Mistakes by NHS funding bodies 'have led to people unnecessarily paying out large sums to cover care, or going without care', according to a new report from the Parliamentary and Healthcare Ombudsman (PHSO).
The PHSO reviewed complaints it received about NHS Continuing Healthcare (CHC) - funding paid by NHS clinical commissioning groups (CCGs) for the ongoing care costs of a person with enduring health needs.
Between April 2018 and July 2020, the PHSO made decisions on 336 complaints submitted by people about CHC. Of the 150 cases investigated, the PHSO found failings in 55 (including those highlighted below), although the individual CCGs have not been identified. The PHSO was also able to resolve 40 further cases without the need for a full investigation.
How people have lost out
- A man with severe brain injuries was reimbursed £250,000 for three years of care costs after the PHSO found his CCG hadn't honoured its first eligibility decision.
- The family of a woman who had had a stroke was paid back £277,000 after the PHSO found that the CCG had only provided funding for one carer, seven hours a day at home, when its own assessment had recommended two carers at all times.
- A woman and her family were awarded £33,000 after her overnight care funding was withdrawn by the CCG without consultation.
Ombudsman Rob Behrens said: "Our casework demonstrates that failing to provide vulnerable people with the care they are entitled to causes huge suffering, as well as financial harm, for them and their families. NHS CCGs must improve communication with patients and families and properly train staff to make sure they get continuing healthcare funding decisions right first time."
The PHSO is calling on NHS England and the Department for Health and Social Care to clarify what CCGs’ obligations are through national guidance.
CHC assessments by CCGs were paused from March to September 2020, creating a backlog now being worked through.