Trust wrongly asked for clinical evidence to support claim for NHS continuing healthcare funding

Summary 880 |

Mr R complained that the Trust had not fully considered Mrs R's (his late mother's) eligibility for NHS continuing healthcare funding. Mr R also complained that the Trust asked his representative to provide evidence and records to support his request for funding.


What happened

Mr R, via his representative, asked for a retrospective assessment of Mrs R's eligibility for NHS continuing healthcare funding for the period from summer 2004 to spring 2007.

The Trust said that it would only review the periods from early winter 2005 to late autumn 2006, and autumn 2006 to spring 2007. This was because checklist screenings to decide how much NHS continuing healthcare funding Mrs R was eligible for had been carried out for the remainder of the claim period. The Trust asked Mr R's representative to provide evidence and records to support the request for funding. The Trust would not progress the continuing healthcare funding review without these.

What we found

We partly upheld this complaint. The Trust correctly declined to consider part of the review period because the appropriate checklist screenings had already been done. However, the Trust had a duty to review Mrs R's eligibility for NHS continuing healthcare funding as there was evidence that she may have needed such care. In these circumstances, it was the Trust's responsibility to gather the evidence and records needed to complete the review.

Putting it right

The Trust acknowledged its failings and apologised to Mr R for the injustice caused. The Trust continued the review of Mrs R's eligibility for NHS continuing healthcare funding for the periods winter 2005 to autumn 2006, and autumn 2006 to spring 2007. The Trust reviewed its processes for dealing with requests for retrospective reviews and brought these in line with guidance.

Health or Parliamentary
Health
Organisations we investigated

Oxford Health NHS Foundation Trust

Location

Oxfordshire

Complainants' concerns ?

Came to an unsound decision

Result

Apology

Recommendation to change policy or procedure

Taking steps to put things right