Returned Checklist and GP reminders.
12. Mr I complains the ICB incorrectly returned a checklist received on 30 June 2022 from Mrs I’s GP. He says the application was rejected by the ICB on 15 July 2022 on the grounds the handwriting was illegible. He says this was not communicated to him or his family. As a result, no action was taken until a second checklist was completed in February 2023.
13. Mr I also complains the ICB did not issue his mother’s GP with a reminder after it had sent back the checklist in June 2022. Mr I says, once the ICB had returned the checklist on 15 July 2022, the decision was not communicated to his family by either the ICB or the GP. He says the ICB did not investigate why the GP failed to resubmit another one.
14. The ICB apologised for not informing Mr I the checklist had been returned. It explained it had been returned as the GP had not completed it correctly.
15. The ICB initially said in its first response it is not the responsibility of the ICB to remind GP’s when a checklist had been returned. In its second response, the ICB said it would start to issue reminders when applications are returned. The ICB sincerely apologised for the shortfalls in its service. In its third response it recognised it would be good practice to send reminders. It explained implementing service improvements did not confirm it was obligated to do so.
16. We have seen an IRP took place on 2 September 2025.
17. The National Framework says:
‘216. Where it has not been possible to resolve the matter through the local resolution procedure, the individual may apply to NHS England for an independent review of the decision, if they are dissatisfied with: • the procedure followed by the ICB in reaching its decision as to the person’s eligibility for NHS Continuing Healthcare.’
18. The National Framework goes on to say:
‘Annex D: Independent Review Panel Procedures An IRP’s key tasks are, at the request of NHS England, to conduct a review of the following: (b) the procedure followed by an ICB in reaching a decision as to that person’s eligibility for NHS continuing healthcare
and to make a recommendation to NHS England in the light of its findings on the above matters.’
19. In line with the National Framework, the IRP’S role includes reviewing the procedural concerns Mr I had about the ICB. Therefore, when Mr I applied for an IRP, this was the appropriate place for him to raise his concerns about the ICB’s actions. On review of the IRP report, we are pleased to see in section 14 and 16, recommendations were made by the IRP regarding the procedure followed by the ICB. This included actions for the ICB to take to make service improvements. This put right what went wrong and there is nothing further we can add to IRP’s recommendations.
Retrospective review
20. Mr I complains the ICB completed a retrospective review of his mothers’ needs for the period June 2022 to February 2023. Mr I said a checklist should have been completed in June 2022. This checklist was returned to the GP by the ICB. A new checklist was not completed until February 2023. He says because of the ICB’s actions, it should backdate his mother’s care costs to June 2022 without the need for further assessment.
21. The ICB said it has a duty to carry out an assessment and does not award CHC funding without justification.
22. We have reviewed the records.
23. Mr I made his first complaint to the ICB on 13 November 2023. In this complaint he requested the ICB backdate his mother CHC funding to the date the first checklist was completed, June 2022.
24. The ICB in its first response on 29 April 2024 acknowledged Mr I’s request. It said it would conduct a retrospective review of his mother’s needs backdated to 30 June 2022, as a previously unassessed package of care (PUPoC). This was the first time Mr I was aware a PUPoC would be carried out.
25. On 12 June 2024 Mr I contacted the ICB. He explained the ICB should drop its requirement for a retrospective review. He explained the ICB should take responsibility for the delays it had caused and proceed to reimburse the care costs for his mother.
26. On 17 July 2024 the ICB responded. It explained it is a legal requirement for a retrospective review to be taken. It said it would not be appropriate for a CHC Team to assume because a patient was eligible for funding during a particular period, they would automatically be eligible for an earlier period.
27. On 5 June 2025 the ICB confirmed again it would be completing a retrospective review. It did acknowledge it had not mentioned it was a legal requirement in its first letter, 29 April 2024.
28. The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 says:
‘Duty of relevant bodies: assessment and provision of NHS Continuing Healthcare 21 In exercising its functions… a relevant body must comply with paragraphs (2) to (11).
(2) A relevant body must take reasonable steps to ensure that an assessment of eligibility for NHS Continuing Healthcare is carried out in respect of a person for which that body has responsibility in all cases where it appears to that body that— (a)there may be a need for such care; or (b)an individual who is receiving NHS Continuing Healthcare may no longer be eligible for such care.’
29. Based on the regulations, the ICB were correct to say it had a duty to ensure an assessment was carried out. Point 14 of the National Framework says NHS England, ICBs and local authorities must comply with their responsibilities, as set out in the Standing Rules and Care Act legislation, as appropriate, in relation to NHS Continuing Healthcare.
30. We have seen Mr I explained in an email to the ICB on 18 March 2025 the checklist completed in June 2022 would have resulted in an assessment. He indicates this is why his mother’s GP made the referral to the ICB. As noted above, a second checklist was not completed until February 2023. A full assessment was completed after the February 2023 checklist.
31. The National Framework says:
‘What happens following a positive Checklist?
A positive Checklist means that the individual requires a full assessment of eligibility for NHS Continuing Healthcare. It does not necessarily mean the individual is eligible for NHS Continuing Healthcare.’
32. We are aware the ICB rejected the checklist in June 2022. We cannot say if it would have resulted in a full assessment. We acknowledge Mr I says it would have been positive. If it was positive, a full assessment would have been completed. As it says in the National Framework, it does not necessarily mean the individual is eligible for NHS Continuing Healthcare.
33. We will now consider what actions the ICB took. The ICB agreed to a PUPoC assessment. Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012 says:
‘Definition of a previously unassessed period of care A request for a PUPoC assessment refers to a request for an ICB to consider NHS CHC eligibility where the ICB had responsibility for an individual, for a specific past period of care, where: • there was no consideration of NHS CHC eligibility by the relevant ICB for that individual during the past period of such care • that individual had funded that past period of care in full or in part • there is appropriate, objective evidence that the individual should have been considered for eligibility for NHS CHC in accordance with The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (as amended) and the national framework’
34. In line with this guidance, there had not been a consideration of Mrs I’s eligibility, in part or full, for the period June 2022 to February 2023. As Mr I says the checklist in June 2022 would have been positive, we consider there was evidence Mrs I should have been. We therefore consider the period June 2022 to February 2023 met the definition of PUPoC.
35. Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012 goes on to say:
‘The NHS CHC full assessment process Where the checklist indicates that a full assessment of part or all of the claim period is appropriate, the completed needs portrayal should then be used to complete the decision support tool (DST) for that period (the current version of the DST should be used to process PUPoC requests). The DST must be completed by a multi-disciplinary team (MDT), as arranged by the ICB and in accordance with the national framework.’
36. The assessment carried out under Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012 is the same assessment which would have been carried out under the National Framework had a positive checklist been accepted in June 2022. This would have placed Mrs I’s back in the position she was if a positive checklist had been accepted in June 2022. The ICB did not get anything wrong here.
37. We acknowledge Mr I feels due to the delays in the CHC process the ICB should backdate his mother’s care costs to the date of the first checklist. We understand this has caused him significant frustration. We consider the ICB’s decision making is in line with relevant legislation and guidance. Its decision to complete a PUPoC assessment is supported by the National Framework and Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012 guidance.
38. Following the PUPoC assessment, Mr I still had the ability to challenge the decision. The National Framework explains if someone does not agree with a decision following an assessment, they have the right to request a review through an independent review panel (IRP). We can see Mr I has already explored this. We note the IRP did not find failings in the ICB’s eligibility decision.
39. We thank Mr I for bringing his complaint to us. We will not be taking any further action.