11. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.
12. We have discussed this with Mrs N to understand the reasons why they could not do so. We have also considered the time the ICB has taken to respond to Mrs N’s complaint.
13. Miss T transitioned from child to adult CHC in November 2017 when she turned 18 years old. The ICB decided it would only partly fund the CHC at 40%, and the family were told they had to use their compensation monies from their legal claim for the remaining 60% of care needs she required.
14. Mrs N says on 8 September 2021 she was informed by her daughter’s CHC case manager that Miss T was eligible for 100% CHC funding and she should not be using her personal funds.
15. From February 2022, Miss T received 100% CHC funding.
16. Mrs N made her formal complaint to the ICB on 11 March 2024 and again on 19 August 2024.
17. The ICB responded to this complaint on 4 June 2024, 14 June 2024 and 28 October 2024.
18. Mrs N told us her date of knowledge was 8 September 2021, when she was advised by her daughter’s new case manager that Miss T was eligible for 100% CHC funding and should not be expected to use her compensation from her legal claim to pay for her care needs.
19. From the evidence we have seen, we consider Mrs N’s date of knowledge was later, in February 2022 when the ICB decided Miss T was eligible for 100% CHC funding.
20. This means for Mrs N to be within our time limit, she should have complained to us by around February 2023. She complained to us in March 2025. This means this complaint is outside our time limit by around two years.
21. The total time taken for the local resolution process was over seven months.
22. From the chronology of events there are three periods of time when Mrs N could have either pursued her complaint with the ICB or brought her complaint to us. We will consider these in turn including Mrs N’s explanation for the same.
23. The first period is from February 2022 when the ICB decided Miss T was eligible for 100% CHC funding, and the family became aware, the previous funding arrangement was incorrect.
24. Mrs N told us her daughter’s caseworker at the ICB advised they would review Miss T’s case to understand why she was not considered for 100% CHC when she turned 18. Mrs N says she did not receive any further information from the case manager. She says from around June 2022, her daughter’s health started to deteriorate, and this was an incredibly intense period up to her death in March 2023.
25. There was a delay of one year from when Miss T sadly died to when Mrs N decided to make her formal complaint. We understand Mrs N was grieving the death of her daughter. She also told us her mother was unwell and sadly died one year after her daughter’s death and she was supporting her mother during this time.
26. Mrs N also told us during this time the ICB was completing a LeDeR report (Learning Disability Mortality Review) to review the care Miss T had received and if there was any learning for the ICB to improve its service. Mrs N told us she received the ICB’s LeDeR report ten months after her daughter’s death.
27. We also understand during this time Miss T’s financial deputy, (who advised on the money she had been awarded in her legal claim) decided to seek legal advice on possibly recovering the money the family had to contribute towards Miss T’s CHC funding between November 2017 to February 2022.
28. Mrs N says she eventually discontinued the legal claim because it was causing her financial hardship and mental exhaustion.
29. Following the local resolution process, we understand there was a further three month delay before Mrs N brought her complaint to us. Mrs N told us she was mentally and emotionally exhausted and sought support from an advocacy service in bringing her complaint to us.
30. We are very sorry to hear about Mrs N’s complaint. The circumstances leading to her daughter’s death, was clearly an incredibly difficult time for the family. We appreciate the process to apply for CHC is long and frustrating and this coupled with the lengthy local resolution process caused the family frustration and compounded their grief.
31. Having discussed the reasons for the delay with Mrs N we consider the family could have made their complaint to the ICB when Miss T was found eligible for 100% CHC funding in February 2022.
32. We understand Mrs N was informed in September 2021 that the ICB’s previous decision of only contributing 40% towards her daughter’s care package was incorrect. Therefore once the ICB had rectified this, a complaint could have been pursued.
33. We appreciate after Miss T’s death the family were grieving. Mrs N was providing care and support to her mother, she was also involved in the ICB’s LeDeR investigations, pursuing a legal claim and was not ready to make her formal complaint until March 2024. We also understand Mrs N was mentally exhausted from this period and required support from an advocate to bring her complaint to us.
34. We consider the family could have brought their complaint to the ICB sooner and, following receipt of the ICB’s final response, it could have also brought this complaint to us sooner.
35. There are not, therefore, strong reasons to explain the three periods of delay. In these circumstances, it seems likely the family could have complained to us earlier. We therefore cannot see strong grounds to set aside the time limit.
36. Whilst we do not diminish the impact this complaint has had and continues to have on Mrs N and her family, the regulations which govern our work state, a complainant must complain within one year when they first become aware they have a reason to complain.
37. We consider the delay in bringing this complaint to us is too long for us to set to one side. We have decided not to consider it further.
38. We thank Mrs N for bringing her complaint to us.