On 14 December 2023 the government published revised guidance on dealing with requests for assessments of previously unassessed periods of care (PUPOC) from 1 April 2012 onwards. The updated guidance is central to how Integrated Care Boards (ICBs) should respond to such requests and ICB’s must consider this publication alongside the National Framework for Continuing Healthcare (CHC) & funded nursing care (FNC) funding and the Regulations.

Points to look out for

The new guidance now requires ICBs to

• gather the relevant care records and documentation i.e. this is not the responsibility of the applicant
• make a direct referral to the correct ICB if they are not the responsible commissioner; and
• complete the application within a 12-month timescale.

The guidance maintains the following requirements for an individual to make a claim in respect to PUPOC:

• eligibility for CHC funding was not considered at the time
• the individual (or those acting on their behalf) have funded that care themselves and
• there is reasonable evidence that the individual should have been considered for eligibility for CHC funding in accordance with the amended NHS Commissioning Board and CCGs (Responsibilities and Standing Rules) Regulations 2012 and the national framework.

Practical matters

ICBs should have clear and consistent arrangements in place to handle PUPOC requests which, as well as other points, will highlight the difference between a genuine PUPOC request and a complaint.

Complaints

An application on behalf of a patient should be treated as a complaint if:

• there was a consideration of eligibility for CHC during the past period of care. For instance where an NHS Checklist was completed or a decision was made not to undertake a Checklist or a Decision Support Tool (DST), this indicates that eligibility was considered at that time
• the individual, or someone acting on their behalf refused consent for a CHC related assessment, provided that the ICB took reasonable steps at that time. This is because ICBs cannot be responsible for the unwise decisions of individuals many years after an assessment was offered
• if the individual is concerned about the manner in which a Checklist or DST assessment was carried out.

PUPOC request

However, ICBs should consider the need to treat a matter as a PUPOC request even if a checklist was previously carried, if there was a later change in need which was not captured in the Checklist or DST. In those circumstances further investigations should be carried out as it may be appropriate to treat the later period as a potential PUPOC.

The guidance also sets the recommended steps to be taken when considering a PUPOC claim, including the evidence to be obtained, the timeframes, decision making as well as the use of the Independent Review Panel and the Parliamentary and Health Service Ombudsman (PHSO).

How can Capsticks help

Our specialist Advisory team supports ICBs on a daily basis with decision making on funding eligibility, care packages and placements. Our expertise covers not only CHC but also funding for children, joint funded packages and s.117 after-care related issues.

We advise clients on policy drafting, assurance in relation to complex decision making, responses to Individual Funding Requests as well as demands for funding on other exceptional grounds. Whilst a lot of our work takes place behind the scenes, we regularly support clients with complaints, ombudsman investigations and threats of Judicial Review.

If you have any queries around the new guidance or in relation to the support we can provide to ICBs generally, such as training, we would be pleased to speak with you. Our growing team operates nationally and we are pleased to now have Advisory team members based in our new Manchester office.

For more information please contact Francis Lyons, Adam Hartrick, Amy Holden or Naomi McMaster.