Son was unhappy about NHS decision not to fund father's care

What happened

Mr E lived in a care home from beginning of 1997 until he died in late 2008. During his stay, he was assessed for NHS continuing healthcare funding in autumn 2004, early spring 2007, summer 2007 and again in mid–autumn 2008. Following these assessments he was awarded differing levels of care funding.

Following the assessment in autumn 2004 he was classified as eligible for high band Registered Nursing Care Contribution. After he was assessed again in summer 2007, Mr E was classified as eligible for medium band Registered Nursing Care Contribution. Following the final assessment in mid–autumn 2008 he was classified as eligible for full NHS continuing healthcare.

Mr A disputed the level of care funding awarded to his father during this period and believed him to be eligible for full NHS continuing healthcare funding for the entire period from early spring 2004 to the end of 2008.

What we found

We partly upheld this complaint. The CCG explained that Mr E was assessed for NHS continuing healthcare on each occasion. However, there was a 30–month gap between the first and second assessments where there was no record of an NHS continuing healthcare assessment taking place. There was no evidence to explain why an assessment was not carried out at any time between 2005 and 2006.

During the assessments in 2007 and 2008, Mr E's next of kin and power of attorney at the time, Mrs F, was present for the assessments. The CCG informed Mrs F of the results and gave her the opportunity to comment on the findings. The CCG also advised Mr E and his Family of their right to appeal at that time but they made no appeal.

All the assessments clearly indicated that the CCG was considering continuing healthcare funding for Mr E. The CCG also made Mr E's representative and next of kin aware of the result of the assessments and gave her the opportunity to raise concerns if she wasn't happy with them. There was no evidence that the representative and next of kin raised any objections and we decided that the decision of the CCG not to review the periods covered by these assessments was appropriate.

There was no evidence that any assessments of Mr E's eligibility for NHS continuing healthcare were carried out in the 30 months between autumn 2004 and spring 2007, which is clearly an unassessed period of care. This was a failing by the Primary Care Trust (subsequently replaced by the CCG in 2013).

Putting it right

The CCG agreed to consider reviewing Mr E's eligibility for NHS continuing healthcare for the period of autumn 2004 to early spring 2007.