DST timing
12. Mrs R complains the ICB did not complete a DST for her mother within 28 days of the positive checklist in August 2022. Mrs R believes the ICB would have found her mother eligible for CHC funding if it had completed the DST when it should have.
13. The ICB did not directly address why it did not complete a DST within 28 days of the positive checklist. The ICB said it initially scheduled the DST for 1 November 2022, but had to reschedule this for 25 November due to staff leave. The ICB could not complete the DST on 25 November as Mrs P was not medically optimised.
14. 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.
15. Mrs P had a positive checklist which was completed on 16 August 2022 and received on 19 August. Mrs R’s complaint is that the ICB did not complete a DST within 28 days, which would have been 16 September. The ICB did not schedule the DST until 1 November, and then postponed this until 25 November. This then did not go ahead as explained above.
16. Mrs R was fully involved with her mother’s CHC application process as her next of kin, so would have been aware of what was happening at the time. We appreciate Mrs R may not have been fully aware of the 28-day timescale as set out in the National Framework at the time. It therefore would not be reasonable to say her date of knowledge for this aspect of the complaint was 16 September 2022. It is reasonable to say Mrs R had cause complain about this from November 2022, when the ICB delayed, and then cancelled, the DST.
17. To be in time, Mrs R would have needed to bring her complaint about this to us by November 2023. Mrs R initially wrote to us with her complaint on 13 June 2025, making this aspect of her complaint 19 months out time.
18. Mrs R wrote to the ICB with her initial complaint on 17 May 2024, and it replied on 19 August. Mrs R went back to the ICB with her outstanding concerns on 4 September, and it replied again on 14 November. Therefore, local resolution took approximately six months.
19. Mrs R told us this was a very difficult time for her family, which we of course understand. Mrs R said the staff involved at no point provided her with any information about the process, how to challenge any decisions or raise a complaint, and the timescales involved with this. Mrs R said staff also repeatedly actively discouraged her from continuing with the NHS CHC process. Mrs R also told us she only felt ready to raise the complaint several weeks after her mother died.
20. Mrs P sadly died in February 2024. We understand why Mrs R did not feel emotionally ready to raise her complaint with the ICB until she did in May 2024. We will not hold this time against her in our consideration.
21. We recognise the NHS CHC process is complex and can be confusing. Even if staff did discourage Mrs R, or not make her aware of the appeals or complaints process, this information is available online. We need to consider that there were 15 months between November 2022 and February 2024 where Mrs R could have looked into how to raise her complaint with the ICB. Mrs R also did not contact us for seven months following receipt of her final response letter from the ICB, which contained our details.
22. We consider Mrs R could have done more to progress her complaint in a more timely manner, both before and after local resolution. We have not seen sufficient reason to put our time limit to one side here. We will therefore not consider this aspect of the complaint any further.
January 2023 assessments
23. Mrs R complains the ICB did not accurately consider her mother’s needs in assessments in January 2023. Mrs R also complains the ICB did not respond to the concerns she raised about these in February 2023.
24. Mrs R told us she received the outcome of these assessments in February 2023, so she would have had cause to complain about them at that point. It is difficult for us to say when exactly Mrs R would have had cause to complain about not receiving a response to the concerns she raised.
25. To be in time, Mrs R would have needed to bring her complaint about the assessments to us by February 2024. Mrs R initially wrote to us with her complaint on 13 June 2025, making this aspect of her complaint 16 months out time.
26. Similar considerations apply here as above, with the difference being there were instead 12 months between February 2023 and February 2024 where Mrs R could have looked into how to raise her complaint about the assessments with the ICB. We recognise Mrs R did send an email outlining her concerns in February 2023, but she did not raise a formal complaint. There were still 12 months here where Mrs R did not pursue this further with the ICB.
27. We consider Mrs R could have done more to progress her complaint in a more timely manner, both before and after local resolution. We have not seen sufficient reason to put our time limit to one side here. We will therefore not consider this aspect of the complaint any further.
Change in needs
28. Mrs R complains the ICB did not reassess her mother following the negative checklist in June 2023, despite her having a change in needs in December 2023. Mrs R said she was not aware that she needed to initiate this process.
29. The ICB said it told Mrs R she could ask for another assessment if her mother’s condition deteriorated when it shared the not eligible decision with her, but she did not do so. The ICB also said it was not clear from the notes if it fully or clearly explained this process to Mrs R.
30. Mrs P’s records do not contain any evidence of the ICB making Mrs R aware she could ask for another assessment if her mother’s condition deteriorated. The ICB told us it would have shared this with Mrs R and her mother’s care home verbally, but it recognised it should have recorded this in the notes, and it had not done so.
31. As we were not there, we cannot say with any certainty what happened. In the absence of any further corroborating evidence, we are unable to form a view on whether the ICB made Mrs R aware she could ask for another assessment if her mother’s condition deteriorated.
32. There is nothing in the National Framework which says an ICB must tell families the responsibility is with them to ask for another assessment if required. We need to consider that Mrs R could have proactively contacted the ICB following her mother’s change in needs in December 2023, to see what options were available.
33. In terms of the stance the ICB has taken, the National Framework does not provide any specific guidance which covers this situation, but does say, ‘Local health and social care joint processes should be in place to identify individuals for whom it may be appropriate to complete a Checklist, including for individuals in community settings.’ This suggests the onus is on ICBs to determine how they approach such matters.
34. In the absence of any national guidance, we can refer to our Principles of Good Administration. Our principles say, ‘When taking decisions, and particularly when imposing penalties, public bodies should behave reasonably and ensure that the measures taken are proportionate to the objectives pursued, appropriate in the circumstances and fair to the individuals concerned.’
35. As the ICB found Mrs P to be not eligible for NHS CHC following the negative checklist in June 2023, it would not have been directly involved in her care going forward. As the ICB was not involved in Mrs P’s care, we consider it is entirely reasonable for it to say it would not act unless it was informed of Mrs P’s deterioration.
36. We have seen that it was reasonable that the ICB did not re-assess Mrs P when her needs changed, as it was not aware this had happened. We will therefore not consider this aspect of the complaint any further.
37. This concludes our consideration of Mrs P’s complaint. We understand how challenging these events have been for Mrs P, and we thank her for bringing her complaint to us for our consideration.