Summary: We will not investigate Mrs Y’s complaint that the ICB failed to pay interest when it refunded nursing home payments made by Mrs Y’s mother, Ms X. Mrs Y also complained the Council and the ICB’s communication about this was poor. During our consideration of the complaint, the ICB apologised, offered to pay interest to Ms X, and said it would improve services. The Council accepted shortcomings in how it handled Mrs Y’s enquiries about the payment, and it addressed this by apologising and providing staff training. The Council and ICB have provided a reasonable remedy to the complaint, and an investigation would be unlikely to add anything further for Mrs Y.

The complaint

1. Mrs Y complains NHS Devon Integrated Care Board (the ICB) failed to pay interest when they refunded nursing home payments made by her mother, Ms X, that should have been covered by NHS funded nursing care (FNC). Mrs Y also complains that Devon County Council (the Council)’s and ICB’s communication with her about the payment was poor, and that this caused her stress and anxiety.
2. As a result of her complaint to the Ombudsmen, Mrs Y wants the ICB to pay Ms X interest on the nursing home fees it refunded. She wants the ICB and Council to apologise, and to make a goodwill payment to her for anxiety and stress caused.

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The Ombudsmen’s role and powers

3. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
4. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe it is unlikely they could add to any previous investigation by the bodies.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I considered information from Mrs Y, the Council and the ICB.
6. Mrs Y had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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My assessment

7. Ms X, who was living at a nursing home, was assessed for NHS Continuing Healthcare funding (CHC). Ms X was found not eligible for CHC, but was awarded FNC. Mrs Y appealed the decision, as she felt the FNC payment should have been backdated as Ms X had been living at the nursing home, and receiving nursing care, for ten months before the assessment took place. The ICB decided not to backdate the payment. Mrs Y complained to the ICB.
8. In its response to Mrs Y’s complaint, the ICB acknowledged it had not given a clear explanation of the reasons for not backdating FNC. The ICB reviewed Ms X’s assessment. It found that while Ms X’s needs may not have “fully met” the FNC framework, there was “a degree of nursing care required”. The ICB agreed to backdate the payments, “partly due to recognising there was a requirement for some nursing needs and partly as a goodwill gesture.”
9. The ICB then asked the Council to make this payment to the nursing home, so the nursing home could then reimburse Ms X directly. The ICB’s letter to Mrs Y said it should take two weeks for the payment to reach the nursing home.
10. Ms X had still not received the payment by the specified date. Mrs Y contacted the ICB, and was told it had made the payment to the Council as agreed. Mrs Y then spoke to several different Council teams but was unable to obtain confirmation the payment had been made.
11. Ms X received the payment three weeks after the ICB’s response to the complaint.
12. Mrs Y later complained to the Council about how it had handled her enquiry, as she said she was put through to the wrong team and her questions were not answered. The Council acknowledged some shortcomings in customer service, apologised to Mrs Y, and said it would provide training to the relevant team.
13. Mrs Y complained to the Ombudsmen that the Council and ICB had failed to pay the interest on the back payment. After contact from PHSO, the ICB reviewed the payment, and confirmed interest had not been applied. It said it calculated the interest owed using a formula set by the Department of Health, and offered to pay Ms X interest of £806.72. The ICB also said it would share learning from the complaint with the relevant staff.
14. I recognise it must have been frustrating and stressful for Mrs Y when the payment was delayed and she could not obtain confirmation from the Council or ICB about what had happened. However, Ms X received the payment a week later. The ICB has now also offered to pay the interest directly to Ms X. Both the Council and ICB have apologised to Mrs Y for the poor communication about the payment. An investigation would be unlikely to add to these responses for Mrs Y and Ms X.

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Final decision

15. We will not investigate Mrs Y’s complaint about the Council and the ICB. An investigation would be unlikely to add to the responses already provided by the ICB and the Council.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman