale was sent to us upon refusal.

      • Michelle Wetherall 3 weeks ago

        Hi Jenny,
        Your comments are very interesting and I can see that you have spent years researching and following matters concerning NHS CHC. I have now come to the end of this stressful process, having secured a full refund of my late father’s nursing home fees, following an IRP that found our case to be Unsatisfactory and Unsound.
        I have spent the best part of the last four years fighting for justice and like you many hours researching, reading and appealing decisions.
        I’ve picked up on the fact that your relative’s case was over 9 years ago?
        I’m left wondering if your case is still on going or concluded and if so how?
        9 years is a very long time! And yet you are still contributing advice/ help to this forum – thank you! Is this because you feel compelled to continue to help others navigate this process or because you are still embroiled in an appeal?
        Now that I am at the end of this nightmare, it is difficult to move on. On one hand I don’t want all my knowledge to be wasted, yet I know that it’s not healthy for me to be constantly talking,reading and researching all about NHS CHC.
        What I’m trying to say, is that the impact of fighting for CHC can and does overwhelms relatives lives.
        The media is awash with mental health issues, particularly with the royal family endorsing so many mental health charities, yet it is NHS CHC/CCG’s that are actively contributing to the harmful stress that patients and families are faced with during the process. As I reflect on what happened in my case, I know that I neglected my own well being and health in pursuit of justice for my father and success with CHC.
        There was no support from CHC/CCG only barriers and deadlines. I can not help but think of others that are experiencing what I have just gone through.
        I am left with a very unique set of circumstances as I struggle to make sense of the last four years.
        The loss of my father, my unexpected cardiac arrest during the appeal process and the euphoria of a successful outcome from IRP. A simple google of my name and Nottingham will tell you my story in Sept 2017.
        Jenny, I guess what I’m saying is that whilst i have contributed to this forum and tried to empower others to “fight on” without specialist help, it comes at a cost emotionally. I’m not promoting in anyway that families should seek specialist help but there is a part of me, that is now beginning to realize just how much my own health has suffered. The NHS saved me, for which I will be eternally grateful, but on the other hand did they contribute to the stress that brought me to cardiac arrest. I will never know!

        • Jenny 3 weeks ago

          Thanks for your concern, and I’m glad you’re recovering. I’m out the other side thanks. I eventually secured CHC for relative during their lifetime, and recovered unassessed periods of care plus expenses retrospectively. I never ventured into the IRP or appeals process – it seems a quick route to madness.
          I secured CHC and a Review alone, but it’s essential to be very well prepared and informed. The book and this site were invaluable. I had help with the retrospective case from a specialist who was recommended on this site years ago. She helped me with process, specialist areas of law and drafting, and she was an immense source of informed support. I have a background in law and a tenacious nature. It’s difficult to imagine how anyone can get through the whole process this alone.
          I continue to post my experiences in the hope that unlawful and unfair practices are exposed, and that others are forewarned of them.
          I’m glad to be out of it, but happy to help where I can.

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