Nottingham and Nottinghamshire Integrated Care Board

3. Mr L complains that Nottingham and Nottinghamshire Integrated Care Board (the ICB) incorrectly informed him in January 2023 he could appeal his mother’s CHC eligibility. Mr L says it was not until 24 April 2025 the ICB said he did not have the right to appeal his mother’s eligibility.

4. Mr L says as a result, he and his family have spent a lot of time, emailing, phone calls, preparing, attending meetings, presenting their evidence for CHC funding. He explains three years of their lives have been affected by this.

5. Mr L is seeking service improvements and a financial remedy.

6. On 29 November 2022 an FNC review took place. On 13 January 2023 the ICB informed Mr L a route of appeal was available.

9. Mr L says the ICB incorrectly informed him in January 2023 he could appeal his mother’s CHC eligibility. He says it was not until 28 April 2025 the ICB told him he did not have the right to appeal his mother’s eligibility.

10. The ICB have not disputed this. The ICB has apologised for the error in its communication.

11. The records show an FNC (funded nursing care) review took place on 29 November 2022 for Mr L’s mother, Mrs T. The review took place with access to a Decision Support Tool (DST) completed on 1 April 2022. The FNC review recorded Mrs T did not have a primary health need and therefore is not eligible for Continuing Healthcare funding.

12. It also noted there were no documented changes to her level of needs. It recorded she remained eligible for FNC. It explains her family were informed. Mrs T’s family wished for a further review in three months as they believed her health had deteriorated.

13. We have considered the National Framework. It says:

‘NHS-funded Nursing Care reviews

282. When reviewing the need for NHS-funded Nursing Care, potential eligibility for NHS Continuing Healthcare must always be considered. This will normally be achieved by completing a Checklist and where necessary a full assessment for NHS Continuing Healthcare using the DST.

283. However, where: • a Checklist and/or DST has previously been completed (with the result that the individual was not found eligible for NHS Continuing Healthcare), and • it is clear that there has been no material change in need

then it will not be necessary to repeat the Checklist and/or DST and this should be recorded. The individual should be informed of this outcome and the reasons for it.’

14. We have not seen the ICB got anything wrong here. In line with 282 of the National Framework potential eligibilities for NHS CHC must always be considered. The review confirms Mrs T did not have a primary healthcare need. Further, a second DST or checklist did not need to be completed because a DST had been completed previously and it was recorded there had been no material change. We acknowledge Mr L disagrees with this consideration.

15. The National Framework goes on to say:

‘286. If at the NHS-funded Nursing Care review it is determined that the individual does not require assessment for NHS Continuing Healthcare, they or their representative should be advised of this and provided with a copy of the annotated Checklist or DST which indicates that there has been no material change in their needs. They should be given information explaining how they can request a review of the outcome of the NHS-funded Nursing Care review, should they wish to do so.’

16. We have seen in the records on 13 January 2023 the ICB sent a letter to Mr L. The letter was to advise Mr L of the three month review. This information was correct. It says following a recommendation by the MDT Mrs T did not have a primary healthcare need. This information was not correct. This is because it was not an MDT which reviewed Mrs T. The letter states the ICB should be contacted if the family remain unhappy with the outcome.

17. The National Framework does not specifically say what should happen in this circumstance. Only an individual has the right of review.

18. We have considered NHS-funded Nursing Care Practice Guidance Supporting the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2022. It says:

‘Complaints

104. If the individual is dissatisfied with the outcome of a decision relating to their eligibility for NHS-funded Nursing Care, they are entitled to ask their ICB for a review of that decision. If they remain dissatisfied following this, they can pursue the matter through the NHS complaints procedure’

19. At this point Mr L was entitled to ask the ICB for a review of the decision. On 1 March 2023 Mr L submitted his appeal following his mother’s FNC/CHC review.

20. We have reviewed the ICB’s NHS Continuing Healthcare (Adults) Local Resolution Procedure February 2022. It says:

‘5. Local Resolution Process Communication of the Eligibility Decision The CCG (ICB) will send a letter to the individual/their representative to communicate the eligibility decision; the letter will enclose a copy of the Decision Support Tool and provide details of how to request a review. The letter will usually be sent within seven working days of the CCG’s decision.

If the individual/their representative wishes to request a review of the eligibility decision, they should write to the CCG within six months of the date given on the letter.’

21. The ICB’s local guidance is in keeping with the National Framework and NHS-funded Nursing Care Practice Guidance. We cannot say at this point Mr L was incorrectly informed.

22. We will now consider what the ICB said on 28 April 2025 following the completion of local resolution.

23. For context, the ICB sent its final response to his appeal on 14 January 2025. It upheld its previous decision Mrs L was not eligible for CHC funding.

24. The ICB clarified Mr L was unable to apply for an independent review panel (IRP) and the assessment under dispute was an FNC review, not a full DST. We have not seen where the ICB said he was unable to appeal the review which took place on 29 November 2022.

25. On 25 July, the ICB confirmed it had understood Mr L’s appeal to be in relation to CHC eligibility. The ICB then says an appeal, or review of an eligibility decision is only available following the completion of a Decision Support Tool (DST) containing a multidisciplinary team (MDT) recommendation.

26. This does not appear to be in keeping with the ICB’s Local Resolutions Guidance, National Framework or Funded Nursing Care Practice Guidance. However, we have not seen this view impacted Mr L’s appeal.

27. We acknowledge the frustration and upset caused by the information the ICB provided to Mr L. It is understandable this caused confusion following the local resolution process.

28. We consider the actions the ICB took in 2023 were correct. From the evidence we have seen Mr L did have the right to appeal the decision. The ICB completed local resolution and allowed an appeal to be heard. We have seen the ICB has acknowledged and apologised for the misunderstanding around the process. This is appropriate action to take in line with NHS Complaint Standards, which set out an organisation should acknowledge and apologise where appropriate.

1. We have carefully considered Mr L’s complaint about Nottingham and Nottinghamshire Integrated Care Board (the ICB). We understand his complaint has been ongoing for a long time and how frustrated he has found the process of appeal.

2. We have seen no indication the ICB failed to act in line with national guidance. We have not found it got anything seriously wrong in its decision making.