44. I turn now to the actions of the PCT who took over the responsibility for continuing care cases in April 2002. They also took over the Health Authority’s eligibility criteria. Mrs Pointon had complained in January 2002 to the Health Authority about their decision not to fund an extra carer every five weeks to maintain the pattern of respite care. She had also complained to this Office. The incoming PCT agreed with Mrs Pointon that a further assessment of her husband’s condition should be carried out on 15 April. It was completed by a member of the District Nursing Team and was headed ‘Health Needs Assessment’. Once again this assessment followed the pattern of assessing purely physical and nursing needs against very specific criteria (paragraphs 17 and 18) that it would be very difficult to provide in the home setting. The Consultant Psychiatrist was consulted by the Manager, but once again was asked very specific questions about the type and frequency of professional input that Mr Pointon needed at that time and gave no recognition, either to Mr Pointon’s psychological needs, or to the unusually high standard of care that Mrs Pointon and her team were providing.

45. The Assessor criticised the range of this assessment and confirmed that the questioning rendered funding for respite care at home practically impossible. The PCT and Social Services decided that Mr Pointon’s health needs were being met, that the respite care was purely social and refused funding in May.

46. In subsequent discussions the clinicians and the nurses agreed that Mrs Pointon was giving highly personalised care with a high level of skill. This was later described by the independent Consultant as nursing care equal if not superior to that that Mr Pointon would receive in a dementia ward.

47. In September 2002 the independent Consultant commissioned by Mrs Pointon, produced a report which confirmed that Mr Pointon’s symptoms stemmed solely from a health condition that was severe, complex and unpredictable, needing 24-hour care and frequent interventions to prevent him harming himself. After the Consultant Psychiatrist and the Consultant Geriatrician had confirmed the independent Consultant’s opinion that Mr Pointon did meet the eligibility criteria for NHS continuing care, a package of care was agreed with Social Services whereby the NHS would fund the cost of an additional carer every fifth week. The PCT have explained that they can only make Direct Payments within a package of payments with Social Services. However, they have also agreed that should Mr Pointon require in-patient care at a future date, then he would be admitted to an in-patient facility agreed by Mrs Pointon. It is sad to reflect that this solution is the one that Mrs Pointon suggested in January 2002. Whilst I am pleased that agreement was reached eventually, I agree with the Assessor’s opinion that the PCT assessed Mr Pointon against the wrong criteria, once again focusing on physical needs and also failing to recognise that the standard of care provided by Mrs Pointon was equal to that that a nurse could provide. I uphold the complaint.

48. In May 2003 in the light of the Ombudsman’s report (paragraph 14), the Department of Health issued guidance to Strategic Health Authorities and PCTs on the procedure to use when reviewing continuing care cases dating back to April 1996. It is my opinion that they should also review the eligibility criteria to ensure that the criteria for funding care at home, and the recognition of patients’ psychological as well as physical needs, are clearly defined. While I am aware that the continuity of her husband’s care is one of Mrs Pointon’s main concerns, I recommend that the PCT discuss with Mrs Pointon, in the light of the Department of Health guidance, the provision of Mr Pointon’s current funding, and determine whether any retrospective payments are indicated.