3. Mrs W complains she wants the ICB to complete a CHC retrospective review of her late mother-in-law’s needs from 1 January 2018 to 16 July 2018 but the ICB will not do so.
4. Mrs W say this has been frustrating and is unfairly affecting her late mother-in-law’s estate.
5. Mrs W wants the ICB to complete a retrospective review of her late mother-in-law’s continuing healthcare needs for the period from 1 January 2018 to 16 July 2018.
6. Mrs W’s mother-in-law’s care needs were assessed on 3 November 2017, including a CHC assessment. This found her needs did not meet the criteria for CHC funding.
7. Mrs W appealed the decision. In August 2019 a local resolution meeting did not uphold her appeal and the original decision stood.
8. Mrs W’s mother-in-law died in July 2018. A positive checklist completed in July 2018, after her needs changed, found she had been eligible for CHC funding for the last two weeks of her life.
9. Mrs W requested a retrospective review of her mother-in-law’s care needs and complained to the relevant clinical commissioning group (CCG) about how long this was taking.
12. Mrs W complains the ICB has not completed a retrospective review of her late mother-in-law’s CHC needs from 1 January 2018 to 16 July 2018. Mrs W believes her mother-in-law’s needs increased during this period.
13. The ICB’s July 2021 response said it accepted there was a significant delay in processing the retrospective review and at the time of its response the needs portrayal document and decision support tool (DST) still had to be completed. The ICB said this was because the CHC retrospective and appeals team had moved in house and there was a delay in the team getting the care home records. The ICB also said the COVID-19 pandemic contributed to the delay. The ICB apologised and explained it would progress the case once it received the records.
14. The ICB did an CHC assessment of Mrs W’s mother-in-law’s needs on 3 November 2017. This found she was not eligible for CHC. A change in her needs was identified in July 2018. A positive checklist on 16 July 2018 found she was eligible for CHC until her death in July 2018.
15. Mrs W says her mother-in-law’s needs increased in 2018 but the CHC assessment would only look at her records up to 3 November 2017. So there was an unassessed period of care from then until 16 July 2018 when she was not reviewed to see if she was eligible for CHC funding.
16. The PUPoC guidance says unassessed periods of care should be reviewed by the ICB to determine if an individual would have been eligible for CHC during the unassessed period.
17. We have asked the ICB about the status of the retrospective review. It told us the team will review the period from 3 November 2017, the date of Mrs W’s mother-in-law’s last DST, as she did not receive a three-month review in February 2018, up to her death in July 2018.
18. The ICB said the review team would start work on the needs portrayal document from 5 January 2023 and would schedule a meeting with the family in the coming weeks.
19. Mrs W wants the ICB to complete a retrospective review. It has confirmed to us it is working on the review and will be contacting Mrs W.
20. We understand Mrs W has been through a difficult and stressful time pursuing the retrospective review with the ICB, and we were very sorry to learn this. We do not consider we need to take any further action. Our enquiries have established Mrs W will receive the outcome she wants.
1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs W’s complaint about Birmingham and Solihull Integrated Care Board (the ICB). After careful consideration, we have decided not to take further action due to what the ICB tells us it is doing.
2. The ICB says it is in the process of completing a continuing healthcare (CHC) retrospective review, and it will contact Mrs W about this in the coming weeks. This is the outcome Mrs W wants so we will not take any further action. We understand pursuing the CHC process can be difficult and stressful, particularly when it involves a close loved one. We appreciate it has been difficult for Mrs W to pursue her case, and we were very sorry to learn about her concerns.