Summary: We cannot investigate Ms B’s complaint about the Council’s refusal to undertake a retrospective Continuing Health Care (CHC) assessment for her mother, Mrs C. This is because the decision to accept or reject an NHS CHC assessment is not an administrative function of the Council. The decision whether to undertake a retrospective assessment is for the NHS to consider. We cannot investigate this complaint.

The complaint

1. Ms B complained the Council refused to accept that an initial Continuing Health Care (CHC) assessment of her mother, Mrs C, undertaken in 2019 was flawed and refused to agree to undertake a retrospective assessment. Ms B wants to Council to complete a proper CHC assessment for Mrs C.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as NHS (Local Government Act 1974, sections 25 and 34A, as amended)

Back to top

How I considered this complaint

3. I discussed the concerns with Ms B and considered the information and documentation she and the Council provided. I sent Ms B a copy of my draft decision for comment.

Back to top

What I found

4. Ms B complained about Mrs C’s CHC assessment completed in 2019, the handling of the Continuing Healthcare process and subsequent dispute about funding arrangements.
5. Continuing Healthcare (CHC) is an NHS funding stream for service users who are considered to have a ‘primary health need’. If a service user is assessed as having a primary health need, the NHS will pay for their care (including any social care provision and, sometimes, accommodation) in its entirety. Even if somebody is found not to have a primary health need, the NHS may still contribute towards the cost of that person’s nursing care. This is known as NHS-funded Nursing Care (FNC).
6. The National framework for NHS continuing healthcare and NHS-funded nursing care (the Framework) is the key guidance relating to CHC/FNC. This sets out that the local CCG is responsible for (among other things):

• Ensuring compliance with the Framework
• Making decisions on eligibility for CHC/FNC
• Recording assessments/outcomes
• Commissioning arrangements (on an individual and strategic basis)

7. The Council were involved in the CHC/FNC process for Mrs C. However, under the Framework, overall responsibility for the CHC/FNC process (including decisions on eligibility) rests with the local CCG. Ms B’s complaint relates to processes and decisions for which the CCGs involved in Mrs C’s care were responsible.
8. The Council’s response to Ms B was from an integrated Council/Clinical Commissioning Group (CCG) team and referred Ms B to us. The Council was acting on behalf of the CCG in this case and should have referred Ms B to the Parliamentary and Health Service Ombudsman (PHSO) who deals with complaints about health care not the Local Government and Social Care Ombudsman. Information about PHSO can be found on the website below:

Making a complaint | Parliamentary and Health Service Ombudsman (PHSO)

Back to top

Final decision

9. We cannot investigate this complaint. This is because the decision to accept or reject an NHS CHC assessment is not an administrative function of the Council. The decision whether to undertake a retrospective assessment is for the NHS to consider not for the Local Government and Social Care Ombudsman.

Back to top

Investigator's decision on behalf of the Ombudsman