Mistakes in continuing care funding decision

What happened

A primary care trust (PCT) assessed Mrs R for NHS continuing care funding in spring 2008. It found she was not eligible for funding. Mr R disagreed with this decision and corresponded with the PCT about this. The PCT agreed to review his mother's eligibility for NHS continuing care with the family's consent.

Mr R next contacted the PCT in spring 2010 about the funding decision. The PCT subsequently reassessed his mother's eligibility for funding in early 2013. It found she could have funding.

In the interim, the local authority issued a summons to Mr R for nursing home fees that had not been paid. Mr R employed a solicitor to deal with this while he was waiting for the PCT to complete the reassessment.

The PCT paid the debt to the local authority once the reassessment was complete. Mr R asked for his solicitor's fees to be paid, but the PCT declined. Mr R complained about this to us.

What we found

We partly upheld this complaint. When it decided whether to reimburse Mr R's costs, the CCG, which took over this case when the PCT ceased to exist, did not consider all the circumstances of his case. We said that it should have taken account of the delay before this case was finished, and the impact this had on Mr R. Although we would not usually expect CCGs to compensate people for the time they spent on an appeal against an NHS continuing care cost decision, Mr R experienced exceptional inconvenience.

We could not link the wrong continuing care funding decision and Mr R's legal costs.

Putting it right

The CCG apologised to Mr R and paid him £250 compensation. It also agreed to draw up an action plan to address the failings.