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

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