Sick face years 
waiting for NHS 
to settle payouts

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major difficulties faced by claimants in accessing funding for continuing healthcare have prompted significant criticism of variations in eligibility bound up in a highly-bureaucratic process.

One case in South Yorkshire involving a patient who contracted gangrene took more than five years to resolve.

The unnamed woman from Rotherham was admitted to a nursing home in November 1999 after fracturing her hip in a fall. She also suffered from dementia and other health problems until her death in September 2005.

A friend applied on her behalf for NHS funding in April 2003. Officials at the former Rotherham Primary Care Trust (PCT) concluded she was not eligible from November 1999 to August 2004 but did qualify after that as her condition had become more complex. An appeal against the decision failed and following the health ombudsman’s intervention health chiefs again ruled against her case.

Following another complaint, the ombudsman concluded in May 2008 that no evidence of her healthcare needs had been provided between 2000 and 2002 and other significant events, including the onset of gangrene, had not been considered.

It ruled the review process by the PCT was flawed and that the PCT and the health authority had not acted fairly.