The ICB did not make the service improvements as it said it would
15. Miss N says the ICB created an action plan to improve its CHC service, but it did not then make sure that necessary changes to her father’s care took place in a timely manner. In particular, she says it did not react to changes in her father’s showering requirements and nursing needs quickly enough or communicate with his family clearly about this. She says this caused them to lose further faith in the ICB and meant her father did not get the improved care he was due for a longer time than he should have.
16. The ICB said it was pleased it had provided significant changes in its CHC process and for keeping families informed. It says it recruited a single point of contact for families, and recognises there are always opportunities to improve its processes further. It told us it would apologise again if we found it had made mistakes on this issue. It said it could not amend certain services for Mr C until it had confirmed costings from the care agency.
17. The National Framework says ICBs are responsible for planning and delivering a person’s care once they have been found eligible for CHC. The ‘Care planning and delivery’ section says they should plan that care strategically and operate a person-centred model. Our ‘Principles of Good Administration’ say public bodies should give people information in a timely manner and do what they say they are going to do. The ‘Handbook to the NHS Constitution’, page 37 says patients have the right to healthcare which is ‘effective and right’ for them.
18. Miss N says her father’s CHC case manager said he needed two carers for certain tasks in December 2022. We can see from the records that Miss N first asked the ICB after April 2023 about it providing a second carer for her father’s assessed needs and to help him with showering on 20 June. The ICB confirmed it had not approved this yet on 27 June and said it would request an increase in his care once it had received costings from the care agency. Mr C’s care home also asked the ICB if it could confirm it would approve funding for his showering needs on 10 July.
19. The records show the ICB requested more documentation from the care home about this (and Mr C’s other needs) on 26 July. The care home sent these, plus information on costings to the ICB on 1 August. The ICB said it needed to finally approve these before it could confirm the additional care, including for his showers, would be funded.
20. On 14 December the ICB sent Miss N’s sister an email saying it was ready to deliver the increased care hours but had multiple entries in its system chasing the care costs so it could do this. Miss N’s sister said she thought the ICB had received those costs in May. The ICB said it had now received the costs and had sent them to the appropriate team on 19 December. It told Mr C’s family there were some issues with getting the approval on 24 January 2024. Miss N’s sister emailed again to ask about it in February.
21. Miss N has told us that her father was doubly incontinent and, in the last weeks of his life, was only able to have one shower a week. She said this was when a family member was able to assist the carer.
22. We can see the ICB investigated the issues we asked it to and produced an action plan to improve its CHC service. It wrote to Miss N about this in November 2023 and apologised for the mistakes it had made which meant she had come to us. We can see this plan did address her key concerns and should mean its CHC assessment process is improved, which Miss N was concerned about.
23. But we can also see it had not actioned either all of the updates in relation to Mr C’s needs, or his care plan. The ICB was aware it needed to do this for over ten months after it had accepted these changes were needed. The records show the ICB was trying to get confirmation of costings, but it is not entirely clear why these took as long to confirm and ratify as they did. Although we can see ICB did provide Miss N with updates, the records show it did not always initiate these. Our view is this meant Mr C did not receive fully the effective care the Handbook to the NHS Constitution says he should have. When we weigh up the evidence, the ICB does not appear to have acted in line with the National Framework or our Principles of Good Administration in how it managed Mr C’s increased care needs. We have found it got something wrong here.
24. Miss N and her family felt they had to chase the ICB. This caused Miss N worry about when her father would receive the care he was due and meant he did not get access to this as quickly as he should. This is turn was distressing for the family when he could not have the personal care he needed towards the end of his life.
Holding a meeting with Mr C’s family
25. Miss N says she asked the ICB to meet with her and her sister to discuss what had happened to her father once we had concluded our previous look at her complaint in April 2023. She told us the ICB had not organised this by the end of February 2024. By the end of July 2024 it had still not organised this. She therefore feels it took too long to set a meeting up even though it cancelled proposed meetings at short notice. She says this caused her family further distress and concern about how the ICB was dealing with Mr C.
26. The ICB says it tried to organise this meeting on several occasions, but had to postpone it due to issues such as staff sickness or room availability. It says Mr C’s family turned down an offer to meet online which further delayed the process. It says it understood how important this meeting was to Miss N and her sister.
27. The NHS Complaint Standards say organisations should provide a suitable remedy if something has gone wrong. This includes ‘expediting an action’. The ICB’s complaints policy says this can include having a meeting with complainants to discuss a complaint and try to resolve matters. The policy says the ICB should show sensitivity about where this meeting would be held. Our ‘Principles of Good Administration’ say public bodies should do what they say that are going to do and deal with people promptly.
28. The records show the ICB offered Miss N a meeting to discuss its investigation and consider further updates and clarifications on 7 July 2023. This was in line with the NHS Complaints Standards and its own complaints policy.
29. But we can also see it had not arranged this meeting by 13 September when Miss N emailed to ask about this. The ICB did maintain contact with her and sent a further email on 3 November which included a letter from its CEO. The email also said someone would be in touch to arrange the meeting with Mr C’s family.
30. The records show the family said in December 2023 it did not want to meet with the ICB online. We can see this meant the ICB could only arrange a face-to-face meeting, which did limit its options as to availability of attendees and rooms. The ICB arranged face-to-face meetings with the family for 28 December and 18 January 2024. But it said it had to cancel these because of staff illness and room availability. When Miss N came to us in February 2024, the ICB had not yet held the meeting.
31. We appreciate the ICB did try to arrange dates for a meeting but had to cancel due to unforeseen circumstances. But we can also see these dates were already over five months after it had proposed that as an option for Miss N.
32. The ICB’s complaints policy does not say it must offer a meeting. But it did. It had not held a meeting eight months later. It is not clear why this was not possible at all in that time. The ICB did not do what it said it would do in a timely fashion, as our Principles and the NHS Complaints Standards said it should. We have found it got something wrong here.
33. We think this meant Mr C’s family had to keep pursuing this longer than they should have done. We think this caused them a great deal of frustration and caused them to doubt further how well the ICB dealt with concerns around its CHC service. As Mr C was still receiving a service at the time, this added to their worries about his care.