• Phil Austen-Jones

Received an awkward complaint? Easy - just decide the outcome before investigating the issues

In order to manage the length of my blog posts and ensure clarity of points, I am going to break down the sequence of events that occurred next over a few posts.


This post will focus on the process used by West Hampshire CCG in responding to our complaint against the January 2018 review. You will see that, not only did they not follow their own policy, they broke the law, although WHCCG still claim they did everything appropriately.


I’ll provide the evidence. You decide.


We submitted our complaint on 7 February 2018. It focused on two key failures.

· Failure to follow due process in the January 2018 review by determining an MDT was required despite one priority and two severe domain scores.

· The unlawful changing of the review outcome by the reviewer and the senior manager.


The law (The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009) states:


“Procedure before investigation

13 (7) At the time it acknowledges the complaint, the responsible body must offer to discuss with the complainant, at a time to be agreed with the complainant-

(a) The manner in which the complaint is to be handled”


We already had a ‘Local Resolution Meeting’ lined up to discuss remaining issues from our complaint regarding the previous review in December 2017. WHCCG emailed us stating that we could discuss our new complaint at this Local Resolution Meeting. This all seems fine, except WHCCG came to the meeting to tell us the outcome of our second complaint. They provided no opportunity to discuss our complaint, that would have enabled us to ensure that the CCG fully understood our complaint and our desired outcome, prior to determination of the investigation outcome. I will talk through the debacle of the Local Resolution Meeting in my next blog post. Needless to say, WHCCG had not even investigated the issues within our complaint before determining the outcome.


SO WHAT DID WHCCG DO?


Our complaint was about process. Despite this, without our knowledge or consent, the Head of Continuing Healthcare, did her own review of the clinical evidence on 13 February 2018. This was in agreement with the Deputy Director of Continuing Healthcare and a Complaints Manager. It is ironic that the telephone log states “material change would warrant an MDT”, not a minor change as claimed by the reviewer and the senior manager.


The subsequent email that gave the outcome of the review by the Head of CHC gives numerous views on domain scores but, most significantly, states,


“I think that the ASC domain may still reflect a priority level.”


She went on to say,


“We can either take the very diplomatic (and easier) approach and agree not to go to MDT based on the likelihood that she will meet the priority level in ASC or take the more challenging approach and continue with MDT consideration. My feeling is that we should pursue MDT but this will undoubtedly leave us open to further complaints and an appeal if the outcome is not eligible.”


The Deputy Director emailed back to state,


“My view is we need to MDT where there is any doubt, we have to be fair and consistent across the population. So this would be back to MDT.”


In order to be fair and consistent to the population, I therefore assume that they treat everyone with the same level of disdain for law, consent and policy.


BUT WHAT THE HECK


· Why on earth is the Head of CHC making a clinical judgement for a complaint about process?


· Why would you be open to further complaints if you are following due process?


· Why are they determining the outcome of a complaint before investigating the matter?


· And the basis for processing personal sensitive data? Where was the consent?


· And, more worryingly, why is West Hampshire CCG still defending these unlawful actions?


AN ALTERNATIVE AGENDA?


NHS Continuing Healthcare is a legal right based upon eligibility, not finance. Yet West Hampshire CCG has set about making major cost savings including specified amounts within NHS Continuing Healthcare. The minutes of a WHCCG Board meeting of 23 May 2019, presented to a later meeting of 25 July 2019, show in paragraph 8.4 WHCCG congratulating themselves on achieving £14m of savings in CHC against a target of £11m, despite a growing population. These minutes are available on WHCCG’s website. These savings can then be put into a troubling context.


Within the same email from the Head of CHC about my wife, she wrote the following:


“The challenge we face is that her needs have potentially not changed – it is our view of levels of need in domains and meeting eligibility criteria that has changed over the years.”


If their views have changed over the years, then they are acting in contravention of NHS Continuing Healthcare guidelines. Whilst there have been amendments to the National Framework, “the revisions have not changed the way in which eligibility decisions are made, nor have they changed the level of nursing/healthcare needs that entitles an individual to NHS continuing healthcare.” (Public information Leaflet 2013).


The Head of CHC was new to her role. Over the course of the next two years (and pre-Covid) across the CCGs that WHCCG administer, according to NHS England statistics, the eligibility rate for ‘standard CHC’ at MDTs dropped from over 30% to under 20%. What with the initial attempt to reduce my wife’s package of care, it makes it very easy to see how WHCCG made their financial savings.


I look forward to publishing my next blog post when I will share with you how the Head of CHC misled us (or lied to us, unless she couldn’t remember what she had done two days prior). She claimed that she had not seen the evidence regarding my wife but had to stick with MDT due to the paperwork from the reviewer and senior manager.


Why follow due process and the law if it gets in the way of financial savings?

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