Concerns relating to the delays
14. Mrs X tells us that following an Independent Review Panel Meeting held in March 2020, her mother was found eligible for CHC funding. Accordingly, the IRP made recommendations to the ICB to provide reimbursement payments.
15. Mrs X says the retrospective claim started in 2012 however, an offer for redress payment was made in November 2021. Mrs X complains if the ICB had considered the retrospective claim in a robust and timely manner, she would have been entitled to a higher rate of interest. This is because the claim would have been considered in line with the 2007 guidance.
16. We are sorry to hear Mrs X concerns and can understand why she feels strongly about the delays she has experienced in the initial claim being considered. We have carefully considered these.
17. We appreciate that the retrospective claim was initiated in 2012, however, an eligibility decision was reached in March 2020 when NHS England considered this. We appreciate the distress the delays in the retrospective claim being considered have had. We are satisfied that following an eligibility decision being reached by NHS England, the financial impact of this has been remedied.
18. We are satisfied the ICB has applied the relevant guidance when calculating redress payments. This is because at the time it received NHS England’s recommendations in March 2020, the applicable guidance was the 2015 version.
19. We can see from the records the ICB paid interest at the Retail Price Index (RPI) which is in line with section ‘Interest rate’ of the 2015 which says:
‘CCGs are advised to apply the Retail Price Index for calculation of compound interest when considering redress cases. The index is calculated monthly, with an average for each calendar year. CCGs are advised to apply the average rate for the year for which care costs are being reimbursed’.
20. Mrs X also says that the ICB has failed to provide an ex-gratia payment in line with paragraph two (section redress) of the 2015 guidance. This says:
‘CCGs are independent decision-making bodies. When making redress payments they should employ a transparent rationale and ensure they fully consider the individual circumstances of each case, taking legal advice where necessary. CCGs have the discretion to consider making ex-gratia payments, over and above the care costs and interest, however, these are expected to be exceptional and would need to be made in accordance with a CCG’s own Standing Financial Instructions and any other pre-requisite guidance’.
21. Mrs X raises concerns that because the retrospective claim was ongoing for over nine years as well as the distress of the case moving from organisations, the ICB should make an ex-gratia payment. Based on this she says the ICB has failed to appropriately consider the ‘specific circumstances of the case’ when considering the level of applicable redress payment.
22. We have carefully considered this concern. As detailed above, we are satisfied that the ICB has applied the correct interest rates (RPI rate) in line with the guidance that was applicable at the time it calculated the redress payments. We are satisfied that the decision of eligibility being overturned remedies this and we have seen no evidence to suggest that an incorrect redress amount has been calculated.
23. We do however recognise that the delays in the initial claim being considered have caused Mrs X distress. We would not usually expect stress caused by the delay to warrant additional financial redress.
24. The ICB has a duty to ensure that public funds are managed appropriately in line with the Health and Care Act 2022. We can see that following NHS England’s recommendations, redress payments have been made applying the correct amount of interest rate applicable at the time of this being calculated. We therefore find no evidence to suggest that an ex-gratia payment should be made in this case.
Conclusion
25. Having carefully considered the evidence, we find no evidence of failings in the ICB’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 the family’s experience, nor the impact this has had on them.