Mrs A complained about the Health Board’s decision that her mother, Mrs B, was not eligible for NHS Continuing Health Care (“CHC”) to cover the full costs of her nursing home fees between March 2015 and June 2017.
The investigation found that the correct administrative process had been applied by the Health Board in March 2015 when it determined that Mrs A was no longer eligible for CHC. However, it failed to carry out the required annual review in June 2016. On subsequent review in June 2017, Mrs A was again found to be eligible from the date of the review. However, there was no evidence that an earlier date of eligibility was considered in view of the failure to carry out the 2016 review.
The Ombudsman approached the Health Board and, in settlement of the complaint, it agreed to reconsider the evidence of Mrs B’s care needs for the period between June 2016 and June 2017 to see if it could identify an earlier date when she became eligible, and where appropriate, to reimburse any fees owed in accordance with the relevant payment guidelines.