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Selected Investigations Completed April - September 1999 > Part I, Case no. E.1321/97-98
Complaint against:
Herefordshire Health Authority
Summary of case
In August 1996 Mrs Z's mother was admitted to hospital following a stroke. On 21 October a continuing care assessment was carried out using a scoring system applied by the Health Authority in which scores of 14 or more signified that care should be provided by Social Services and scores of 13 or less signified NHS care. Mrs Z's mother scored 12 and was transferred to another hospital for rehabilitation. In a second assessment conducted on 25 November she scored 13 but, additionally, in a newly introduced mini-scoring system she scored 7. The additional scoring system was used for those scoring 13 or less in the main assessment with a mini score of 7 or less indicating NHS care, and 7.5 or more indicating Social Services care, unless the patient had specialist needs. In a further assessment on 30 January Mrs Z's mother's still scored 13 but on this occasion she had a mini-score of 8; her care was then transferred to Social Services. On 5 March Mrs Z asked for her mother's case to be reviewed by a continuing care review panel (CCRP) but that request was refused by the Health Authority. Mrs Z complained that that was unreasonable as NHS guidance only permitted the Health Authority to refuse her request for a CCRP if her mother had fallen well outside their eligibility criteria.
Findings
Mrs Z's request for a CCRP was considered by a Health Authority manager and an independent lay person appointed by the Health Authority to chair CCRPs. After considering the facts of Mrs Z's mother's case and the NHS guidance on CCRPs they decided that it was appropriate for the Health Authority to refuse a CCRP as the correct assessment procedures had been followed. The Ombudsman considered that the NHS guidance intended CCRPs to be an additional safeguard for patients and their families who had concerns that the eligibility criteria for continuing NHS care were not correctly applied. The guidance permitted health authorities to refuse a CCRP where the patient fell well outside the eligibility criteria, but the Ombudsman could not understand how Mrs Z's mother's assessment results could be seen as anything other than borderline. He found that, although the manager and the chair had themselves considered the request for a CCRP and the assessment process in some detail, that was not an acceptable substitute for a CCRP; Mrs Z was entitled to have her mother's case reviewed by a fully empowered CCRP which had access to independent clinical advice.
Remedy
The Health Authority accepted the Ombudsman's findings and agreed to implement his recommendations to hold a CCRP for Mrs Z's mother at the earliest opportunity. They apologised to Mrs Z.
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