NHS England appropriately followed national guidance when it decided continuing care funding

What happened

Mrs T lived in a nursing home from 2003 until her death in 2010. She funded her own care until 2010, when she was found to be eligible for continuing care funding. This meant that the NHS paid her nursing home fees for the final three months of her life.

Mrs T's daughter, Ms P, asked the NHS to review whether her mother should have received continuing care funding in the past, because she did not think that her mother's needs had changed. The NHS considered the available information and decided that Mrs T had not been eligible for continuing care funding in the past. Ms P appealed this decision and NHS England reviewed it. NHS England upheld the decision and concluded that Mrs T had not been eligible for continuing care funding in the past.

Ms P subsequently asked us to review NHS England's decision.

What we found

NHS England followed national guidance when it reviewed Mrs T's case and reached a decision. It had established the relevant clinical facts about Mrs T, and there had been an appropriate discussion about how her needs affected her and interacted with one another. NHS England applied the correct eligibility criteria and the conclusions were clinically reasonable.

We did not uphold the complaint from Ms P.