Annual Report 2007-08 - the Parliamentary and Health Service ...

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When the first of these two deadlinesexpired on 30 November 2007, therewere about 1,500 outstanding casesin the NHS, which the Departmentof Health told us would be concludedby the target date of 31 March 2008.Many of these cases had been the subjectof complaints to us in the past and weresent back to the appropriate NHS bodyto be re-reviewed with a robust,transparent process and an understandable,evidence-based decision letter. But justtwo months later the Department toldus that it was not, after all, confident thatthe NHS was on track to complete allreviews by this target date. It said thiswas due to difficulties Strategic HealthAuthorities were having in obtainingevidence and to the larger than expectednumber of cases that some had received.We were of course disappointed toreceive news of further delay. However,we welcomed the actions the Departmentof Health put in place to put pressureon Strategic Health Authorities, andthe deadline was met in most cases.The significant reduction from the30 November 2007 figure of about 1,500retrospective continuing care casesin the NHS to just over 100 cases on31 March 2008 shows progress. Sincethen there has been an ongoing reductionin the numbers. The Department’sRecovery and Support Team has beenworking with these Strategic HealthAuthorities to clear this backlog, and hasbeen keeping us informed of progress.New National FrameworkOn 26 June 2007 the Departmentof Health published the NationalFramework for NHS Continuing Careand NHS Funded Nursing Care in England– something that we recommendedin our 2004 follow-up report oncontinuing care. This came into operationon 1 October 2007, and establishednational criteria for eligibility forcontinuing care funding and a frameworkfor assessing who should receive it. Inessence, it aims to make funding decisionson who is eligible for NHS continuing care‘fairer, faster and easier to understand’.It is not retrospective, so does notapply to any claims made before1 October 2007. However, the set ofassessment tools it contains is beingused to improve the handling ofretrospective claims. Strategic HealthAuthorities tell us that this Frameworkis greatly helping them come to speedyand just decisions about those whoshould receive NHS funding forcontinuing care.48
Parliamentary and health service ombudsman annual report 2007-08An improvement in the qualityof continuing care complainthandling and reviewsWhen an individual makes a complaintabout a retrospective review of localfunding decisions for continuing care,they make that complaint in the firstinstance to their Primary Care Trust. Ifthey are dissatisfied with the outcome,they take it to their Strategic HealthAuthority and then, if the matter is stillnot resolved, to the Ombudsman.So far, the evidence suggests that thequality of these reviews has improvedduring the last year. We have beenencouraged by the quality of thosereferred to us. In particular, we arepleased that we have seen far fewerinstances of the sort of systemic flawsthat we saw in the past. These werecharacterised, for example, by poorportrayals of healthcare needs,inadequate assessment panels and failureto communicate sufficiently well withfamily members. We are also pleasedto report that we generally have goodrelations with Strategic Health Authorities,and usually discuss with them in advancethe cases we are proposing to send backfor their attention, with the result thatthey have complied with ourrecommendations in full, as expected.In last year’s Annual Report, we expressedour confidence that claimants would infuture receive a robust, fair andtransparent review of their eligibility.This confidence was well placed, and webelieve that the higher quality of reviewstems from the fact that we encourageStrategic Health Authorities, in ourreports on investigations and otherdocuments, to use our Principles of GoodAdministration when reviewing claims.We have emphasised to them that athorough, fair and robust review processmust include:• evidence that the person’s individualhealthcare needs were properlypresented;• a fair, proportionate and reasonableprocess of assessment/review, whichis inclusive of relatives and carers;• consideration of the person’s individualhealthcare needs by an appropriatelyconstituted and qualified panel, andcomparison of the healthcare needsto the eligibility criteria; and• a decision conveyed to the claimantthat clearly explains how it wasreached, the evidence used, andthe rationale.Many Strategic Health Authoritieshave told us that the Principlesof Good Administration and theaccompanying explanations havehelped them develop much bettersystems for reviews and assessments.‘I thought you would like to know that South CentralSHA, via West Berkshire PCT, has at long last paid methe outstanding amount owed as a result of youroffice upholding my complaint/s against the formerThames Valley SHA and Wokingham PCT… Pleasepass this on to all those who have helped in this longand frustrating business.’Mr Z, a complainant featured in our 2003 continuing care report49
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