Ombudsman urges Integrated Care Boards to “learn from mistakes” after healthcare group failed to properly assess 24-hour care of woman
The Parliamentary and Health Service Ombudsman (PHSO) is urging Integrated Care Boards (ICBs) to “learn from mistakes and take action” to prevent other families facing unnecessary financial strain, after it found that a healthcare provider failed to properly assess and fund an elderly woman’s care.
The Ombudsman recommended Humber and North Yorkshire ICB, previously East Riding of Yorkshire Clinical Commissioning Group, pay £26,382.73 plus interest to the elderly woman’s daughter for costs incurred and unreimbursed care.
After undertaking an internal assessment, the ICB paid £37,124.47 to the woman.
The woman behind the complaint and her late mother funded the mother’s continuing healthcare (CHC) 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”, said the Ombudsman.
The mother had chronic obstructive pulmonary disease (COPD), anxiety, hypoxia, a low blood oxygen condition causing shortness of breath, and a tremor.
According to the PHSO report, 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 and her mother suffered “substantial financial loss” and “acute anxiety” about money running out, the report observed.
The Ombudsman revealed that the woman complained about the money she was owed for her mother’s care, but the CCG only reimbursed her for £2,418.81.
It investigated and concluded that there were “avoidable delays” in establishing the PHB once funding was agreed. Further, 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.
As well as calling for a repayment, the Ombudsman recommended the ICB acknowledge its failings and produce an action plan “to ensure the same mistakes are not repeated”.
Parliamentary and Health Service Ombudsman Rebecca Hilsenrath said: “Losing a parent is among the most difficult experiences any of us will undergo. That trauma should not be needlessly exacerbated by having to shoulder the immense emotional and financial burden of providing care due to a lack of proper assessment. These women should never have had to pay for this care and should never have had to suffer the consequent anxiety about running out of money.”
The PHSO revealed that the ICB has since complied with its recommendations.
A spokesperson for NHS Humber and North Yorkshire Integrated Care Board said: "We are truly sorry for the impact this has caused to the family and acknowledge the failings that the Parliamentary and Health Service Ombudsman identified in their investigation.
"We aim to carry out all assessments in a fair and timely manner, so people get the help they need, when they need it.
"Following the investigation, we’ve made restitution to the complainant and improved our processes to prevent such incidents occurring in the future."
Lottie Winson
