Surrey and Sussex ICB

4. Mr Y complains the ICB did not pay interest when it reimbursed the cost of his wife’s care in March and May 2024.

5. Mr Y says they have been financially disadvantaged as they have not received the interest he believes they are entitled to.

6. Mr Y wants the ICB to acknowledge its mistakes and apologise for the financial impact they had on him. He wants it to pay the interest they are owed.

7. Mrs Y was found eligible for continuing healthcare (CHC) in April 2021. This is a package of care that is funded by the NHS for people who have a primary health need. Mr Y asked the ICB to fund his wife’s care via a personal health budget, which means the ICB provided an amount of money each month, determined by the type and amount of care Mrs Y needed, and Mr Y would use that money to fund the care.

8. In April 2023, following a review of Mrs Y’s needs, the ICB ended her CHC funding.

9. Mr Y immediately appealed the ICB’s decision and a date was set for it to hear his appeal in August 2023.

10. In the meantime, a palliative care nurse completed a CHC checklist and arranged for the ICB to assess her needs for CHC eligibility. The ICB did this in June 2023 and found Mrs Y was eligible for CHC. Mr Y continued to fund his wife’s care until the ICB reinstated the personal health budget from September 2023. This decision was completed separately to the appeal scheduled for August 2023.

11. The ICB heard Mr Y’s appeal, and it overturned the eligibility decision it made in April 2023.

12. This resulted in Mr Y being due two reimbursements for care costs they had paid. The first was from April (the date Mrs Y’s CHC was removed) to June 2023 (when Mrs Y was found eligible for CHC again via the appeal). The second was from June 2023 until the personal health budget was reinstated in September 2023.

13. Mr Y received both reimbursements in March and May 2024. The ICB did not apply interest to the reimbursements, explaining they had been processed within 12 months of Mr Y making the claim.

16. Mr Y has complained the ICB has not applied interest when it reimbursed him for the cost of his wife’s care. The ICB explained to Mr Y’s representative it does not pay interest if it processes the reimbursement in the same year it receives the claim.

17. The ICB told us this approach to interest payment is set out in the NHS Continuing Healthcare Refreshed Redress Guidance. We have looked at what the guidance says to assist our thinking on this complaint.

18. The guidance is clear, ‘redress is about placing individuals in the position they would have been in had NHS Continuing Healthcare been awarded at the appropriate time and not about the NHS of the public profiting from public funds.’

19. The guidance advises ICBs to apply interest when considering a redress case. It also provides further detail on how to calculate the interest using the Retail Price Index (a method of calculating inflation using the change in the cost of a fixed basket of goods and services), and that compound interest should be applied (interest awarded on interest each month).

20. We cannot see it guides ICBs to only apply interest after certain periods of time. There is further guidance from the Financial Ombudsman Service. Its ‘understanding compensation’ guidance says, ‘typically, the interest should be calculated from the date the loss crystallised to the date compensation is paid. If your customer has lost money at more than one point in time, you should calculate interest from the date of each crystallisation to the date of settlement.’

21. The ICB did not follow these pieces of guidance. It should have followed the NHS Continuing Healthcare Refreshed Redress Guidance by putting Mr Y in the position he would have been in had CHC been in place at the appropriate time. He would have had access to that money to do with as he wished. The guidance is clear ICBs should apply interest in redress cases. It does not provide a set of circumstances where it is not appropriate to apply interest.

22. This is further supported by the Financial Ombudsman Service’s guidance which sets out that interest should be calculated from the point the financial loss started. In this case, Mr Y’s financial loss started on the date the ICB removed his wife’s CHC funding in April 2023 and continued until it reinstated her personal health budget in September 2023.

23. We have found Mr Y has been financially disadvantaged by the ICB’s mistake here. He had to pay a substantial amount of money to cover the cost of his wife’s care. It was over £25,000. This was money he should not have had to pay as Mrs Y should have benefitted from CHC funding at the time.

24. This meant Mr Y did not have access to his own money during this period of time. He was not accruing any interest on the money and did not have any other opportunities to do what he wished with it.

25. We have found failings in how the ICB managed Mr Y’s reimbursement, and we have found he has been financially disadvantaged. The ICB has told us what steps it is going to take to put this right for Mr Y and we have set those out in our recommendations below.

1. We uphold the complaint about Surrey and Sussex Integrated Care Board (the ICB). We have found it did not follow the relevant guidance when it decided not to apply interest when it reimbursed Mr Y for the cost of his wife’s care.

2. We have recommended that the ICB calculate and pay Mr [name redacted] the interest on his reimbursements. We have also asked it to write to Mr Y to apologise for the impact this had on him.

3. It is clear this process has been very frustrating for Mr [name redacted]. We hope our decision brings the matter to a positive close for him.

26. Mr Y wants the ICB to apply interest to the reimbursements he received in 2024. He also wants it to acknowledge its failings in how it managed his reimbursements and apologise for the impact they had on him.

27. We have referred to the NHS Complaint Standards. These state that NHS organisations should be open and honest when things have gone wrong, recognise when this has had an impact on people, and identify suitable ways to put things right.

28. Based on this, the ICB needs to take steps to resolve this complaint for Mr Y. Its mistakes have had a financial impact on him, which it should put right.

Recommendation 1

29. Within one month of the date of this report, the ICB should calculate and pay Mr Y the interest on the reimbursements it made in March and May 2024. It should calculate the interest payment based on NHS Continuing Healthcare Refreshed Redress Guidance and the Financial Ombudsman Service’s ‘understanding compensation’.

Recommendation 2

30. Within one month of the date of this report, the ICB should write to Mr Y to acknowledge its mistakes when it managed his reimbursement. It should apologise for the financial disadvantage its mistakes caused him.

31. The ICB should send us evidence it has complied with our recommendations.