Summary: Mr and Mrs X complain the Council failed to arrange care for Mrs X, leaving Mr X who is blind struggling to care for them both. And, it did not tell them the costs of a meal service, causing financial loss. The Ombudsman finds no fault in the Council’s actions in providing care and support to Mr and Mrs X. However, the Ombudsman finds the Council at fault in its communications about the cost of the meal service. The Ombudsman recommends the Council provides an apology and takes action to prevent recurrence.

The complaint

1. Mr and Mrs X complain the Council failed to arrange care when Mrs X left hospital. Mr X, who is blind, then struggled to care for both Mrs X and himself. This impacted his physical health and caused them both stress. They also incurred costs in seeking help from others.
2. Mr and Mrs X also complain the Council gave them incorrect information about the costs of a meal service, causing further financial loss.

Back to top

What I have investigated

3. I have investigated the complaints above. At the end of this decision I have set out why I have not investigated other matters.

Back to top

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. 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 there is another body better placed to consider this complaint. (Local Government Act 1974, section 24A(6), as amended)
6. 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)

Back to top

How I considered this complaint

7. I spoke to Mr and Mrs X and I reviewed documents provided by them and the Council. I gave Mr and Mrs X the opportunity to comment on a draft of this decision and I considered the comments provided.

Back to top

What I found

Care after illness or hospital discharge

8. If a person has been in hospital or had an illness or fall, they may need temporary care to help them get back to normal and stay independent. This temporary care is called intermediate care, reablement or aftercare.
9. Most people receive this type of care for around one or two weeks, although it can be free for a maximum of six weeks. It will depend on how soon they are able to cope at home.
10. Hospital staff should contact social services to arrange a discharge assessment. This is so the council can find out what help a person needs when they go home.

What happened

11. In May 2019 Mrs X asked the Council to carry out a care assessment for Mr X as she was struggling to care for him due to her increasingly poor mobility. She also asked for a care assessment for herself as she was struggling with tasks and wanted to arrange carers.
12. The Council has provided a copy of its initial assessment of Mr X. The Council records he has eligible care needs as he needs help managing nutrition and maintaining a habitable home. However, his wife currently meets his needs and he does not want support from the Council. The assessment also records Mrs X will be having a hip operation soon, however she has arranged accommodation for Mr X during this time.
13. The Council has also provided a copy of its initial assessment of Mrs X. The Council records she has eligible care needs as she needs help making use of her home safely and maintaining a habitable home. The Council signposted Mrs X to support services. It records she does not want support from the Council as she will be paying for a help at home service herself.
14. Mrs X contacted the Council again as she needed support. The Council has provided a copy of its further initial assessment. This records Mrs X is managing now that her pain is under control and she does not need support at home at present. Mrs X said she had arranged accommodation for Mr X for while she was in hospital and a friend to support if needed after her operation. The Council told Mrs X the hospital would refer her for intermediate care or reablement before she left hospital.
15. The Council spoke to Mrs X again following a referral from her GP due to her pending hip operation. Mrs X’s position remained the same however the Council also said it would send her information about community services, including meal delivery services.
16. I note one of the leaflets was about a meal delivery service called Apetito. The leaflet says customer have to pay for meals but it does not say how much this will cost.
17. In August 2019 Mrs X entered a private hospital for a hip operation. While she was in hospital Mr X stayed in accommodation provided by a charity.

18. Mr and Mrs X say they expected the Council to put a care package in place once Mrs X left hospital as she would be unable to look after herself or Mr X until she recovered.
19. The Council says the hospital did not tell the Council it had discharged Mrs X or ask the Council to carry out an assessment.
20. Mrs X says she returned from hospital on Wednesday 14 August and her friend left on Thursday. Mr X says he returned home on Friday 16 August. Mr and Mrs X say they then had no-one to provide care or support to them. They were unable to shop or cook and had no access to food. Mr X called an emergency social worker.
21. The Council says Mr X called at 12pm on Saturday 17 August. The Council says this was the first it knew Mrs X had been discharged. Its social worker visited Mr and Mrs X the same day.
22. The Council has provided a copy of the record made by the social worker following the visit. This says she will make an urgent referral to the community reablement service for Mrs X. The social worker notes Mr X can do most things for himself except arrange meals. She had phoned the meal delivery service Apetito but as it had closed she left a voicemail asking it to deliver meals to Mr and Mrs X from Sunday. There are no records that show the social worker explained the charges for this service.
23. Mrs X says the social worker told them the meal service would be free for six weeks for Mrs X and that Mr X would pay a reduced fee as he was blind. And, that she would arrange care for Mrs X from Monday.
24. On Monday 19 August the social worker made a referral to the reablement service but her colleague explained Mrs X’s GP should refer her for intermediate care. On the same day Mrs X’s GP confirmed to the Council it would refer her to the intermediate care team for urgent care and support. I note the NHS, rather than the Council, would provide this intermediate care. The social worker updated Mrs X and suggested the Red Cross could help with shopping and light housework. However, Mrs X said she did not need that service at that time.
25. On 27 August Mrs X called the Council to complain about charges for the meal service. She said she was told it would be free for her for at least six weeks. The Council explained there was always a charge. Mrs X said she would not have used the service had she known, as she had food in the freezer and just needed someone to heat it up. Mrs X also complained she still had no care and was struggling to wash and change her bedding. The Council chased Mrs X’s GP on the same day and said it would chase the Red Cross. It also told Mrs X she could have a social care assessment if she wished or contact the Council after involvement with the intermediate care team.
26. The Council’s records show it spoke to the intermediate care team on 28 August. They explained they had spoken to Mrs X on 19 August and she had said she was managing independently and using crutches. An Occupational Therapist had visited on 20 August and decided Mrs X did not need urgent physiotherapy but the hospital should have referred her for community physiotherapy. The intermediate care team took no further action as they decided Mrs X was managing independently. The Council left a message with the Red Cross on the same date and contacted the community physiotherapy team to see if it had received a referral from the hospital.

27. The Council’s records show it tried to contact Mrs X on 28 August and spoke to her on 29 August. Mrs X was unhappy the hospital did not ensure she had support in place before leaving. The Council offered a care assessment but Mrs X said she did not feel she needed ongoing support. She needed help cleaning the shower and the Council said it would contact the Red Cross again about supporting with domestic tasks. Mrs X again insisted the social worker told her the meals would be free, but they would continue to purchase them now as they were beneficial.
28. I note the Council has no record of speaking to Mr X again after the visit on 17 August and Mrs X did not ask for support for him.
29. The Council’s records report the Red Cross had been trying to contact Mrs X by phone for the past 10 days but her line was always engaged. It said it would try to contact her again.
30. On 10 September Mrs X complained the Council had given their contact details to Apetito and agreed they would pay for this service without their consent. They thought the social worker had arranged the meals and that they would be free.
31. Internal correspondence shows the social worker did not tell Mr and Mrs X the cost of the meals as she did not know the costs but insists she did not say they were free.
32. The Council responded to the complaint on 13 September. It said its social worker arranged the meal service while visiting Mr and Mrs X with their knowledge and consent. Further that they were told the meals were chargeable during a phone call on 28 August when Mrs X said they would continue with the service as it was beneficial. The Council did not uphold the complaint and said they could contact the Ombudsman.
33. Mrs X contacted the Council on 27 September regarding the lack of care and support in place when she left hospital. The Council followed this up with a letter on 30 September. It outlined its actions and explained she should complain to the hospital and her GP about the delay and then lack of intermediate care.
34. I note the Council has no records to suggest Mr X asked for support for himself after the visit on 17 August or that Mrs X complained he was struggling and needed support.
35. When I spoke to Mr X he said he struggled to care for them both. He had to help his wife out of bed for the first two weeks and tried his best to provide her personal care. He also paid some neighbours to help with tasks, such as shopping. He said it affected him physically and mentally and he was now suffering from anxiety and tension. Mrs X said her husband became very depressed by the situation. They had no help until six to seven weeks after discharge when the Red Cross visited two hours’ per week to help with housework.

Findings

36. The Council’s records show it assessed Mr and Mrs X and considered if they would need support while Mrs X was in hospital for a hip operation. Mrs X had told the Council she did not need further support. Further, that she had arranged accommodation for Mr X.
37. There is nothing to suggest the Council knew or should have known the date Mrs X left hospital. The Council therefore does not appear to have had opportunity to arrange support for Mrs X or Mr X in advance of her discharge.
38. After Mrs X left hospital the Council’s social worker visited Mr and Mrs X promptly following their contact and considered what support they would need. The Council took steps to make sure Mrs X was referred for intermediate care. The Council noted Mr and Mrs X would need help with meals and arranged the meal delivery service. It also suggested the Red Cross could help with shopping and housework. The Council noted Mr X could manage independently except for arranging meals. There is no evidence Mr X told the Council he would need more support than this. The Council appears to have taken account of relevant information in deciding on the support necessary and I do not find any fault in its decision making process.
39. The NHS is responsible for intermediate care. If Mrs X considers they were wrong to decide she could manage independently she would need to complain to the NHS. I recognise Mr X’s complaint that he struggled to look after Mrs X while she had no care, however there is no evidence he or Mrs X raised this with the Council or asked for support for him.
40. Mrs X told the Council she was still without care on 27 August and it chased her GP on the same day. On 27 and 29 August, the Council offered Mrs X a social care assessment. I note this would have allowed it to assess what care she needed and decide if she was eligible for care and support from the Council. But Mrs X said she did not need ongoing support, only help with housework. The Council identified the Red Cross could help Mrs X with housework and took steps to ensure it contacted Mrs X.
41. Having reviewed the information provided, I consider the Council appears to have taken into account relevant information in deciding what care and support Mr and Mrs X may need at each stage. I have not seen any evidence that suggests the Council was made aware Mr X may need further care or support and then failed to act on this. I therefore find no fault by the Council in its provision of care and support to Mr and Mrs X.
42. In regards to the meal service, there is no substantive evidence to show the Council properly explained the costs to Mr and Mrs X. This is fault. I note Mrs X said they would not have used the service if they had known the cost. However, I am mindful the Council identified they were unable to make meals themselves, they had the benefit of the service and, once they knew the cost, they continued to use it. I therefore consider it more likely than not they would have used the service even knowing the cost. Consequently, I do not find the Council caused Mr and Mrs X any financial loss however, I consider an apology is due for its failure to provide details of the cost. I also consider the Council should take action to prevent recurrence.

Agreed action

43. To remedy the injustice set out above I recommend the Council take the following actions within one month of the date of my decision.
• Provide Mr and Mrs X with a written apology for its failure to provide clear information on the cost of the meal service.
• Take steps to ensure staff can provide information on the costs of the meal service in future.
44. The Council has accepted my recommendations. It explains it will provide an information sheet on current pricing alongside its leaflet on meal deliveries.

Back to top

Final decision

45. I find the Council at fault in its communications about the cost of a meal service. However, I find no fault in its provision of care and support. The Council has accepted my recommendations and I have completed my investigation.

Back to top

Parts of the complaint that I did not investigate

46. I did not investigate Mr and Mrs X’s complaint that the Council shared their personal details with a third party without consent. This is because the Information Commissioner’s Office is the appropriate body to deal with complaints about breaches of data protection.
47. I did not investigate Mr and Mrs X’s complaint about intermediate care. This is because the NHS provided this service and the Parliamentary and Health Service Ombudsman is the appropriate body to deal with complaints about the NHS.

Back to top

Investigator's decision on behalf of the Ombudsman