3. Mr P complains that the ICB has refused to retrospectively assess Mrs Y for continuing healthcare (CHC) funding.
4. He says it has not overturned an incorrectly completed checklist and has failed to provide a CHC assessment as it should have done.
5. He says this means he has lost out on the opportunity for Mrs Y’s care home costs to be refunded.
6. Mr P would like the ICB to carry out a full and proper retrospective assessment of the period between 13 May 2010 and 25 February 2012.
7. Mrs Y died in February 2012. Mr P asked Greater East Midlands Commissioning Support Unit (the CSU) to undertake a retrospective review to see if Mrs Y was eligible for CHC funding. The CSU was the authority that managed the CHC process for Newark and Sherwood CCG. This then became Nottingham and Nottinghamshire CCG and is now the ICB.
8. On 10 April 2013, the CSU wrote to Mr P saying it had completed an NHS checklist and found Mrs Y was not eligible for CHC funding. It said it would not, therefore, complete a full retrospective review of her care needs..
9. Mr P, through his legal representatives, complained to the CSU on 21 August 2013 and asked it to do a retrospective review. The CSU replied on 28 August 2013 and confirmed it would not undertake a retrospective review. Instead, it referred Mr P to its complaints team at Newark and Sherwood NHS CCG.
10. Mr P, through his legal representatives, complained to Newark and Sherwood NHS CCG in September 2013. Newark and Sherwood CCG replied in October 2013. It said the checklist exercise had been completed correctly and provided further contact details for complaints about CHC funding.
11. On 21 November 2013, Mr P’s legal representatives wrote to Newark and Sherwood NHS CCG saying it was obtaining GP and care home records so it could complete a detailed medical assessment. They believed this would demonstrate Mrs Y was eligible for CHC funding. It also queried the period the CSU and CCG had considered in the checklist. There was further correspondence between Newark and Sherwood NHS CCG and the legal representatives in November and December 2013.
12. On 4 February 2014, Newark and Sherwood NHS CCG sent a final response to Mr P’s representatives. The CCG said it could consider re-examining 2007 and 2009 if further evidence was provided which showed Mrs Y’s needs were higher for that period than in 2010. It otherwise pointed the complainant to the Parliamentary and Health Service Ombudsman and provided details of how to contact us.
13. In August 2018, Mr P’s representatives wrote to Nottingham and Nottinghamshire CCG about this complaint as this now covered this area (this CCG is now the ICB) . It replied on 10 September 2020 and drew their attention to the response from 4 February 2014.
14. Mr P’s representatives complained to us on 9 September 2021.
16. The law says we must consider the time limit in every case before making a decision about whether we can investigate it. Health complaints must be brought to us within one year from the day on which complainants are first aware they have a reason to complain.
17. We can see Mr P was aware the CSU had completed a checklist for Mrs Y and was not going to carry out a full CHC retrospective assessment in April 2013. This was when the CSU wrote to him. This is therefore the date Mr P knew the CSU had not found Mrs Y eligible for CHC funding, and that he had a reason to complain.
18. We can see Mr P and his legal representatives contested this decision. On 4 February 2014, Newark and Sherwood CCG wrote confirming this decision, and referred Mr P and his representatives to us. This was within 12 months of Mr P knowing he had a reason to complain.
19. Mr P’s representatives contacted the ICB in August 2018 to again complain about it not undertaking a retrospective assessment review for Mrs Y.
20. There is no indication that Mr P, or his representatives, sent any previously unseen medical evidence to the ICB between February 2014 and August 2018, which would indicate the ICB needed to review the 2013 checklist decision. We can see Mr P was aware his representatives were continuing to pursue the case on his behalf, as he signed a consent form for them to do so in June 2019. This demonstrates that either he or his representatives could have come to us after February 2014 but did not.
21. The ICB replied in September 2020. Mr P’s representatives brought the complaint to us in September 2021.
22. The complaint came to us seven years and five months after the date it needed to be brought to us. We have not seen a reason to put aside the time limit.
23. We understand this is likely to be disappointing for Mr P. We appreciate he engaged in a lengthy process of complaining about this CHC funding decision. We would like to thank him for raising his concerns with us.
1. We have carefully considered Mr P’s complaint about the Nottingham and Nottinghamshire Integrated Care Board (the ICB), which was previously the Nottingham and Nottinghamshire Clinical Commissioning Group (CCG). The complaint is outside of our time limit.
2. We have looked at the complaint and the information provided, and we have not seen sufficient evidence to allow us to put the time limit aside.