Summary: We will not investigate Mrs X’s complaint that her cousin, Mrs Y, is not eligible for NHS continuing Healthcare funding because the Council is not responsible for this decision. We will not investigate Mrs X’s complaint that her cousin has been overcharged for her residential care because it is unlikely that we would find Mrs Y has been caused an injustice.

The complaint

1. Mrs X complains on behalf of her cousin, Mrs Y, about the decision that she does not qualify for NHS continuing healthcare (CHC) funding. She also says the Council gave her wrong advice about the capital threshold for financial support. She says this resulted in her cousin overpaying for her residential care.

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The Ombudsman’s role and powers

2. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.

We cannot investigate a complaint where the body complained about is not responsible for the issue being raised. (Local Government Act 1974, section 24A(1), as amended)

3. 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’. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• the fault has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement.

(Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

4. I have considered comments and information from Mrs X and the Council. I have written to Mrs X with my draft decision and given her an opportunity to comment.

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What I found

5. Mrs Y lives in a residential care home. The placement is funded by the Council.
6. Mrs X is unhappy with the decision that Mrs Y is not eligible for CHC funding. Decisions about whether a person qualifies for CHC funding are the responsibility of the NHS, not the Council. The Ombudsman cannot investigate complaints about decisions which are the responsibility of the NHS. We therefore cannot pursue this matter further. If Mrs X disputes the decision about Mrs Y’s entitlement to CHC she can use the NHS appeals process.
7. Mrs X says the Council wrongly advised her that the capital threshold for local authority funding for residential care was £21,500 instead of £23,250. She says Mrs Y has overpaid the care home. In its response to her complaint the Council confirmed that when it completed Mrs Y’s financial assessment it based it on the correct threshold of £23,250 so Mrs Y was not disadvantaged financially. In these circumstances, an investigation by the Ombudsman is unlikely to conclude Mrs Y has been caused an injustice.

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Final decision

8. The Ombudsman will not investigate this complaint because the Council is not responsible for the decision on Mrs Y’s eligibility for CHC funding and it is unlikely that Mrs Y has been caused an injustice.

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Investigator's decision on behalf of the Ombudsman