Failure to assess for continuing healthcare

What happened

We had previously asked the CCG to complete a report and a healthcare checklist to decide whether Mr J senior was eligible for a retrospective assessment for NHS continuing healthcare funding. The CCG completed three checklists and decided not to carry out a full assessment of Mr J senior's healthcare needs.

Mr J disputed the outcome of these checklists, which he felt showed that his father qualified for a full assessment.

The CCG acknowledged that two of the checklists suggested that Mr J's father qualified for a full assessment. However, it explained that the period of care for one of the checklists coincided with an acute clinical episode. It said that it was normal practice to allow acute episodes to settle before completing a checklist.

What we found

We partly upheld this complaint. We agreed that the first checklist did not indicate that a full review of Mr J senior's needs was warranted. However, the final two checklists indicated that a full assessment was required.

While the CCG's explanation was reasonable with regard to checklists conducted in 'real time', this was a retrospective review of Mr J senior's healthcare needs. Furthermore the disputed checklist related only to a portion of a period of care for which eligibility was being claimed. As such, we would expect to see an analysis of the whole period, not discounted in any way by comparing it with what would happen in a 'real time' case.

Putting it right

The CCG agreed to complete a full review of Mr J senior's eligibility for continuing healthcare funding for the disputed period.

It also apologised to Mr J for the failings identified in this investigation.