A woman has been repaid over £37,000 after England’s health Ombudsman found that a healthcare provider failed to properly assess and fund her mother’s care.
The Parliamentary and Health Service Ombudsman (PHSO) is urging Integrated Care Boards (ICB) to learn from mistakes and take action to prevent other families facing unnecessary financial strain after a case investigated by the Ombudsman highlighted the issue.
A 61-year-old woman from Beverley, who wishes to remain anonymous, and her late mother financed the latter’s continuing healthcare (CHC) – which are care packages for adults arranged and funded by the NHS - between May and November 2018. This was due to a failure by East Riding of Yorkshire Clinical Commissioning Group (CCG) to fully arrange and fund the care.
The woman and her mother suffered substantial financial loss and also acute anxiety about money running out.
The mother had chronic obstructive pulmonary disease (COPD), anxiety, hypoxia, a low blood oxygen condition causing shortness of breath, and a tremor.
The woman felt she had to coordinate care and look after her mother with little support from the CCG, now known as Humber and North Yorkshire ICB.
The CCG began assessing the mother on 11 May 2018 and agreed funding for 21 hours of care a week. In October funding was agreed for 24-hour care but a Personal Health Budget (PHB) was not finalised before she died on 1 November 2018, aged 81.
The woman complained about the money she was owed for her mother’s care, but the CCG only reimbursed her for £2,418.81.
PHSO’s investigation found avoidable delays in establishing the PHB once funding was agreed. The Ombudsman also found that an assessment could have been completed earlier for night care.
Other failings included:
- communication not meeting guidance
- the mother’s health needs not appropriately assessed
- a clinical review not completed until September
- reimbursement guidance not followed and case circumstances not considered.
The Ombudsman recommended the ICB pay £26,382.73 plus interest to the woman for costs incurred and unreimbursed care, acknowledge its failings and produce an action plan to ensure the same mistakes are not repeated.
The ICB has complied with our recommendations and after undertaking an internal assessment paid £37,124.47 to the woman.
The woman said:
“We were concerned that we were going to run out of money. We knew the care she needed and how much it would cost.
“Over that summer I was trying to care for my mother whilst working full-time. It’s those kinds of memories that will haunt me. She should have had proper carers and I was filling gaps because we couldn’t afford to get carers.
“In the midst of this I had a bereavement and lost a really close friend very quickly, and I was also supporting my son.
“It was just a very difficult time and my mother was very anxious and very fragile.
“The Ombudsman helped enormously. They explained to me what should have happened and that’s the first time anybody did that, except for the initial assessment.
“I hate the thought of another person going through the stress and financial worry we suffered. I hope me complaining helps to change things for the better so that this doesn’t happen to anyone else.”
Parliamentary and Health Service Ombudsman Rebecca Hilsenrath said:
“Losing a parent is among the most difficult experiences any of us will undergo. That trauma should not be needlessly exacerbated by having to shoulder the immense emotional and financial burden of providing care due to a lack of proper assessment. These women should never have had to pay for this care and should never have had to suffer the consequent anxiety about running out of money.”
The Ombudsman published its report Continuing Healthcare: Getting it right first time in 2020, which outlined common failings seen in NHS CHC. The report found that failings, like those in this case, often resulted in families funding care when the NHS should have.
Rebecca Hilsenrath added:
“When there are errors in healthcare, it is vital they are recognised and addressed for everyone’s sake. Every complaint we uphold represents an error the NHS has investigated but failed to address. Our investigations aim to encourage learning and service improvements, so that the NHS can avoid placing financial strain on other families with complex health care needs.”