Request
Dear Sirs,
We are a firm of Solicitors instructed by our clients to request that PCTs undertake retrospective and current reviews of a patient’s eligibility for NHS Continuing Healthcare and to manage, monitor and progress cases in line with their instructions.
We undertake frequent monitoring of such requests with a number of PCTs under your jurisdiction and are finding it somewhat difficult to provide our clients with realistic timeframes for dealing with these matters. We are aware that the PCTs have resource issues. However, we must manage our clients’ expectations and are obliged to provide regular updates to our clients.
Paragraph 152 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (Revised) provides that:-
“152. Each PCT should agree a local process, including timescales, which is made publicly available; a copy should be sent to anybody who requests a review of a decision”.
We are not being provided with timescales, even upon specific requests for this information.
Further, Annex E, paragraphs 8 and 10 of The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2009 (Revised) provides that:-
“8. If the case cannot be resolved by local resolution (or local resolution will cause undue delay [emphasis added]) the individual (or their representative) may ask the appropriate SHA (i.e. the SHA in whose area the decision-making PCT is situated) to arrange an IRP to review the case with regard to the matters listed in paragraph 2 above.”
“10. Clear and timely communication is very important. Each SHA should develop and publish timescales for the hearing of IRP cases”.
We would be obliged if you could provide us with published timescales for the progression of retrospective and current reviews for eligibility for NHS Continuing Healthcare funding which applies to the PCTs within your jurisdiction.
We would also be grateful if you could please provide further information/clarification in relation to Paragraphs 8 and 10 and the procedure to follow when adopting this course of action, together with the likely timescales involved for this process.
We look forward to hearing from you as a matter of urgency.
Our Response
I refer to your email requesting information in respect of eligibility for NHS Continuing Healthcare (CHC).
I can confirm in accordance with S.1 (1) of the Freedom of Information Act 2000 (FOIA) that we do hold some of the information that you have requested.
With respect to paragraph 152 of the National Framework, Primary Care Trusts (PCTs) in the East Midlands area have agreed a Local Disputes Policy which I have attached for your information. This sets out the process to be used when CHC assessments are disputed.
With respect to Independent Review requests for National Framework or Retrospective Reviews, NHS East Midlands adheres to the nationally agreed Independent Review Panel Operational Framework and aims to convene a panel within 3 months of a request (in line with the Ombudsman’s expectations).
I hope that this information is of use. If you are dissatisfied with the way in which we have dealt with your request you can ask us to review our decision by writing to:-
Mr Moosa Patel
Director of Corporate Affairs
NHS East Midlands
Octavia House
Interchange Business Park
Bostock's Lane
Sandiacre
Nottingham
NG10 5QG
If at the conclusion of any review you remain dissatisfied you may complain to the Information Commissioner who can be contacted at:-
The Office of the Information Commissioner
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
