Ms C complained about the actions of the Health Board in determining whether her father, Mr D, was eligible for NHS Continuing Health Care (“CHC”) funding. Mr D had significant and specific care needs due to early onset dementia.
The Ombudsman investigated whether:
a) the process followed by the Health Board to assess Mr D’s eligibility for CHC funding was in line with the National Framework
b) the Health Board appropriately addressed the issue of Mr D’s CHC funding eligibility in its response to the complaint.
c) the Health Board’s response to the complaint was timely and reasonable.
The Ombudsman’s investigation found that the Health Board had not followed the process to determine Mr D’s CHC eligibility in line with the National Framework. This constituted maladministration. Following complaints from Mr D’s MS and Ms C, the remedial action taken by Health Board was inadequate. Its reasoning for the current funding position was unclear, and it had not properly addressed the potential financial implications for Mr D of the maladministration going back to the point he was discharged from hospital. The Ombudsman upheld all 3 parts of the complaint.
The Ombudsman made a number of recommendations, which were accepted by the Health Board. These included:
• an apology to Ms C
• ensuring that it had now reached a CHC eligibility decision in line with the Framework
• undertaking a retrospective review of Mr D’s CHC eligibility for the whole period dating back to his discharge from hospital
• reviewing its dispute resolution process (with the Council)
• arranging a joint review (with the Council) to identify improvements arising from the shortcomings identified in this case.