BackA 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.
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Source: The Parliamentary and Health Service Ombudsman, UK
