NHS Ombudsman news and a Fast-track decision

The reports of the English Parliamentary and Health Services Ombudsman are now being published – click here to access the relevant page.  This is good news.  The Local Government and Social Care Ombudsman has done this for many years – and that just leaves the Public Services Ombudsman for Wales as the ‘outlier’: hopefully his office will follow this example asap.

The first batch of published reports contains one of interest concerning NHS Continuing Healthcare (CHC) funding and ‘Fast-track Assessments’ (FTAs) – an issue on which there have been few reported decisions.  The primary legislation concerning eligibility for NHS Continuing Care is – in its essentials – the same in England and Wales.  In Wales, the 2014 Framework requires (as does the English equivalent Framework) that FTAs should be completed by ‘an appropriate clinician’ (para 3.86) and that FTAs should be accepted and actioned immediately by the LHB. Disputes about the fast track process should be resolved outside of the care delivery (para 3.89).

East Leicestershire and Rutland CCG (P-001012)

1 March 2017 Mr A, a care home resident, was found to be ineligible for NHS CHC funding, following the completion of a Decision Support Tool (DST).  In July 2018 Mr A’s GP prescribed end of life medication for him and completed fast-track tool as he had become non-responsive and was refusing food and fluids.

The Clinical Commissioning Group (CCG) declined the fast-track application on the basis that:

  • Mr A did not have a rapidly deteriorating condition; and
  • there had been ‘no changes’ to his care needs since his last DST.

Mr A died later that year.

In considering the reasons for the CCG refusal the ombudsman held:

  • that while a previous DST may be referred to during a CHC review, the fast-track document is a standalone assessment at the point of need. Regardless of whether there had been a rapid deterioration or not the previous DST was not relevant.
  • It was not appropriate for the CCG to refuse funding on the basis that his ‘deterioration was gradual’. The relevant regulations state that it is for the ‘appropriate clinician’ to decide, and it is then the duty of the CCG to respond promptly and positively to ensure that the appropriate funding and care arrangements are in place without delay.

The ombudsman’s ‘recommendation’ therefore was that the CCG reimburse Mr A’s estate the sum of the care home fees paid between July and his death and to pay his son (who bought the complaint – represented by Beacon CHC) £550 in recognition of the emotional impact to him.


Photograph of ‘Trecastell’ by Richard Jones -@lluniaurich

Posted 19 May 2021