Dorset Clinical Commissioning Group

3. Mrs R complains that Dorset CCG refused to carry out a full continuing healthcare (CHC) assessment for her father, Mr W, following his positive checklist on 19 May 2021.

4. Mrs R says the delay has put a huge strain on her father and family. He is still waiting for an assessment and is living in a care setting. This may have had a financial impact, and she says he is being denied a full assessment.

5. Mrs R would like the CCG to carry out a full assessment.

6. The following is intended to be a brief background to the complaint.

7. On 19 May 2021, the CCG carried out a checklist for Mr W. A checklist is a national screening tool used to help identify if a person needs a full continuing healthcare (CHC) assessment.

8. A full assessment is carried out using a decision support tool (DST) to assess a person’s eligibility for CHC funding. A DST is a national tool used for decision making, regarding eligibility for CHC.

9. The outcome of Mr W’s checklist was positive, and he screened in for a full assessment. The full assessment has not yet taken place.

Decision not to carry out a Decision Support Tool (DST)

12. Mrs R says that her father, Mr W, screened in for a full assessment following a positive checklist on 19 May 2021. She complains the Trust refused to carry out the full assessment.

13. We have carefully considered the CCG’s complaint response for its reasons to not proceed with a full assessment. The CCG said, at the time of the checklist, Mr W had open referrals with Speech and Language Therapy (SALT), a dietician, and community mental health services.

14. The CCG said it tried three times to get information from the referrer and was unsuccessful. It also said it is difficult to understand a person’s needs when they have open referrals.

15. The CCG explained to Mrs R that it could not allocate someone to look at the case, or proceed to a full assessment, until a new up to date checklist was submitted for Mr W.

16. Mr W has been waiting for a full assessment for almost one year. We have considered the National Framework which sets out what should happen when someone has a positive checklist. It says:

‘85. The Checklist threshold at this stage of the process has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity. There may, very occasionally, be exceptional circumstances where a full assessment of eligibility for NHS Continuing Healthcare is appropriate even though the individual does not apparently meet the indicated threshold.

86. Completion of the Checklist is intended to be relatively quick and straightforward. It is not necessary to provide detailed evidence along with the completed Checklist (refer to paragraphs 97-99)’.

17. We recognise the CCG says, at the time of the checklist, Mr W had outstanding health referrals. In line with the National Framework, the purpose of a checklist is to see if someone screens for a full assessment. It purposely has a low threshold and is not a tool used to determine eligibility.

18. The National Framework sets out that it is not necessary to provide detailed evidence with a completed checklist. The information we have seen shows Mr W had already screened for a full assessment, regardless of any open referrals. It is unclear why an open referral would be a reason not to progress from a positive checklist to a full assessment.

19. As Mr W screened in for a full assessment, our view is this should have proceeded to the DST stage, in line with paragraph 87 of the National Framework:

‘87. There are two potential outcomes following completion of the Checklist: • a negative Checklist, meaning the individual does not require a full assessment of eligibility, and they are not eligible for NHS Continuing Healthcare; or • a positive Checklist meaning an individual now requires a full assessment of eligibility for NHS Continuing Healthcare. It does not necessarily mean the individual is eligible for NHS Continuing Healthcare’.

20. This is not a discretional decision, and the process had already been started. We do not think it would be proportionate for another checklist to be carried out. This is because Mr W has already screened in on 19 May. As the CCG refused to carry out a full assessment, we have seen indications of failings.

21. We spoke with the CCG to set out our concerns, in line with the National Framework. We asked if the CCG would be prepared to reconsider its decision in light of what we have seen.

22. The CCG considered our concerns. It explained it has reconsidered the case and agrees the case should not have been closed. The CCG has confirmed it will undertake a full assessment based on the original checklist. The CCG says this will be for the full period since the date of the referral.

23. The CCG has explained it will contact Mrs R directly to discuss the next steps regarding a full assessment.

24. The CCG has agreed to take further steps to resolve the complaint for Mrs R. We are satisfied this will put right the CCG’s mistakes. This is in line with our Principles for Remedy and the National Framework. Based on this we do not think we need to take any further action at this time.

25. We hope these actions resolve matters for Mrs R.

1. We have carefully considered Mrs R’s complaint about Dorset Clinical Commissioning Group (the CCG). We have seen there are indications the CCG did not act in line with the National Framework. It has agreed to take steps to put things right. Therefore, we have decided we do not need to take any further action at this time.

2. We recognise how important Mrs R’s complaint is to her, and how difficult this has been for her and her family. We hope our decision will provide some reassurance.