Older man left frustrated and out of pocket in continuing healthcare assessment (CHC) claim

What happened

Mr R complained to us after his primary care trust (PCT) told him that he had to pay his wife's nursing home £50 for copies of her records. We tried to persuade the PCT to change its position on this, but were unsuccessful. Mr R had no option but to pay the charge for the assessment to go ahead. He complained to the PCT and then approached us again.

As a result, Mr R said, he had been left out of pocket and discriminated against because his clinical commissioning group (CCG) was not operating a fair system. He was also unhappy with the CCG's response to his complaint and the time it took to reply.

What we found

The National Framework makes it clear that CCGs have to carry out the process of assessing eligibility for CHC funding. In order to do that properly they need to consider all relevant evidence, including care records.

Inevitably there will be times when they will have to pay an administrative overhead to get the information they need. The NHS should not depend on patients or their relatives paying these costs. We did not see any evidence that the CCG discriminated against Mr R but we agreed that the CCG should not have charged him and was not operating a fair system.

The CCG did not give Mr R a reasonable explanation for why it asked him to pay the nursing home's charge. Indeed part of its response to him seemed to have been intended to mislead. Here, the CCG did not act in line with the complaints regulations. It had said that it would reply to his complaint in six weeks but it took about four months to get back to him.

Putting it right

We recommended that the CCG should write to Mr R to apologise for its failings and to repay the £50 fee, along with £250 for his time, trouble and frustration. We also recommended that the CCG should see if it had any other cases where it had passed on charges to claimants, and to offer them an apology and a refund.