5. Dr U complains the ICB failed to provide his daughter, Miss U, with respite care as outlined in her current plan.
6. Dr U says he is frustrated with the ICB’s failures and not keeping to the plan over the last eight years. He also told us his experience has been difficult and upsetting and affected his partner too. Dr U explains they are both experiencing carers strain.
7. Dr U would like the ICB to find a care provider that will meet Miss U’s respite needs in line with her care plan.
8. Miss U is entitled to NHS continuing healthcare (CHC) funding. CHC is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS.
9. We note in the information provided by Dr U, Miss U needs day services and this has been reduced by the ICB from five days per week to two.
12. The ICB explained it contacted several different providers, but none were able to meet Miss U’s needs due to the level of observation, capacity and support needed.
13. The ICB acknowledged Dr U’s preferred day care service but explained that service is unable to provide the full respite entitlement, due to demands on its service.
14. The ICB highlighted which care service providers it contacted and why it is unable to commission respite care with them. The ICB explained it offered to arrange carers to support Miss U at home, but Dr U does not think this is appropriate. The ICB explained it will continue to look for providers that can offer the respite support Miss U needs.
15. The ICB also offered Miss U a personal health budget, where funds can be released to Dr U to create a bespoke package of care at home with personal assistants that he recruits.
16. Paragraph 185 of the National Framework states:
‘Where an individual is eligible for NHS Continuing Healthcare, the ICB is responsible for care planning, commissioning services, and for case management. It is the responsibility of the ICB to plan strategically, specify outcomes and procure services, to manage demand and provider performance for all services that are required to meet the needs of all individuals who qualify for NHS Continuing Healthcare. The services commissioned must include ongoing case management for all those eligible for NHS Continuing Healthcare, including review and/or reassessment of the individual’s needs.’
17. Paragraph 186 says:
‘ICBs should operate a person-centred approach to all aspects of NHS Continuing Healthcare, using models that maximise personalisation and individual control and that reflect the individual’s preferences, as far as possible, including when delivering NHS Continuing Healthcare through a Personal Health Budget, where this is appropriate.’
18. Paragraph 192 goes on to explain:
‘Where a person qualifies for NHS Continuing Healthcare, the package to be provided is that which the ICB assesses is appropriate to meet all of the individual’s assessed health and associated care and support needs. The ICB has responsibility for ensuring this is the case and determining what the appropriate package should be. In doing so, the ICB should have due regard to the individual’s wishes and preferred outcomes.’
19. We also refer to the National Framework Practice Guidance 43, which sets out several responsibilities ICBs have in relation to NHS CHC commissioning:
• ‘ICBs should consider commissioning from a wide range of providers in order to secure high quality, value for money services. In exercising this responsibility, ICBs should have regard to the case management role set out in the National Framework 187-190 of ensuring that the care/support package meets the individual’s assessed needs and agreed outcomes and is appropriate to achieve the identified intended outcomes in the care plan • ICBs should commission services using models that maximise personalisation and individual control and that reflect the individual’s preferences as far as possible • ICBs are reminded that people in receipt of NHS Continuing Healthcare have a right to have a personal health budget.’
20. We have seen evidence that shows the ICB tried to provide the appropriate care provision with the resources it had available to it. We can see it attempted to contact several care providers. We can also see in the ICB’s attempts to get other providers, it considered the family’s preferences and needs. We note the ICB reassured Dr U that it would continue to search for care providers who can offer the respite support Miss U needs.
21. It is for these reasons we have not seen any evidence to support the view that the ICB has not met the requirements of the National Framework. We realise this is a challenging situation for Dr U and his family and that these events continue to cause them stress.
22. We understand having no extra respite care will have caused Dr U and his wife worry as well as carers strain, as they are left to either provide the care themselves or make other arrangements.
23. We are satisfied the ICB is making reasonable efforts to commission agencies and that alternatives have been offered while it tries to find a permanent care provider. We are not taking any further action because we do not think anything has gone wrong.
1. We have carefully considered Dr U’s complaint about Coventry and Warwickshire Integrated Care Board (the ICB).
2. We have seen no sign that the ICB did not act in line with the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care (the National Framework).
3. We will explain the reasons for our decision in this statement.
4. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Dr U for sharing his experience with us. It is also important to acknowledge that finding no signs of service failure does not take away from Dr U’s experience, or the upset and frustration these events caused him and his family.