NHS Continuing Healthcare
The Ombudsman and CHC Complaints
When the Parliamentary and Health Service Ombudsman can look at a CHC case, what it examines, and what it cannot do.
What is the Ombudsman?
The Parliamentary and Health Service Ombudsman, or PHSO, is the independent body that investigates complaints about the NHS in England. In a Continuing Healthcare context it considers whether an Integrated Care Board or NHS England has acted with maladministration or service failure, and whether that has caused an injustice that has not been put right. It is free to use, and it is independent of the NHS.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
The Ombudsman is the last resort in a Continuing Healthcare dispute. It is not another eligibility panel, and it will not usually re-score a Decision Support Tool. What it examines is whether you were treated properly: whether the process was run as it should have been, and whether failures in that process caused you injustice. Used in the right place, it is a powerful check on how Integrated Care Boards handle these cases.
When the Ombudsman is the right route
The Ombudsman fits where the problem is how the case was handled:
- Long or unexplained delays in assessing or deciding
- Evidence that was submitted but never considered
- The family excluded from the process, or not told of their rights
- An Independent Review Panel that did not properly address the case
- A decision reached without following the national framework
How to prepare a complaint
The Ombudsman decides on the paperwork, so a clear account matters:
- Set out what went wrong, in order, with dates
- Show the injustice it caused, not just the disagreement
- Attach the correspondence, decision letters and review panel outcome
- Say plainly what you are asking the Ombudsman to put right
- Keep to the process failures rather than re-arguing the diagnosis
Where people often go wrong
- Going to the Ombudsman before finishing local resolution and the review panel
- Asking it to re-score the Decision Support Tool, which is not its job
- Missing the twelve-month window without a good reason
- Describing the upset without pinning down the specific failures
- Sending a large unindexed bundle rather than a clear, dated account
- Going to the Ombudsman before finishing local resolution and the review panel
- Asking it to re-score the Decision Support Tool, which is not its job
- Missing the twelve-month window without a good reason
- Describing the upset without pinning down the specific failures
- Sending a large unindexed bundle rather than a clear, dated account
What the Ombudsman looks at
The Ombudsman focuses on process and fairness rather than re-deciding eligibility. That includes unreasonable delay, failing to gather or consider evidence, not involving the family, poor record keeping, and not following the national framework. Where it finds fault, it can recommend a fresh assessment, an apology, a financial remedy or changes to how the Board works. It looks at whether the decision was reached properly, not simply whether you disagree with the outcome.
Frequently Asked Questions
Can the Ombudsman overturn a CHC decision?
It does not usually re-decide eligibility. It can find that the process was flawed and recommend a fresh assessment or another remedy, which can lead to a different outcome.
Do I need an MP to refer me?
For health service complaints in England you can approach the Ombudsman directly once local resolution is complete. An MP referral applies to some other kinds of complaint, not NHS health complaints.
How long do I have?
Usually within twelve months of becoming aware of the problem, although the Ombudsman has discretion to look at older matters where there is good reason.
Does it cost anything?
No. The Ombudsman service is free and independent of the NHS.
This page explains complaints to the Parliamentary and Health Service Ombudsman about NHS Continuing Healthcare in England. It is general information rather than legal advice, and it does not replace an assessment of an individual's needs.