Staffordshire and Stoke-on-Trent Integrated Care Board

3. Mrs Y complains about Staffordshire and Stoke-on-Trent Integrated Care Board’s (the ICB’s) decision that a full assessment of CHC eligibility for Mr M was not required on 24 November 2023. She complains Mr M’s needs had materially changed and therefore a full review should have been completed, but only an FNC review was carried out.

4. Mrs Y states this has had a financial impact to the estate.

5. Mrs Y is seeking a full assessment and retrospective review of Mrs Sims CHC eligibility since 2019.

7. Continuing health care (CHC) funding is NHS funding provided to cover the health and social care needs of people with complex health needs. Funded nursing care (FNC) is NHS funding to over nursing care only.

8. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this by email with the solicitor, who brought this case to us on Mrs Y’s behalf, to understand the reasons why it could not do so. We have also considered the time the organisation has taken to respond to Mrs Y.

9. The complaint is about the ICBs decision not to carry out a full consideration of CHC eligibility in November 2023. The ICB wrote to the solicitor managing in January 2024 and confirmed a full review of eligibility was not required. At this time, it is reasonable to state the solicitor was aware there was reason to complain, and so we consider this is the date of knowledge. The complaint should therefore have been made no later than January 2025.

10. We have considered the length of time the ICB took to respond to the complaint. The ICB issued its final response on 22 August 2024. The complaint could have been brought to us any time after this date, and it would have been in time if it had been brought to us at this point.

11. The solicitor first contacted our office in December 2024, which is within the 12-month time limit. However, the full information required for the complaint, including the final response and signed consent form, were not supplied until March 2025. This means the case is out of time by three months.

12. We contacted the solicitor on 29 December 2025 and set out the case is out of time and asked if there were any reasons for this.

13. The solicitor contended the case is in time as it had first contacted us within the 12-month time limit. However, the legislation states a case must be made in full within 12 months, which was not done in this case. The solicitor brings many complaints to us and so would be aware of this rule.

14. The solicitor has also explained there was a delay in Mr M signing the complaint form which was sent to him in January 2025, and contributed to the delay. We understand this could have taken a few weeks to finalise given Mr M was in a care home.

15. The solicitor also explained further reviews took place in November and December 2024. It stated determinations for one period can have a direct impact on others, and the matter therefore remained ongoing. It also said it contacted the ICB in November 2024 to submit a complaint in relation to a separate period of eligibility. The solicitor said this shows the issues were continuing to progress.

16. The reviews which took place in November and December 2024 were to review Mr M’s current care needs, and if Mr M was found eligible at this time, this would not have been backdated. A backdated review would only be carried out if a request for a previously unassessed period of care (PUPOC) review was requested. We do not consider these reviews in November and December would have had an impact on the lack of a full review being carried out in November 2023.

17. A routine CHC review looks forward and assesses current eligibility for funding. We therefore consider the solicitor could have made a complaint anytime from August 2024 but did not do so in full until March 2025.

18. We have not identified a good reason to set the time limit to one side in this instance. Therefore, we will close this case and we propose to take no further action, as the case is out of time.

19. We recognise complaints mean a lot to the people bringing them to us. As the last stage in the complaints process, we sometimes have to make difficult decisions. In making our decision, we do not wish to diminish Mrs Y’s experience. We are sorry we could not provide you with a more agreeable outcome.

20. Complaints give us valuable insight into the organisations we investigate, and we recognise the CHC process has been challenging for Mrs Y. We would like to thank Mrs Y for sharing her experience with us.

1. We have carefully considered Mrs Y’s complaint about Staffordshire and Stoke-on-Trent Integrated Care Board (the ICB). The complaint falls outside of our time limit and we have decided there is no good reason for us to put our time limit aside to consider it further.

2. We understand pursuing CHC funding and disputing decisions as they relate to CHC eligibility is time consuming and stressful, and we understand it is concerning to feel the estate may have been unfairly disadvantaged.