3. Care Fee Recovery complains on behalf of Mr I about the interest level paid on retrospectively funded continuing healthcare (CHC) fees for Mrs T. It also says a positive checklist was completed but a full assessment for continuing healthcare funding was not put into action.
4. Care Fee Recovery says the family have been affected financially by this.
5. Care Fee Recovery is looking for the interest to be paid at 8% and for the family to be refunded.
6. The request for a review was put forward to Camden Primary Care Trust (PCT) and Richmond and Twickenham PCT on 28 September 2012.
7. After a long period of communication between the PCTs and Care Fee Recovery, Camden CCG (now the ICB) said on 18 May 2018 it was getting all the information to conduct the review.
8. On 3 February 2020, a decision outcome letter from Camden CCG said that Mrs T had been found eligible for full CHC funding for the review period 1 January 2007 to 1 October 2011.
Interest rate
11. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any signs that something has gone wrong.
12. Care Fee Recovery says the delay in having this case reviewed fully has led the family to be paid less due to a change in the interest fees. The interest rate was 8% until 2015, when guidance recommended the Retail Price Index (RPI) rate should be used.
13. We can see there was a long delay of six years after the request was put forward before the periods were fully reviewed. Care Fee Recovery says the reasons for the delay fall under the responsibility of the ICB and its delay has negatively affected the finances of the family.
14. In 2012, the Department of Health (DH, now the Department for Health and Social Care) said individuals could request retrospective reviews of CHC decisions and it set deadlines for these claims. We are aware the deadlines caused significant delays with the CHC process for all ICBs and NHS England regions for several years.
15. We do not hold ICBs responsible for delays in processing the large number of cases they received at this time, unless we can see there was another reason for this. We can see no such reason here and the timeframe is similar to those we were seeing across England.
16. Care Fee Recovery says the responsibility was being passed between the CCGs. Information was being gathered to find out which one was responsible because of changes in the local area, which was important. We understand this would have been frustrating.
17. Care Fee Recovery says if this complaint had been considered quicker, the interest paid would have been at 8%. When the care was paid retrospectively, the interest was set at the RPI rate that was current at the time. Care Fee Recovery says the delay in considering this case has had a negative financial impact for the family.
18. On 1 April 2015, the NHS Continuing Healthcare Refreshed Redress Guidance (Redress guidance) came into force with immediate effect. The Redress guidance says where an eligibility decision had been made after the 1 April 2015, the ICB should apply the RPI rate.
19. We can see that the ICB acted in line with the guidance. While we understand this is frustrating for the family, we have not found any signs of failings in relation to this part of the complaint.
Checklist
20. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. We have found the ICB has already done enough to put right the impact of these events.
21. Care Fee Recovery says a positive checklist was carried out on 12 March 2007, and this which should have put into action a full assessment. An email on 13 April 2018 from Camden CCG says ‘I am in agreement … that Camden CCG was the responsible commissioner [Mrs T] triggered several positive checklists but was not considered for full CHC assessment. There was also a period of unassessed care in 2008 and 2009.’
22. The National Framework (2022) says that after a positive checklist the next steps should be: ‘Write to individual and/or their representative with outcome and copy of the Checklist. Also write to ICB, which arranges for a full assessment of eligibility using the DST [the Decision Support Tool is the form used for the assessment].’
23. Due to a decision made by the nurse who carried out the checklist, a full assessment was not carried out. We consider this is a sign of a failing.
24. When we find signs of failings, it is important we think about whether actions have been taken to put this right.
25. We can see following a full review of this period the care has now been fully funded. We appreciate the checklist not putting into action a full assessment was distressing and frustrating for the family. We consider the failing has been put right and the family have been put back to the position they would have been in if the failing had not happened. We do not intend to take any further action on this part of the complaint.
1. The Parliamentary and Health Service Ombudsman has carefully considered Mr I’s complaint about North Central London Integrated Care Board (the ICB, formally known as Camden CCG). In one part of the complaint we have seen no sign that anything went seriously wrong. In the other part of the complaint we have decided the ICB has already done enough to put right the impact of these events.
2. We understand this has been a long and frustrating process for all involved and we are sorry to hear about the circumstances of this complaint.