6. Miss O complains about the ICB’s decision to not give any financial support. She also complains about the delays in doing a CHC assessment and that she was told her father’s care package could be withdrawn.
7. Miss O says her experience has been deeply upsetting. She says the ICB’s actions caused financial hardship.
8. As an outcome to her complaint, Miss O would like financial compensation.
9. Miss O complained to the ICB on 2 December 2020 about the CHC team and her late father’s care.
10. Based on the information we have seen, Miss O had been caring for her father after his diagnosis to receive palliative care.
Financial support
13. Miss O says the ICB advised she would not get any direct payments for giving care to her father, after his diagnosis to have palliative care.
14. In its final response the ICB explains the usual procedure for employing family members falls into the Personal Health Budget (PHB) procedure. A PHB is an amount of money to support the identified healthcare and wellbeing needs of an individual. It is planned and agreed between the individual, or their representative, and the local ICB. The ICB explained the PHB process is long and cannot be set up quickly in the case of a Fast-Track package of care, which Miss O’s father was in receipt of.
15. The ICB explains if employing personal assistants (PAs) such as family members, the PHB team sets up the recharge with the Local Authority (LA) and there is a three-month review, before proceeding with a PHB. If further or additional care is required, a domiciliary care package would be offered to top up any care by direct payment.
16. NHS England guidance on PHB’s for palliative and end of life care says:
‘People who become eligible for NHS Continuing Healthcare funding under the fast track pathway have a legal right to have a personal health budget.’
17. The National Framework says:
‘Personal Health Budget Standing Rules require ICBs to provide people eligible for NHS Continuing Healthcare with information about Personal Health Budgets to offer them the option of taking them up, and support to do so’.
18. The guidance goes on to say:
‘Personal health budgets can be provided in three different ways, or in a combination of these ways: (a) a notional budget held by the commissioner, (b) a budget managed on the individual’s behalf by a third party, (c) a cash payment to the individual (a ‘direct payment’).’
19. The ICB explains direct payments were in place at the time and were actioned by the LA.
20. The ICB explains there is no documented evidence saying that if the family did not comply, then care would be withdrawn.
21. The ICB has given us evidence of a funding agreement showing direct payments were made to Miss O from 1 February 2021 onwards. With this in mind, we consider the ICB approached this issue in line with NHS guidelines and we have seen no signs of failings in this. While we fully appreciate and understand Miss O’s concerns, we cannot say we have seen the ICB failed in its role.
22. We realise Miss O disputes this and says she was not given any direct payments. As an impartial organisation we depend on evidence. As we were not there at the time of events and have no other evidence to consider, we must take the records at face value.
23. Miss O could raise concerns with the Local Government and Social Care Ombudsman (LGSCO) as the ICB have explained payments were actioned by the LA.
Withdrawal of funding
24. Miss O says she was advised to accept the ICB’s care package, which included domiciliary care, and if she did not agree, the care package would be withdrawn.
25. We can see the ICB explained it has no documented evidence saying that if the family did not agree, then care would be withdrawn. We note in the original response to the family there is a reference to the brokerage of a care package being closed, once the family declined to receive the package.
26. We have reviewed the ICB’s communication trail and cannot see a conversation about the withdrawal of Miss O’s father’s care package. Due to a lack of evidence, we asked the ICB if it could provide evidence in the form of meeting notes, recordings or staff statements. It advised it could not provide any documented evidence.
27. Without further evidence, we cannot take a view on Miss O’s interaction with the ICB on this issue. This is not to say Miss O’s account of events is wrong but that we are unable to come to a view without evidence to support what she says. In the circumstances, we do not consider there is any further action we can take on this part of Miss O’s complaint.
Delays
28. Miss O complains the ICB did not attempt to reassess her father.
29. In its final response the ICB explains that on 18 March 2020 the National Framework was suspended due to COVID-19. Because of this, a multi-disciplinary (MDT) panel could not be set up to compete a decision support tool (DST – an assessment to look at a person’s needs).
30. Emergency protocols were set up for telephone reviews to make sure patients were getting the correct levels of care and to make sure regular checks were made. The electronic record shows that these did take place on 22 May, 25 June and 18 August 2020.
31. The ICB explains that the National Framework was restarted on 1 September 2020 and an MDT was requested for 14 September. A request was also made for medical evidence to support the completion of the DST. This was rescheduled for 28 September because the ICB did not have the consent needed in time for the original scheduled MDT.
32. The reintroduction of NHS continuing healthcare guidance confirms the National Framework was suspended due to COVID-19 and restarted on 1 September 2020.
33. The guidance NHS CHC National Framework says consent is not needed for completion of assessments (DSTs) or for getting and sharing information with:
• care teams • health and social care staff.
34. We asked the ICB if it could confirm who it needed consent from. It explained consent was needed from the next of kin. This was to allow the gathering of information for the assessment to go ahead. Based on this information, we do not consider the ICB acted in line with the National Framework.
35. We have considered how this affected Miss O and her father. Miss O says she suffered from financial hardship. We have seen no evidence to suggest Miss O paid for her father’s care in place of a new CHC assessment. This is because we can see a funding agreement showing direct payments were made to Miss O from 1 February 2021 onwards.
36. As a result of our investigation, the ICB has offered an apology for the delay caused and has explained it would like to assure us and Miss O that changes are being made to its process to make sure future actions around consent are in line with the National Framework. We consider this action is in line with the our Principles.
37. The ICB has accepted that the request for consent was not in line with the National Framework and this caused a delay in doing an MDT assessment. It has explained what actions it has taken to address this failing so that services will be improved in the future. It has also acknowledged Miss O’s frustration and apologised. We consider this is a fair and suitable solution to put things right.
38. We appreciate Miss O has been pursuing her concerns for a long time and this has caused her frustration and distress. We are sorry to learn of her concerns and hope our thorough explanations give reassurance that the right process has been followed.
1. The Parliamentary and Health Service Ombudsman has carefully considered Miss O’s complaint about Birmingham and Solihull Integrated Care Board (the ICB).
2. Based on the information available, we consider Miss O did get direct payments and so we have seen no signs of failings.
3. We considered Miss O’s complaint about her father’s care package being withdrawn and we are unable reach a decision on this and how the ICB communicated with Miss O.
4. Miss O also complains about the delay in the ICB doing a continuing healthcare (CHC) assessment. We consider the ICB’s approach to be in line with our ‘Principles of Good Complaint Handling’ and our ‘Principles for Remedy’. These Principles explain that giving fair and proportionate solutions is an important part of good complaint handling. And where an organisation has failed to get things right and this has led to an injustice (negative effect on someone), it should take steps to put things right.
5. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Miss O for sharing her family’s experience with us. It is also important to say that finding no signs of service failure in this complaint does not take away from her experience, or the upset and frustration these events caused her.