Issue one- concerns relating to the eligibility decision
28. We understand that on the 5 June 2024 the ICB reached a decision that Mrs X’s daughter was no longer eligible for CHC funding.
29. The family appealed this decision and initiated the local resolution process. Mrs X complained that the decision was not sound as the process followed was not robust. Further to this, we can see the ICB acknowledged that there were failings in how the assessment was completed and it decided to complete a new DST.
30. We understand the family has been informed on the 19 February 2026 that the decision has been overturned, and their daughter has been found eligible for CHC funding.
31. Having carefully reviewed the evidence, we can see that there were failings in how the ICB completed the initial assessment which found Mrs X’s daughter not eligible for CHC funding. We have considered the impact of this.
32. We cannot link this to have affected eligibility given that the ICB took actions to complete a new assessment which has found her now eligible. We find it reasonable for this decision to have caused the family distress, worry and inconvenience.
33. Mrs X raises concerns that because of the failings, she felt ‘forced’ to have to instruct legal representatives. For this reason, she says the ICB should pay for the legal fees she has paid. We acknowledge that the process has been long, frustrating and distressing for Mrs X. It is reasonable that she wanted to do everything that she could to ensure her daughter was getting her needs met, this including getting legal advice.
34. Saying this, the decision to instruct solicitors was made by choice. We cannot say that this was caused by the failings. As such we do not consider it reasonable for the ICB to have to pay for the legal fees.
35. We can see the ICB has acknowledged failings and has taken actions to remedy this by way of acknowledging the errors and completing a new assessment. We consider these actions to be in line with our Principles for Remedy, which say organisations need to be open and accountable, whilst acting fairly to put things right. We feel the ICB’s actions remedy the distress this part of the complaint has caused. We do not propose any further actions.
Issue two- concerns relating to the care package
36. Mrs X complains that following the ICB’s decision that her daughter was not eligible for CHC funding, it decided that it would stop her care package. We can understand how worrying this must have been for Mrs X. We have carefully considered these concerns.
37. We acknowledge that the decision to stop the care package was because of the eligibility decision. We are satisfied we have addressed this above.
38. We have carefully considered the events and understand that at no point was the care package stopped. Mrs X has confirmed this is also the case.
39. We understand it must have been distressing for the family to know the care package may stop, however, we can see this did not happen at any point. We can see there is no evidence that there was a reduction in care.
40. We consider this to be in line with paragraphs 90-91 of the National Framework:
‘90. CCGs must have complaints procedures in place to respond promptly to any request to review disagreements voiced by the child or young person or their family or carer about any aspect of the continuing care process.
91. CCGs will already have a system for reviewing assessments or decisions by a senior panel and/or by referral to an out-of-area continuing care team to provide greater patient confidence in the impartiality in decision-making. Any dispute with a child or young person and their family should go through this process. Any package of care should remain in place whilst a dispute is ongoing.’
41. Given that at no point did the package of care stop, we do not find any indications of failings.
Issue three- concerns relating to complaint handling
42. Mrs X complains the ICB has failed to respond to its letter dated 17 April 2025. She tells us that this letter detailed 12 separate complaint issues and says the ICB has failed to respond to this.
43. We have carefully reviewed the complaint file. Having done so, we can see that the letter from Mrs X details 12 separate issues which all relate to the robustness of the initial complained of assessment.
44. Following this, we can see the ICB’s legal representatives wrote to Mrs X on the 4 June 2025. Having carefully reviewed this, although we acknowledge that each issue was not responded to separately, the ICB has acknowledged failings in the issues and reached an outcome for a new assessment to be completed. We do not consider it necessary for each issue to have been separately responded to given that they all relate to the same issue i.e., the robustness of the assessment.
45. We consider the ICB to have responded to the complaint in line with NHS England’s Complaint Policy. This says staff should carry out an investigation, provide a remedy and as soon as is practical after the investigation, the person carrying out the investigation will co-ordinate a written response.
46. We can see following Mrs X raises the concerns, the ICB investigated these. It found failings. It then decided a remedy which was to re-assess their daughter and provided a written response.
47. Based on this, we do not consider there to be any indications of failings.
Issue four- concerns relating to communication
48. Mrs X complains that during the complaint’s process there have been continued delays by the ICB in responding to its concerns. She says both her and her legal representatives have had to continuously chase for updates.
49. We have carefully reviewed these concerns and the complaint correspondence. We can see that there have been some delays. We can see that following Mrs X initiating stage two of the complaint process on the 12 August 2024, the ICB did not respond until the 3 February 2025.
50. We can also see further delays. Following the ICB’s correspondence dated the 3 February 2025 stating that the care package will be gradually stopped, Mrs X wrote back on the 7 February 2025. We can see the ICB did not respond until the 20 March 2025. This was only after Mrs X initiated judicial review proceedings.
51. We do not consider this to be in line with NHS complaints policy which says that complaints should be acknowledged in three working days of receiving them. This can be done in writing or verbally.
52. We have considered the impact Mrs X says she has suffered. We consider it reasonable that this has caused her distress, worry and inconvenience. We are sorry to hear about this.
53. We have carefully considered this in line with our severity of injustice scale (our scale). Our scale contains six different levels of injustice that a complaint can fall into, which increase in severity. This includes the lower impacts such as distress and increase in severity such as where a person has lost their life because of failings.
54. We have considered the distress Mrs X has suffered in line with our scale. We can see that the delays amount to around seven months. This would therefore fall within level three of our scale which includes ‘distress, upset or worry lasting six to 12 months.
55. In order to keep up with the demand on our service, we have decided to focus our resources on complaints where we can make the most impact and where serious impacts have been suffered. We do not feel this part of Mrs X’s complaint meet these criteria. This does not diminish the distress Mrs X and her family have suffered, we recognise it has been a difficult time.
56. Based on this, we have decided not to progress these concerns any further and do not propose any further actions.
57. We recognise this has been a difficult process and we were sorry to hear about Mrs X’s concerns. We thank Mrs X for bringing this complaint to our attention. This has allowed us to robustly consider the complaint.