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NHS officials are working as private consultants and charging frail pensioners’ relatives for help securing funding from the state, a Telegraph investigation has found.
The senior managers, who are paid by the health service to oversee applications for the funding, are charging the vulnerable up to £400 a day for help trying to obtain such grants.
One health official said that after using her private services a family had been awarded an NHS grant worth “thousands and thousands and thousands, like two years’ worth of nursing home fees”.
Another was running the risk of an apparent conflict of interest, offering to secure funding for services in the area where he worked.
Under national rules, any patient with a significant health problem - such as dementia or Parkinson's - should have their care and nursing fees paid in full, if the condition is deemed to be the main reason they need help.
If the NHS decides that help is required simply because someone is frail or elderly, this falls under social care, which is means-tested.
But families and campaigners say the system is unfair - as well as overly complex - with increasing numbers being denied the funds, leaving them facing bills of up to £100,000 a year.
In the last five years, average eligibility per 50,000 population for the funding has fallen by nearly 15 per cent - from 69.33 per 50,000 in 2014/15 to 59.53 in the second quarter of 19/20.
Undercover reporters - posing as relatives of a man with dementia and Parkinson’s - secretly recorded meetings with three NHS officials offering to help them get funding for care.
All the officials claimed to have a high success rate for their clients, securing funds under the system called Continuing Health Care.
The disclosure will fuel concerns that a two-tier system is in operation, with those who can pay for private advice securing an advantage over those who cannot.
Last night, Grace Ioppolo, who has been battling to get her husband’s nursing fees covered by CHC funding for two years, said that she thought it was “outrageous” that NHS officials were working as private consultants for families trying to secure the grants. Her husband, Dr Peter Beal, was diagnosed with Alzheimer's in 2013.
“I don’t think it’s appropriate”, she said. “The system is deliberately confusing and not transparent”.
“If you can pay these people for extra help it is discriminatory. Just because you’ve got money, it shouldn’t give you a better chance to appeal or to get access to funding”.
Rear Admiral Philip Mathias, who spent four years fighting for CHC funding for his elderly mother before finally obtaining it two hours after she died, said he thought it was a “massive conflict of interest” for the officials to be working as private consultants.
“To be offering consultancy work, which they're paid for, whilst they're on the inside track of the CHC process, working in one or another capacity with the NHS, I think stinks”, he said.
He said that if one of the officials was willing to help a family whose relative was based in the same area as where the NHS manager worked, it was "horrendous".
Undercover reporters met several NHS officials who said they worked with families as private consultants to secure CHC funding.
Farouq Ogunseye, who is a project lead for Herefordshire Clinical Commissioning Group, was first approached by an undercover reporter last year, when he was working for Worcestershire CCG.
A CCG is an NHS body which commissions and pays for health services in a geographical area.
The reporter was responding to an advert Mr Ogunseye had placed on his Facebook page offering help for families trying to secure CHC.
After being told that the reporter’s elderly male relative was in Kidderminster in Worcestershire, Mr Ogunseye indicated that he might be able to help and said that he charged £300-a-day.
He later met with two undercover reporters posing as relatives of the man in the nursing home. By this time, he was working for Herefordshire CCG, which is now merging with three Worcestershire CCGs.
“CHC is massive, and there is a lot of people, there’s not a lot of information out there”, he said at the meeting in August.
When asked about his success rate, he said he was able to secure funding for about 40 percent of the cases he worked on and he was handling up to “10 or 11 a month”.
A second consultant, Dean Aldridge, who works for Waltham Forest CCG overseeing quality control on its CHC funding, said that the system was extremely confusing for families who wanted to apply for financial support.
“The education’s so bad the leaflet you get given is crap”, he told the undercover reporters.
Mr Aldridge, who said he charges £400 up to a day to attend meetings with families when their CHC application is being reviewed, said that if the family wanted to appeal the decision to reject the elderly relative for CHC funding, it could be “supported” by him.
As an independent CHC consultant, he would make a “recommendation” about whether their grandfather should be approved. Once the report was submitted, he said that it would have ‘weight’ coming from him, and the assessors would be ‘more likely to look at it and think “oh hold on a minute”. He said that in about a third of the cases he handled he was able to overturn rejections for funding.
A third consultant overseeing CHC applications for two CCGs in the north of England, said that in previous cases she had worked on she had been able to “overturn” some of the levels recorded in the documentation, which meant that an individual’s need went from “moderate to high….from high to severe”.
As a private consultant she charges £300 to assess the needs of the person in the care home and a further £200 to attend meetings. She said that because of her experience, when she attends meetings, “it makes them sit up and listen a bit more”.
She said that she had recently helped one family in the north of England win funding totalling “thousands and thousands and thousands of pounds, like two years’ worth of nursing home fees”.
It is understood that the three officials work for the NHS as contractors.
When confronted Mr Ogunseye insisted that he would not have carried out any work for the undercover reporters’ relative due to the conflict of interest. He said that his claim to have handled up to 11 private clients a month was ‘incorrect’ and that, despite advertising his services, he had never actually done any such work although he hoped to in the future. He said he had only worked for the CCGs as a contractor, not an employee and when he had met the reporters in August, he had expected to be leaving the job with the CCG shortly afterwards.
A spokesperson on behalf of Herefordshire and Worcestershire CCGs’, where Mr Ogunseye worked, said that prior to being alerted by the Telegraph the CCG had been “unaware that one of their Continuing Health Care contractors is allegedly also offering paid consultancy work to local families. Appropriate action has since been taken”.
Mr Ogunseye said that the CCG had suspended his contract pending an investigation.
Mr Aldridge said he had “never billed, invoiced or received payment of any kind from anyone for the advice I have given them”.
He added that he had no involvement in whether CHC was awarded and said he had no conflict of interest. “My objective, when talking to families or working in my contractor role in the NHS, is to ensure that individuals are on the correct funding pathway based on their care needs and that the process is followed correctly, in accordance with the national framework”.
A spokesperson for NHS Waltham Forest Clinical Commissioning Group (CCG), which employs Mr Aldridge, said: “The CCG is currently looking into the matter. It would not be appropriate to comment further at this time.”