3. Mr I complains about NHSE’s decision to uphold East Lancashire Clinical Commissioning Group’s (now the Lancashire and South Cumbria Integrated Care Board) decision that his late grandmother, Mrs U, was not eligible for CHC funding between 3 March 2009 and 17 June 2012.
4. He says his grandmother’s estate has been financially disadvantaged.
5. Mr I would like NHSE to reconsider its decision.
6. A Solicitor (the representatives) acted on behalf of Mr I by dealing with Mrs U’s retrospective review case for CHC funding. Retrospective review cases for CHC funding looks at whether an individual was historically entitled to CHC funding.
7. The representatives requested an independent review panel (IRP) meeting on 9 April 2018 on behalf of Mr I. An IRP is the last stage of the NHS appeals process when an individual applies for CHC funding.
8. NHSE held the IRP on 24 March 2020.
9. NHSE emailed the IRP outcome to Mr I’s representatives on 7 May 2020 advising it found Mrs U was not entitled to CHC funding.
10. Mr I confirmed with his representatives he wished to proceed his complaint with the Parliamentary and Health Service Ombudsman on 3 February 2021.
11. On 21 May 2021 the legal representatives submitted Mr I’s completed complaint form to us.
CHC funding decision
14. 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 with Mr I’s legal representatives to understand the reasons why Mr I could not bring his complaint sooner. We have also considered the time the organisation has taken to respond to Mr I.
15. Mr I’s representatives said they started chasing NHSE for an IRP outcome at the end of June 2020.
16. In July 2020, the representatives said they would chase NHSE again in four weeks’ time, following a request for an update from Mr I.
17. In August 2020, the representatives said in an email to Mr I they had chased NHSE recently and had been advised all its resources were tied up dealing with the pandemic.
18. The representatives said they chased NHSE again in November 2020, December 2020, and January 2021.
19. On 22 January 2021, NHSE advised it had emailed the IRP report and outcome to the representatives on 7 May 2020. This is the date the representatives said they became aware of a problem.
20. On 25 January 2021, the representatives’ IT department confirmed the email from NHSE had been sent and the status was now archived.
21. We consider the evidence suggests NHSE did email the IRP outcome on 7 May 2020, and this is the date of knowledge, not 22 January 2021.
22. Mr I, or his representatives, needed to bring their complaint to us by 6 May 2021. This is the last date possible for submission to be within a year of the date of knowledge.
23. We received a completed complaint form on 21 May 2021, 15 days out of time.
24. We asked the representatives to explain the delay in the complainant bringing the complaint to us. It said:
‘On review of this case, there have been exceptional circumstances causing delays, COVID-19 pandemic, staff adapting and working from home remotely and IT issues, all which were out of our control and lack of communication from NHS England would have reduced the timeline and enabled us to bring the complaint to the Ombudsman sooner.’
25. Once NHSE confirmed its decision on 7 May 2020, the complainant had 12 months from that point to submit a complaint to us. Therefore, the time taken for local resolution before that does not affect the complainant’s ability to bring their complaint to us.
26. We can see how frustrating it may have been for the legal representatives who chased NHSE for the IRP outcome several times before being notified it had already been sent several months prior.
27. We also appreciate the difficulties they experienced with the move to working from home and the IT issues which may have come with this.
28. The evidence does suggest NHSE met its obligation in issuing the IRP by email to the contact provided. It is unfortunate the representatives were facing issues at the time.
29. Mr I’s representatives say Mr I confirmed he wished to progress his complaint to us on 3 February 2021.
30. The representatives emailed us on 2 March 2021 asking to pursue a complaint, which was a one month delay.
31. We sent the representatives a complaint form on 8 March 2021. The representatives note we did not provide a deadline to return the completed form.
32. The representatives returned the completed form to us on 21 May 2021. A further delay of over two months.
33. We expect, as legal representatives, they have a duty to act in the best interests of their clients. As they deal with similar complaints, they are familiar with our time limits and processes. We consider legal representatives have responsibility to ensure they submit a properly made complaint within our time limits.
34. After reviewing the evidence, we consider it would be unfair for us to accept such cases without good reason. We have taken into account the reasons provided for the delay. We consider there was still an opportunity to return the completed form to us on time, by 6 May 2021.
35. We do not think the reasons provided indicate there was a significant barrier which prevented the legal representatives, acting on behalf of the complainant, from making a complaint to us on time.
36. In conclusion, we do not think the reasons the legal representatives provided are sufficient for us to set aside our time limit and we think they could have brought the complaint to us sooner. Therefore, we shall not consider the complaint further. We recognise it this may be frustrating to Mr I and his family after such a long time. We wish them all the best.
1. We have carefully considered Mr I’s complaint about NHS England (NHSE). We have decided the complaint falls outside of our time limit.
2. We appreciate this outcome may be disappointing to Mr I and that it has been a lengthy process dealing with his grandmother’s continuing healthcare (CHC). We have not seen sufficient reason for us to put our time limit aside to consider this complaint further.