NHS England

NHSE

4. Mr L complains about how NHSE handled the IRP meeting on 3 August 2022 about his mother’s, Mrs D, eligibility for continuing healthcare (CHC) funding.

5. Mr L says NHSE did not make sure the IRP had the correct records and details of the appropriate claim period. This meant it had to abandon the IRP without making an eligibility decision. He says it did not write to him to explain what would happen next, as the panel had promised it would.

6. He says it handled his complaints about the IRP poorly. It ignored his emails, denied the IRP meeting had taken place and did not provide him with its complaints policy when he asked for it.

7. Mr L says NHSE’s actions have caused him distress, upset and frustration. He had to take more time dealing with his mother’s claim than he should have and he has lost faith in NHSE.

8. He would like a formal letter from NHSE confirming the outcome of the IRP, an apology and a financial payment.

The ICB

9. Mr L complains the ICB did not give NHSE the right records and the right information about the claim period for his CHC claim for his mother.

10. He feels this was unfair and delayed the process unnecessarily. He found this upsetting.

11. He would like the ICB to give him a meaningful apology.

12. In April 2018 Mrs D’s GP arranged for her to be admitted to a nursing home because it was no longer safe for her to live at home. Mrs D was in her early nineties at the time. She died in January 2022.

13. In April 2018 the ICB’s multidisciplinary team (an MDT is made up of healthcare professionals from different areas of expertise) completed a CHC assessment for Mrs D that recommended for her CHC funded care. It covered a period of 4 to 26 April 2018 (period one). The ICB did not accept this. Mr L appealed this decision and the ICB held a local resolution (complaints) meeting which upheld its decision. He then appealed to NHSE. It held an IRP meeting on 25 February 2020 which upheld the ICB’s decision but recommended for it to complete a retrospective review for a period of a minimum of four weeks from 26 April 2018.

14. The ICB completed a decision support tool (a DST is used to record a person’s needs) dated 12 May 2021 for the period 26 April to 26 May 2018 (period two). It decided Mrs D was not eligible for CHC. Mr L appealed this decision and the ICB held a local resolution meeting on 3 November 2021. This upheld the decision so Mr L again appealed to NHSE.

15. NHSE scheduled an IRP meeting for 21 June 2022, but cancelled this on 19 June because it said it did not have full panel membership. The meeting was rearranged for 3 August.

16. On 2 August the ICB contacted NHSE to say it was concerned the IRP meeting should be postponed again because it thought its paperwork was incorrect. The meeting began on 3 August, but the chair stopped it and recommended rescheduling. The chair recommended for the ICB to review Mrs D’s needs for a longer period, that would cover 26 April 2018 to her death in January 2022.

17. Mr L complained to NHSE that it did not clearly explain to him the outcomes of the meeting. He also complained to the ICB about its mistakes, which he felt had further delayed the eligibility process from being completed.

18. Mr L complained to us in May 2023. In September NHSE held a new IRP meeting, that again covered the period 26 April 2018 to 26 May 2018. It decided Mrs D was not eligible for CHC during those dates.

NHSE

21. Mr L says NHSE allowed its IRP meeting of 3 August 2022 to go ahead despite it not having the correct records and details to make a proper eligibility decision on his mother’s needs. He says the IRP then made a decision which is not supported by the National Framework. He says NHSE did not tell him about the outcome as it should have done. Mr L says NHSE caused unnecessary delays in his mother’s eligibility decision process, which caused him frustration and distress.

22. We can see the ICB thought it may not have sent NHSE the right records for the IRP meeting. It asked NHSE to postpone the meeting scheduled for 3 August, but NHSE did not do this. When we look at the records we can see NHSE did have what it needed to go ahead with the IRP. We have not seen signs that NHSE got something wrong here. As we go on to explain, the 3 August IRP was abandoned, but the availability of records was not the reason for this.

23. It is clear from the record of the 3 August IRP that the IRP chair made an exceptional decision. It was not in line with the National Framework, as Mr L says. But on the basis of the information available at the time, we think the chair acted appropriately. The initial discussions on the day had shown the chair that Mr L felt his mother should have been eligible for the whole period she was in the care home, from April 2018 until her death in January 2022. At this point, only two small parts of that longer period had been considered:

• 4 to 26 April 2018 – this had been reviewed through the entire appeal process, including a previous NHSE IRP • 26 April to 26 May 2018 – this had been through the local appeal process and was the period the IRP was set to look at that day.

24. This meant the period Mr L was concerned about was being broken into several much shorter periods. There was a further three years and eight months that Mr L wanted to be considered. The chair could see that approaching the claim in this piecemeal (with the entire period broken down into smaller parts) way was not going to achieve what Mr L wanted.

25. So the chair suggested for the ICB go back and look at the entire period from Mrs D going into the care home in April 2018 to her death in January 2022. The record of the IRP shows Mr L agreed to this. The ICB was unsure and said it would agree subject to more explanation of what it was expected to do. The chair said he would write to the ICB about this. He also said the IRP would not consider the short period from 26 April to 26 May that day. The meeting was closed.

26. Our Principles say organisations should keep in mind individual needs and respond flexibly to the circumstances. They should also try to deal with other organisations in a co-ordinated way.

27. We think this is what the chair tried to do. We appreciate this meant Mr L did not get a clear outcome on the day as he had expected. And we understand this was frustrating. When we weigh up the evidence, we think the IRP chair acted in line with our Principles. They responded flexibly to the circumstances and Mr L’s needs. We do not think they could have done that before the meeting. It seems it was only when all the parties were together and Mr L was talking about his mother’s care that the full situation became clear.

28. So we looked next at what NHSE did to follow up on the chair’s decision after the abandoned IRP on 3 August 2022.

29. After the meeting, NHSE and the ICB discussed what the ICB needed to do. Those discussions led to an agreement that the ICB would do a retrospective review for the period 27 May 2018 to 5 January 2022 (period three). So it would not look again at the shorter periods it had considered before. This meant NHSE needed to organise another IRP to consider the period it had originally planned to review at the 3 August 2022 meeting. That was period two (26 April to 26 May 2018).

30. The records show Mr L was happy with this. But we can see NHSE did not confirm with him what would happen until February 2023. It then explained the steps it would take. The earliest it could arrange the new IRP was September 2023.

31. NHSE took too long to let Mr L know what would be happening after the abandoned 3 August 2022 IRP. We understand this added to his concerns about the process. NHSE did apologise to him for the delay.

32. In the February 2023 letter NHSE also apologised to him for not being clearer about what had happened. It apologised that the wording it used about the IRP in August 2022 may have given the impression it did not take place, rather than it being stopped while it was in progress. It also said it had amended its processes to make sure it wrote formally to complainants in exceptional circumstances like these.

33. So it seems clear that NHSE made mistakes in how it handled Mr L’s complaint. He raised concerns that he did not know what was happening and NHSE was not telling him. When it responded to his complaint, it said something misleading. We understand how frustrating this was for him. We also note Mr L was asking NHSE for a copy of its complaint policy and it did not send it.

34. Our Principles say organisations should deal with people quickly and give clear and timely information about how people can complain. It does not seem that NHSE did that in Mr L’s case.

35. We note Mr L was able to raise his complaint about the August 2022 IRP with NHSE. So fortunately its mistakes did not prevent him from doing that.

36. The NHS Complaints Standards say if organisations find something has gone wrong, they should acknowledge this and look to put that right for the individual. We think it was right that NHSE apologised for what it got wrong and explained what it would do to improve its service. We think this was fair to put things right and we do not think we could realistically ask NHSE to do more. It was frustrating for Mr L, but when we weigh up the evidence, we do not think a financial payment is needed, particularly given the exceptional circumstances.

The ICB

37. Mr L says the ICB did not give NHSE the right information or records about the period under consideration in August 2022, before the IRP. He says this delayed the eligibility process unnecessarily and caused him upset.

38. For the reasons explained above, we do not think the ICB got anything wrong. The confusion about the availability of records was not the reason the chair decided to stop the IRP. We cannot see that anything the ICB did delayed the consideration of the eligibility decision.

39. We would like to thank Mr L for bringing this complaint to us. We understand why he is frustrated by what happened in August 2022. We hope we have clearly explained why we think NHSE has done enough to put things right where it made mistakes and that our decision reassures him. We know that NHSE has now completed the IRP for period two and the ICB has now done a retrospective review of period three. Mr L knows how he can challenge those decisions.

1. We have carefully considered Mr L’s complaints about NHS England (NHSE) and Hampshire and Isle of Wight Integrated Care Board (the ICB). We have seen no sign that anything went seriously wrong when the chair of the independent review panel (IRP) stopped the meeting on 3 August 2022. We think it has put right what it got wrong in how it communicated with Mr L and handled his complaints about the meeting and its outcomes. We would not ask it to do anything more.

2. We have seen no sign that the ICB did anything wrong that delayed the eligibility decision.

3. We would like to thank Mr L for bringing his complaint to us. There were genuinely unusual and exceptional circumstances involved, which we can see caused him frustration and annoyance.