Summary: Ms X complains about inaction by the Council during her father’s discharge from hospital and also that the Council did not properly consider her father’s wellbeing in its dealings with her and her father. There was fault by the Council because of an inappropriate comment by one of its officers. The complaint is closed because the Council acted to remedy that injustice.

The complaint

1. Ms X complains about inaction by the Council during her father’s discharge from hospital in April 2018. Ms X complains that he was discharged without an assessment of his needs by the Council’s primary assessment team.
2. Ms X says there was an unreasonable delay before her father was assessed by the Council and a support package put in place for him.
3. Ms X also complains the Council did not properly consider her father’s wellbeing in its dealings with her and her father.

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The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

6. I reviewed the complaint and background information provided by Ms X. I discussed the complaint with Ms X by telephone. I made enquiries of the Council and considered its comments on the complaint and information it provided. I sent a draft decision statement to Ms X and the Council and considered the comments of both parties on it.

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What I found

Government guidance on hospital discharge

Hospital discharge

7. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 make provisions on the discharge of hospital patients with care and support needs. The NHS may seek reimbursement from local authorities for a delayed transfer of care in the circumstances set out in Schedule 3 and its regulations.
8. The NHS must issue a notice to the local authority where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment. The NHS should try to give the local authority as much notice as possible of a patient’s impending discharge. However, the NHS cannot issue an assessment notice more than 7 days before it expects to admit the patient to hospital.
9. On receiving an assessment notice, the local authority must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The local authority must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The local authority must inform the NHS of the outcome of its assessment and decisions.
10. To avoid any risk of repayment liability, the local authority must carry out a needs assessment and put in place any care arrangements for meeting eligible needs before “the relevant day”. The relevant day is either the date when the NHS proposes to discharge the patient or the minimum period (2 days after the local authority has received the assessment notice), whichever is the later.
11. The NHS body should tell patients and carers the discharge date at the same time as or before the local authority. Hospital staff may give the local authority an early signal of when discharge is likely to help their planning.

Community care assessment

12. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
13. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
14. An adult with possible care and support needs or a carer may choose to refuse to have an assessment. In these circumstances local authorities do not have to carry out an assessment. Where the local authority identifies that an adult lacks mental capacity and that carrying out a needs assessment would be in the adult’s best interests, the local authority must do so.

Background

The hospital discharge

15. Ms X’s father was admitted to hospital following an accident in March 2018. The hospital contacted the Council on 12 April 2018 regarding a possible discharge for Ms X’s father. A council officer, in turn, contacted the hospital on the following day to discuss the discharge. The hospital advised the Council that Ms X’s father was not medically fit for discharge at that time but the likely discharge date would be 27 April. Both parties agreed the hospital would make another referral to the Council ahead of the likely discharge date.
16. Ms X and her family held a meeting with medical staff on 20 April. The doctor who chaired the meeting informed the family their father was ready to be discharged. The family agreed to the discharge on the understanding that they would meet their father’s care needs. Ms X understands the hospital informed the Council of the meeting and she questions why a council officer did not attend the meeting. The Council, on the other hand, was unaware of the meeting. There is nothing in its records to show the hospital informed it of the meeting.
17. Ms X’s father was discharged to his home on 20 April 2018. The hospital did not make a further referral to the Council ahead of the discharge.

Post discharge

18. Ms X telephoned the Council’s primary assessment team on 23 April 2018. Both parties agreed a date when the Council could conduct a care assessment for her father. This was 27 April.
19. A care assessor visited Ms X’s father on 27 April and Ms X was present at the visit. The assessor completed a provisional care plan for Ms X’s father. The assessor recommended a support package to be provided by the Council’s reablement support workers in the interim until an agency could be found to meet her father’s needs on a permanent basis. It was decided the reablement workers would provide a service from Monday to Friday and Ms X’s family would then provide for her father at the weekends. The Council’s complex care team would be tasked with helping Ms X’s father regain skills he needed to return to his previous level of independence.
20. However, the Council’s reablement team could not start the support service immediately. Ms X told the assessor she would remain in Manchester for two weeks before she planned to return home and she and her sister could support her father in that period before a support service could start.
21. The Council had identified a need for specialist equipment to support Ms X’s father and so the assessor and another officer visited her father’s home gain on 1 May. The equipment was then ordered, and the officers returned on 4 May to fit the equipment and observe Ms X’s father using the equipment.
22. Ms X telephoned the Council on 4 May to remind officers of her intention to return home in the following week.
23. On 11 May, the Council advised Ms X the reablement service would start a support package from 14 May from Mondays to Fridays.
24. During the weekend of 19 May, reablement support workers visited Ms X’s father despite the family’s request for only a Monday to Friday service.
25. The Council commissioned a home care agency to provide care to Ms X’s father from 29 May.
26. The Council’s complex care team commenced a service to Ms X’s father from 11 June 2018.
27. There was a review of the support being provided to Ms X’s father on 28 September 2018. Ms X says the meeting was dictatorial and with the intention of ending her father’s care package without consideration of his wellbeing. She says her father was confused during the meeting and did not understand what was happening. Ms X says this was noted by one of the Council’s officers who then failed to properly record what happened at the meeting. Ms X says she and her family were made to feel they were not respecting her father’s wishes. She feels the Council’s officers minimised the head injury her father sustained.
28. Ms X says the Council’s assessor asked her whether it was right for her father to be given services he did not need when there were others waiting for the service. Prior to this comment been made, Ms X says the complex care team leader and the short-term intervention manager compared her father’s head injury to a broken leg and stated her father did not really fit the criteria for complex needs.
29. Ms X says the assessor ended the meeting before a full discussion could take place and her father said afterwards that he did not know what the officers were talking about. Ms X understood the meeting was to discuss a phased end to the care package for her father. However, the assessor said the end of the care package had already been discussed at an earlier meeting on 10 September.
30. The care package ended on 1 October 2018. Ms X made a complaint to the Council shortly afterwards.
31. In its response, the Council explained it initially received contact from the hospital on a possible discharge for Ms X’s father. It iterated the hospital agreed to contact it again nearer the time when her father was deemed fit for discharge, but it did not hear back from the hospital again.
32. The Council noted Ms X and her sister offered to care for their father for a two-week period until the reablement service could start.
33. On the 28 September meeting, the Council said its records did not show any concerns about Ms X’s father’s mental capacity. It says her father had said before and during the meeting that he wanted the support service to end. It said her father’s wellbeing was taken into consideration by officers and it was clear to them her father was upset at having carers in his home when he felt he no longer needed them.
34. The Council accepted the assessor’s comment about Ms X’s father receiving services when there were others waiting was inappropriate. It upheld the complaint about the comment. The officer apologised to Ms X for the distress the comment caused her.
35. The Council did not accept it minimised the head injury suffered by Ms X’s father. It said her father received a substantial level of care and support.
36. It explained there were times when the assessor took time to answer Ms X’s father’s questions during the meeting and clarified his use of terms such as complex care team and the carers, whereas Ms X’s father understood them to be ‘the third call’ and ‘Constantino’ respectively. The Council says its officers allowed sufficient time for matters to be discussed during the meeting. It did not accept Ms X’s father was left confused by the discussion at the meeting.
37. The Council accepted one of its officers did not make a record of discussions around transportation for Ms X’s father for a hospital visit. It identified training for the officer concerned.

Findings

Inaction by the Council during Ms X’s father’s discharge from hospital in April 2018 and a discharge without an assessment of his needs by the Council’s primary assessment team

38. I do not find fault by the Council here. The hospital signalled the likelihood of a discharge to the Council but did not follow this up either formally or informally. I note Ms X’s belief that the hospital did follow up its initial contact but there is nothing in the Council’s files to support this belief.
39. The Council should normally have assessed Ms X’s father’s needs while he was in hospital and ahead of his discharge. However, it could not do so because it was not made aware of his discharge.

There was an unreasonable delay before her father was assessed by the Council and a support package put in place for him.

40. The Council does not have a service level agreement which sets out the timescale for the completion of needs assessments and a timetable for the provision of services after the assessments. So, I cannot assess delay on the basis of a clear service requirement.
41. It leaves me to examine whether the support package was put in place in a ‘reasonable’ period of time. Having assessed the circumstances of this case such as Ms X’s agreement to provide care for her father for a two week period and the commencement of the care service shortly after the period, I do not find there was unreasonable delay here. I am satisfied the Council provided the service as soon as was practicable. The timing of the start of the service does suggest the Council relied on Ms X and her sister’s offer to care for their father for a period. But I do not find this means it delayed the provision of the care service unreasonably given the offer was made by Ms X.

The Council did not properly consider her father’s wellbeing in its dealings with Ms X and her father

42. I accept Ms X had difficult conversations with officers and there was a clash of views on how long the care service should continue for her father. But I cannot conclude that officers did not properly consider her father’s wellbeing as a result of her clashes with officers.
43. The evidence I have seen shows the services set out in Ms X’s father’s care plan were provided to him. The Council’s officers clearly recorded her father as saying he wanted the service to end before and during the 28 September meeting. I acknowledge 28 September meeting was a difficult one and its conclusion is one Ms X disagrees with. However, I cannot now conclude the Council failed to consider her father’s wellbeing as a whole.
44. I note the Council’s finding that the assessor made an inappropriate comment and another officer did not fully record what happened at the 28 September meeting. The Council apologised for the officer’s comment. I consider the apology was a satisfactory remedy for the upset the comment caused Ms X. I do not consider any further remedy from the Ombudsman is now necessary.

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Final decision

45. There was fault by the Council because one of its officers made an inappropriate comments and another officer did not make a full record of a meeting. The Council remedied the upset caused to Ms X by apologising for these failings.

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Investigator's decision on behalf of the Ombudsman