Mr A complained, on behalf of Mrs B, that Hywel Dda University Health Board (“the Health Board”) had failed to follow the correct process when considering her appeal against its decision that she was not eligible for NHS Continuing Healthcare funding. Specifically, he complained that the Health Board had determined the appeal before the full written reasons for appeal had been submitted.
The Ombudsman found that the Health Board had failed to follow the “Continuing NHS Healthcare – The National Framework for Implementation in Wales” when it determined the appeal without firstly allowing the submission of the full written reasons for appeal. This amounted to maladministration which caused an injustice. The Ombudsman also found that the Health Board’s local policy was not consistent with the National Framework in respect of this issue.
Instead of investigating the complaint, the Ombudsman obtained the Health Board’s agreement to allow the full reasons for appeal to be submitted before then determining the appeal. It also agreed to amend its policy to ensure it was consistent with the provisions of the National Framework.
It agreed to undertake these steps within 6 months.