Overview
The complainant (Mr C) complained on behalf of his stepmother (Mrs A) about the assessment made of her condition on 15 October 2007, which led to Ayrshire and Arran NHS Board's (the Board) decision that she was not entitled to NHS Continuing Care, despite having qualified for a previous period in England. Mr C also complained that the benefits of moving to be closer to him as her only surviving relative were discounted by the Board and he also complained about how the Board handled the matter. Sadly, Mrs A died on 26 January 2008.
Specific complaints and conclusions
The complaints which have been investigated are that:
- (a) the assessment on 15 October 2007 was inadequate (not upheld);
- (b) the Board discounted the benefit of Mrs A's move to be closer to her family (not upheld); and
- (c) the Board failed to explain properly the decision not to award continuing care funding (upheld).
Redress and recommendations
The Ombudsman recommends that the Board;
- (i) apologise to Mr C for failing to explain the decision properly;
- (ii) undertake a retrospective assessment of Mrs A's eligibility for NHS Continuing Care from the point of her transfer to Scotland;
- (iii) consider whether they now have a preferred or standardised format for decisions relating to and documentation of assessments for NHS Continuing Care;
- (iv) consider what procedures they have in place to assess cross border transfers where there is no request or need for NHS Continuing Care;
- (v) consider what procedures they now have in place to ensure that all care home residents are routinely assessed at the point of entry and thereafter, with regard to their eligibility for NHS Continuing Care;
- (vi) consider under what circumstances they will consider retrospective requests for NHS Continuing Care; and
- (vii) review the instructions they give to their staff on the handling of assessments relating to extraordinary issues such as cross border patient movement.
The Board have accepted the recommendations and will act on them accordingly.