4. Ms B complains the ICB wrongly decided not to fully assess her mother’s needs to check if she was eligible for CHC funding.
5. Ms B says the ICB did not fully consider all the evidence when it completed a checklist on 27 May 2021 and when this was reviewed on 2 February 2022.
6. She says her mother’s estate has been financially disadvantaged as her needs were not properly assessed and she had to pay for her own care.
7. Ms B wants the ICB to reconsider its decision.
8. In January 2019, Mrs K moved into a residential care home. She had been diagnosed with vascular dementia. In April 2020, she had a stroke.
9. On 27 May 2021, a social worker from the local authority completed a checklist to see if Mrs K needed a full CHC assessment. The ICB reviewed the checklist on 7 July and found she did not need a full assessment.
10. On 13 July, Mrs K was admitted to hospital after having another stroke. She stayed in hospital until she sadly died in August.
11. In October, the ICB shared a copy of the checklist and its review with Ms B. Later that month, Ms B complained to the ICB about the checklist.
12. On 2 February 2022, the ICB did a full review of the earlier checklist. It made some changes to the domain weightings (scores given to different areas of need) but did not change the overall outcome. It shared its findings with Ms B on the same day.
13. On 10 June 2022, Ms B sent a formal complaint about the ICB’s checklist. It responded on 12 September, upholding its original decision.
16. We have to look at whether there are signs the ICB got something wrong. We do this by comparing what should have happened with what did happen. If we find the ICB did make a mistake, we look at what impact it had on Ms B and her mother. We then look at what the ICB has done, if anything, to try to put things right.
17. We looked at all the information available, including the checklist and reviews. The ICB had its own concerns about the checklist and this led to a review on 7 July 2021. Ms B then complained about the decision, which led to a second review on 2 February 2022. We have focused on the second review when considering this complaint. When we refer to ‘the review’, we are referring to the second review on 2 February 2021.
18. The review found mistakes in the checklist. It found the checklist was completed using an old version of the tool. This is important, as the wording used to define the domains is different in the old version. It also found the checklist did not give a weighting in the mobility and altered states of consciousness domains (two of the areas of need that are reviewed).
19. Of the 11 domains, the review changed the weighting for six of them. The ICB did not look at Mrs K’s care records. It made these changes using the information already included in the checklist.
20. We think the ICB should have completed a new checklist using the evidence in Mrs K’s care records. Paragraph 97 of the National Framework says the checklist requires a brief description of the person’s need and the source of evidence used. We do not think the original checklist from 27 May 2021 is a reliable source of evidence.
21. We also looked at how the review weighted Mrs K’s needs in the mobility domain. The original checklist described Mrs K’s needs in this domain as ‘fully mobile with a walking frame but is classed as high risk of falls due to the sedative side effects of her medication. Is able to fully weight bear.’ Based on this information, the review scored Mrs K’s mobility needs as ‘C’ and said ‘there is no evidence of falls despite risk of falls.’
22. The NHS Continuing Healthcare Checklist describes an ‘A’ in this domain as ‘at high risk of falls (as evidenced in a falls history or risk assessment)’. It describes a ‘B’ as ‘at moderate risk of falls (as evidenced in a falls history or risk assessment)’.
23. We think the ICB made a mistake here. The review could only base its decision on the small amount of information in the checklist. It did not have access to a falls history or a risk assessment. We do not think it could confidently say there was no evidence of falls. We also think it should have noted the checklist’s finding that there was a high risk of falls, which is in line with an ‘A’ weighting in this domain.
24. We have discussed our thinking with the ICB and it has agreed to take another look at Mrs K’s needs using the checklist. It has also agreed to collect the relevant care records from the local authority, so it can fully consider the evidence before completing the new assessment.
25. The NHS Complaint Standards say an organisation should identify suitable ways to put things right. We think by doing the agreed actions, the ICB is giving Ms B the opportunity for her mother’s needs to be assessed in line with the National Framework.
1. We have carefully considered Ms B’s complaint about how the Black Country Integrated Care Board (the ICB) completed a continuing healthcare (CHC) checklist assessment for her mother, Mrs K, on 27 May 2021. We think the ICB made a mistake in how it considered Mrs K’s needs in the mobility domain and we do not think it fully considered the information in her care records. CHC is a package of care which is arranged and funded by the NHS for adults who have complex health needs. A checklist is a tool used to check if an individual should be considered for CHC.
2. The ICB has now agreed to collect Mrs K’s care records and complete a new CHC checklist to decide if she should have been eligible for a full CHC assessment.
3. We appreciate how long this process has been for Ms B and we are sorry to learn that Mrs K sadly died while the ICB was reviewing its decision. By taking this action the ICB will put things right for Ms B in line with our Complaint Standards. We are pleased she is happy with the outcome.