3. Ms O complains about Hertfordshire and West Essex Integrated Care Board (the ICB). She complains the ICB agreed to refund nursing fees for her mother, Mrs O, then refused to issue payment.
4. Ms O says her mother’s estate has been impacted.
5. Ms O would like the ICB to reconsider its decision.
6. Between 29 January 2015 and 31 December 2018 Mrs O was not eligible for CHC funding. On 26 January 2019 Mrs O died.
7. On 3 September 2021 the ICB accepted Mrs O was eligible for FNC during the period 29 January 2015 and 31 December 2018. On 16 February 2022 proof of payments were sent to the ICB.
8. On 15 July the ICB proposed a reimbursement of £36,355.20. On 21 July Ms O accepted the proposal.
9. On 13 September 2022 the ICB emailed Ms O. Prior to the request for payment being approved, an additional check was to be completed with the nursing home, to check whether the patient was in a nursing or residential bed. The health authority apologised and confirmed that this should have been checked prior to the offer being made.
10. On 28 November 2022 the ICB confirmed that no reimbursement would be paid in relation to the FNC or continence aspects of this matter.
13. Ms O complains the ICB on 15 July 2022 agreed to reimburse her mother’s estate for nursing fees during the period 29 January 2015 and 31 December 2018. Then on 28 November 2022 the ICB informed her it would not reimburse her mother’s estate.
14. The ICB said in its response it had accepted responsibility to reimburse FNC (funded nursing care) payments made during the period from 29 January 2015 to 31 December 2018. The ICB said after it had agreed costs with Ms O, further checks with the nursing home were carried out. It explained the nursing home confirmed Ms O’s mother had not been charged for nursing care. The ICB said it would not be reimbursing Ms O’s mothers estate.
15. We have seen from the records on 3 September 2021 the ICB agreed Ms O’s mother was eligible for FNC during the period from 29 January 2015 to 31 December 2018.
16. On 15 July 2022 the ICB put forward a figure of £36.355.20 to be reimbursed to Ms O’s mother’s estate. This was accepted by Ms O on 21 July 2022.
17. On 22 September 2022, the care home confirmed to the ICB Mrs O was not billed for nursing at any point.
18. On 28 November 2022, the ICB informed Ms O payment would no longer be made. It explained further checks have shown Ms O’s mother had not paid nursing fees while in care.
19. The National Framework says:
• ‘NHS-funded Nursing Care is the funding provided by the NHS to care homes with nursing, to support the provision of nursing care by a registered nurse for those assessed as eligible for NHS-funded Nursing Care.’
• ‘The registered nurse input is defined in the following terms: ‘Services provided by a registered nurse and involving either the provision of care or the planning, supervision or delegation of the provision of care, other than any services which, having regard to their nature and the circumstances in which they are provided, do not need to be provided by a registered nurse’.’
20. In line with the National Framework, the ICB has explained FNC is funding provided to care home to support the provision of nursing care by registered nurse. It said it has not seen evidence nursing fees were paid while Ms O’s mother was in care.
21. We asked Ms O and her representative for evidence nursing care had been paid for during the period her mother was eligible. Ms O’s representative confirmed on 14 June 2024 they do not have evidence this was paid. They acknowledge the care home fees do not mention any form of care or nursing services.
22. It is our role to decide if the ICB made its decision in line with the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care. We cannot question decisions when they have been made without maladministration (fault) and we can only uphold a complaint about a decision if there is some specific fault in the way the ICB reached its decision.
23. We acknowledge Ms O’s frustration the ICB had agreed to reimburse her mother’s estate before completing checks with the care home. We can see the ICB had apologised for this in its letter. The ICB’s decision in line with the National Framework. As no evidence nursing care fees had been paid, the ICB did not have a cost to reimburse. We see no indications of a failing.
1. We have carefully considered Ms O’s complaint about Hertfordshire and West Essex Integrated Care Board (the ICB). We acknowledge what a lengthy and difficult process the funded nursing care (FNC) process has been. We understand Ms O’s complaint is important to her.
2. The information we have seen shows the ICB acted in line with the National Framework. We have seen no information to suggest anything went seriously wrong, so we have decided not to consider the complaint further.