Black Country Integrated Care Board

4. Ms F complains the ICB wrongly decided not to fully assess Mrs N’s needs to determine if she was eligible for continuing healthcare funding. She says the ICB did not fully consider all the available evidence when it completed a checklist on 27 May 2021 and when it reviewed this on 2 February 2022.

5. She says the ICB’s mistakes have financially disadvantaged her mother’s estate as she had to pay for her own care when Ms F believes it should have been NHS-funded.

6. Ms F also complains the ICB failed to correctly handle her complaint after it agreed to look at the checklist again on 8 September 2023. She complains the ICB has not done what it promised it would, and it has not contacted her.

7. She says this has caused her worry and distress as the ICB’s failure to act has unnecessarily prolonged an already long process.

8. Ms F wants the ICB to reconsider its decision not to fully assess her mother’s needs and complete a new checklist. She also wants it to acknowledge and apologise for its failure to handle her complaint and pay financial compensation for the distress this has caused her.

9. In January 2019, Mrs N moved into a residential care home. She had been diagnosed with vascular dementia. On 16 April 2020, she had a stroke.

10. On 27 May 2021, a social worker from the local authority completed a CHC checklist. The checklist is a screening tool to determine if the person needs a full CHC eligibility assessment. it looks at their needs in 11 care domains and assigns a score to each, from ‘A’ (the highest level of need) to ‘C’ (the lowest level of need). The checklist is positive and the person screens in for a full assessment if they have certain combinations of ‘A’ and ‘B’ scores.

11. Following concerns from Mrs N’s family, the ICB reviewed the checklist on 7 July and found she did not need a full assessment.

12. On 13 July, Mrs N was admitted to hospital after having another stroke. She remained in hospital until she sadly died on 15 August.

13. On 7 October, the ICB shared a copy of the checklist and its review with Ms F. On 28 October, Ms F complained to the ICB about the checklist.

14. On 2 February 2022, the ICB completed a full review of the earlier checklist. It made some changes to the domain scores but did not change the overall outcome. It shared its findings with Ms F on the same day.

15. On 10 June, Ms F sent a formal complaint about the ICB’s checklist and its decision not to assess her mother for CHC eligibility. It responded on 12 September, upholding its original decision.

16. Ms F brought her complaint to us. We considered the information in the complaint and saw the ICB’s review on 2 February 2022 did not appear to be based on the information in Mrs N’s records.

17. We asked the ICB if it would be willing to complete a new checklist using the evidence in Mrs N’s care records to inform its thinking. On 8 September 2023, the ICB agreed to do this.

18. The ICB has told us that on 26 January 2024, it completed a new checklist to determine if Mrs N should be assessed for CHC eligibility. It did not share this with us or with Ms F, or let her know it had done it.

19. On 10 May 2024, we opened a new complaint because Ms F had had no further information since the ICB agreed on 8 September 2023 to do a new checklist.

20. On 14 May 2024, we wrote to the ICB to propose to carry out a detailed investigation into Ms F’s complaint. The ICB acknowledged our proposal but did not provide any comments and did not confirm it had completed the checklist. We confirmed our detailed investigation on 31 May.

23. We first looked at this complaint in 2023 and we gave Ms F our view on why we thought the ICB had got things wrong in how it came to the decision it did when it completed her mother’s checklist. This explained why we had asked the ICB to look at it again, and complete a new checklist. We know the ICB has completed a new checklist now, but we did not know this when we initially proposed to do this detailed investigation and shared our first provisional views. So we reiterated our view on what the ICB got wrong as part of our provisional decision to illustrate why it still needed to put this right.

24. We now know the ICB did do the new checklist, so the key part of this complaint is how it handled Ms F’s complaint, and it is this part which has prompted us to make the majority of our recommendations. This is the part of the complaint we will look at first, but we have still included our findings on what the ICB got wrong when it completed the checklist in 2021 and 2022 for completeness.

25. We have not looked at, or given a view on the new checklist the ICB completed in 2024, as it is not part of the scope of our investigation.

26. Ms F has complained how the ICB has managed this case after it agreed to take another look at her mother’s checklist. She says this has caused her worry and distress, and has unnecessarily prolonged a process which has already taken a long time.

27. As mentioned above, we originally looked at Ms F’s complaint about the checklist and its review in 2023. We recognised the ICB should have done more. On 8 September, it agreed it would gather Mrs N’s care records and complete a new checklist. We informed Ms F of this through a detailed written statement on 29 September.

28. In January 2024, Ms F contacted us as she had not heard from the ICB. We contacted the ICB by telephone and email on 19 January and asked it to update Ms F on the work it was doing to resolve her complaint. The ICB acknowledged our email and agreed to update Ms F. It did not do this.

29. We contacted the ICB again on 24 April and asked it to send Ms F an update by 1 May. The ICB acknowledged our request and asked for some more information about the case. It did not contact Ms F.

30. Our Principles of Good Administration outline what public bodies should do to provide a great public service. One of the principles of this guidance is being customer focussed. This principle says, ‘public bodies should do what they say they are going to do. If they make a commitment to do something, they should keep to it, or explain why they cannot.’

31. The ICB committed to completing a new checklist on 8 September 2023, and sharing it with Ms F. It did not contact Ms F to update her with its progress or to let her know it had completed the revised checklist, and it did not contact us. When we contacted the ICB in April and it replied to ask for more information, and in our emails relating to this detailed investigation, it does not appear to have realised it had taken the agreed action until the very late stages. It is not clear why. However, it is clear the ICB did not follow our principles. The ICB should have done what it said it would do by sharing its revised checklist with Ms F, either at the time, or when prompted by our numerous contacts in April, and when we proposed to investigate the complaint.

32. The ICB did have earlier opportunities to resolve this complaint for Ms F too, and the NHS Complaint Standards are relevant here. They offer guidance for public bodies on how to handle a complaint. One of the key principles of the Standards is ‘staff look for ways they can resolve complaints at the earliest opportunity.’

33. The ICB had a clear opportunity to resolve this complaint for Ms F when it first looked at it in 2021. Through its own review, it identified mistakes in the first version of Mrs N’s checklist, which it attempted to put right. When Ms F complained, it told her it would fully review the checklist, and put right the mistakes it had already highlighted.

34. The ICB should have done more when it completed its review in February 2022. The review did not take into account the information in Mrs N’s medical records. It only considered the information in the previous checklist. The ICB had already found the previous checklist was flawed, as it concluded it needed to be reviewed. The previous checklist was not a reliable source of evidence.

35. The National Framework guides the ICB on how to complete a checklist. It says:

‘The checklist requires practitioners to record a brief description of the need and source of evidence used to support the statements selected in each domain. This could, for example, be by indicating that specific for a given domain was contained within the inpatient nursing notes on a stated date.’

36. The ICB did not do this when it completed its review in February 2022. It should have looked at the evidence in Mrs N’s records when it reviewed its decision not to fully assess her CHC eligibility.

37. We acknowledge the National Framework is clear completing a checklist is intended to be quick and straightforward, and it is not necessary to provide detailed evidence. Our findings are not intended to suggest the ICB should have provided vast amounts of detail when it reviewed the checklist. It should have looked at Mrs N’s records though, and given a brief description of her needs as guided by the National Framework.

38. By not following the National Framework and considering the evidence in Mrs N’s records, the ICB missed an opportunity to resolve this complaint for Ms F at the earliest opportunity. If it had correctly reviewed the checklist, it is more likely than not it would have resolved this complaint for Ms F.

39. We have found failings in how the ICB handled Ms F’s original complaint. We have also found failings in how it managed its commitment to put things right for her.

The impact the ICB’s failings had on Ms F

40. We have looked at the impact this has had on Ms F. She was told the ICB would put her complaint right for her in 2021. As we have outlined, it should have done more here. This prompted Ms F to bring her complaint to us. The ICB then committed to completing a new checklist in September 2023. The ICB has done this now, but it did not share it with Ms F.

41. Ms F firstly had to complain to us to get the issues with the original checklist and reviews resolved. The ICB has now left her waiting an unnecessary seven further months to tell her or us that it had done this. Ms F has not yet seen the new checklist.

42. We can see why Ms F has felt worried and distressed by this. The ICB has told her it would take steps to resolve her complaint twice. On both occasions, it has failed to do so.

43. Ms F also complained the ICB has financially disadvantaged her mother’s estate as she had to pay for her own care.

44. We cannot say Mrs N should have been fully assessed, nor can we say she should be found eligible for CHC, which is what we would need to know to consider if her estate was financially disadvantaged. We have found the ICB should have reviewed its decision not to fully assess her for NHS funded continuing healthcare with the guidance and principles we highlighted above in mind. It should have done this to give Ms F the greatest reassurance her mother’s needs had been correctly screened for a full assessment.

What the ICB has already done in response to this complaint

45. We are pleased to hear the ICB has already taken steps to resolve this complaint for Ms F since we started looking at it, and to improve its service for other people who need support with continuing healthcare.

46. As we have already stated, the ICB has completed a revised checklist. So we do not need to ask it to do this again now.

47. The ICB has acknowledged it had opportunities to resolve this complaint for Ms F and the poor communication between its departments, and with Ms F which meant this complaint is still ongoing. The ICB has confirmed it has taken action to prevent this happening again, by giving its Time2Talk team responsibility to oversee all complaint related communication between its internal departments, complainants and organisations such as us.

48. We are pleased to hear the ICB has taken these steps. The NHS Complaints Standards say ‘organisations support and encourage staff to be open and honest when things have gone wrong or where improvements can be made. Staff recognise the need to be accountable for their actions and to identify what learning can be taken from a complaint. They are clear about how the learning will be used to improve services and support staff.’

49. By identifying where it should have done better, and also being clear where it has made changes to its processes, the ICB has followed the NHS Complaint Standards.

50. Whilst we appreciate where the ICB has made improvements, there are more steps it should take to resolve this complaint for Ms F. We have made recommendations for what the ICB should do, which is what we have outlined next.

1. We have found Black Country Integrated Care Board (the ICB) should have done more when it reviewed Ms F’s mother, Mrs N’s continuing healthcare (CHC) checklist in May 2021, to explain how it reached its decision. We have also found the ICB should have handled her complaint better and told her it had done a new checklist.

2. The ICB has already taken action to resolve parts of this complaint for Ms F. It has produced a new checklist which clearly uses Mrs N’s records as a key source of evidence. But we think it should do more to put right the impacts this had on her. We recommend the ICB acknowledges what it got wrong and apologises to Ms F for the impact it had on her. It should share its newly completed checklist, and it should pay Ms F financial compensation.

3. Ms F has not asked us to recommend specific service improvements for the ICB, but we are pleased to read it has proactively put steps in place to prevent situations such as those raised in this complaint from happening again.

51. Ms F has told us she wants the ICB to acknowledge where it should have done better and apologise for the impact this had on her. She would also like financial compensation.

52. We have referred to the NHS Complaint Standards. These state that NHS organisations should be open and honest when things have gone wrong, recognise when this had an impact on people, and identify suitable ways to put things right.

53. We have found the ICB should do more to resolve this complaint for Ms F. As we have set out above, the ICB’s mistakes have had an impact on her.

Recommendation one

54. Within one month of the date of this report, the ICB should write to Ms F to acknowledge its poor communication with her, and its failure to follow up properly on what it said it would do in the agreement it made with us on 8 September 2023.

55. The ICB should apologise to Ms F for the worry and distress its poor communication has caused her, and how it has unnecessarily prolonged this complaints process for her.

56. When it writes to Ms F, the ICB should also share the checklist it completed on 26 January 2024.

Recommendation two

57. We can make recommendations for financial compensation where we have identified a failing which has caused an injustice or hardship.

58. To determine a level of financial remedy, we have looked at ‘Our guidance on financial remedy’ which includes a severity of injustice scale. It guides us on how much remedy we should recommend, making sure our recommendations are consistent across the complaints we handle, and transparent for everyone who uses our service.

59. Following this review, we can see there appears to have been complaint handling failings that have lasted for more than six months, on top of failings in the issues Ms F complained about. Based on this, we recommend within one month of the date of this report, the ICB pays Ms F £1100 in recognition of the worry and distress she has continued to feel since it reviewed the checklist on 2 February 2022.

60. The ICB should send us evidence it has complied with our recommendations.