Care funding case closed before agreed deadline

What happened

In summer 2012 Mrs B, via her solicitors, asked the PCT to review her mother's eligibility for continuing care funding from spring 2010 onwards. When her mother, Mrs C, went into a care home. Mrs B asked for a retrospective review, and a current review.

The PCT assessed that Mrs C did not meet the criteria for a continuing care assessment from winter 2012 onwards. The solicitors disagreed with the decision but did not provide any detail to support their view.

In early 2013 the PCT asked the solicitors for more information to support the claim for the earlier period. It asked them to send the documents by the middle of the next month. The solicitors asked for more time, and the PCT agreed an extension until spring. Close to the date, the PCT wrote to tell the solicitors the case had been closed. This letter crossed with a letter from the solicitors asking for leniency as Mrs C had recently died and they were awaiting instructions from the executors of her will. The PCT did not respond to the solicitors' letter.

The solicitors provided the necessary information in winter 2013 and the clinical commissioning group (CCG, which had by then taken over from the PCT) declined to reconsider the case. The solicitors complained about the PCT's decision to close the case, but the CCG deemed it had been appropriate. Mrs B then came to us.

What we found

We partly upheld this complaint. The CCG acted reasonably on the request for a current review because the PCT had made a decision and the solicitors had not given it any information to support their dissatisfaction with the decision.

As for the retrospective review, it was inappropriate for the PCT to close the claim before the agreed deadline. The PCT should have acknowledged the solicitors' letter informing it of Mrs C's death and considered whether to allow any more time.

Putting it right

The CCG agreed to reconsider the decision to close Mrs B's case.