NHS England - South (South East)

3. Mr X complains about how NHS England has progressed his mother’s continuing healthcare claim (CHC) following her being found eligible in the Independent Review Panel (IRP) meeting in September 2022. Mr X specifically raises concerns that NHS England has failed to disclose the ‘next steps letter’ which he says confirmed that the full period of his mother’s condition would be reviewed.

4. Mr X says because of this, it has meant that the full period has not been reviewed. As a result, his late mother’s estate has been financially detrimentally affected.

5. As an outcome, Mr X would like NHS England to disclose the next steps letter he refers to.

6. CHC funding is NHS funding provided to cover the health and social care needs of people with complex health needs. To decide who is eligible the relevant Integrated Care Board (ICB) carry out assessments and reach a decision on eligibility.

7. If a person remains unhappy with this decision, they can request for an IRP to be convened by NHS England. The IRP’s role is to review the ICB’s decision in line with the records. It has the power to make recommendations if it finds that a person should have been eligible for CHC funding.

8. In this case, Mr X progressed his concerns to NHS England who convened an IRP on the 27 September 2022. The IRP found Mr X’s mother should have been eligible for CHC funding and overturned the ICB’s decision. It made recommendations to the ICB to reconsider this and accordingly the ICB processed redress payments.

11. We understand Mr X has a number of concerns relating to how his mother’s claim and redress payments were being considered. We can see he has concerns that fraud was being committed and therefore raises concerns with NHS CFA.

12. NHS CFA is a special health authority whose task is to consider any fraud, bribery or corruption that happens in the NHS.

13. We understand during his discussions with NHS CFA, Mr X received an email dated 14 September 2023 which essentially stated that the full period of his mother’s condition would be reviewed. It stated (only included extract relevant to this complaint): ‘We note the outcome of the IRP of NHS England and further note you have been offered the opportunity to seek a further review covering the full period of your mother’s condition from the IRP and you are yet to pursue this course’.

14. We can see that Mr X has since been in contact with NHS CFA, the ICB and NHS England to request for the full period to be reviewed. We are sorry to hear about the difficulties he has experienced and can understand why he feels so strongly about this complaint.

15. We can see NHS England has confirmed this offer was never made by it and it has no knowledge where this information has derived from. Mr X has concerns that NHS England made this offer in a ‘next steps letter’ to the ICB/ NHS CFA and now this is not being disclosed to him.

16. The National Framework says in section ‘Establishment and operation of the panels’ in paragraph 22: ‘A full record should be made of the IRP hearing, including details of those present and their role, the issues and evidence considered, the conclusions and recommendations reached by the IRP, and the reasons for them. A copy should be sent by NHS to all parties’.

17. We have carefully reviewed all available evidence including submissions from Mr X, correspondence between all parties including Mr X, the ICB, NHS CFA and NHS England.

18. We can understand the reason for Mr X’s concerns and acknowledge that the email from NHS CFA did refer to the full period of his mother’s condition being reviewed. However, having reviewed the available evidence we have seen no evidence to suggest that this was agreed by NHS England or communicated to any parties including the ICB or to NHSCFA.

19. We can see NHS England states in its email dated 21 December 2023 ‘the CHC team has been in contact with NHS CFA and it has confirmed that this instruction did not originate from NHS England’.

20. We have also requested all correspondence from NHS England that was sent to all parties, including the ‘next steps letter’ which accompanies the IRP report. Having reviewed these, there is no evidence to suggest that NHS England agreed to review the full period.

21. We can see it shared the IRP report including the recommendations letter dated 29 November 2022 to Mr X and the ICB. In this, there is no reference to a request for the full period to be reviewed.

22. We can also see NHS CFA is also unable to confirm the source of this information. Following Mr X raising concerns, NHS CFA stated ‘the paragraph from my letter was the understanding we had at that time. The position of the ICB either then or subsequently is a matter for you to address with them’.

23. We are satisfied NHS England has acted in line with the National Framework referenced above as it has disclosed all relevant records to Mr X. There is no evidence to suggest that pertinent information is being withheld. There is no evidence to suggest that NHS England agreed to review the full period of Mr X’s mother’s condition.

24. We therefore find no indications of failings in NHS England’s actions. We do, however recognise the distress the original email from NHS CFA has caused to Mr X.

Conclusion

25. Having carefully considered the evidence, we find no evidence of failings in NHS England’s actions. We therefore do not propose any further actions on this complaint.

26. It is important to acknowledge that where we have not identified any indications that something went wrong, it does not detract from Mr X’s experience, nor the impact this has had on him.

1. We have carefully considered Mr X’s complaint about NHS England. We appreciate this has been a difficult time for Mr X and we have kept this in mind when considering the complaint. We offer our condolence for the loss of his mother.

2. We have carefully considered Mr X’s concerns that NHS England has failed to disclose a letter which confirmed that it will review the full period of his mother’s condition. Having done so, we have decided that there is no evidence to suggest that NHS England has not shared relevant information with Mr X. We therefore consider there are no indications of failings.