Summary: We will not investigate Mrs B’s complaint about the Council’s actions regarding her late father’s, Mr C’s, planning for discharge from hospital and failure to refer him for NHS Continuing Health Care (CHC) funding. This is because it is not an administrative function of the Council to award CHC funding. Mrs B can ask the NHS to consider a retrospective assessment for Mr C.

The complaint

1. Mrs B complains the Council failed to properly consider her late father’s, Mr C’s, health care needs when planning for his discharge from hospital. Mrs B says the Council failed to complete a Decision Support Tool which would have showed the level of healthcare Mr C required.

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The Ombudsman’s role and powers

2. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome.

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

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How I considered this complaint

3. I considered information provided by the complainant.
4. I considered the Ombudsman’s Assessment Code.
5. The complainant had an opportunity to comment on my draft decision.

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My assessment

6. The Council says Mr C was discharged to a residential placement and did not require nursing care.
7. Mrs B says Mr C did require nursing care and prior to having a stroke was fit and healthy. Mrs B says Mr C should have remained in hospital on the rehabilitation unit. Mrs B says Mr C needed nursing care and disputes the Council’s view that he only needed personal care.
8. It is not an administrative function of the Council to decide whether a person is eligible for CHC funding, nor can the Council decide not to provide CHC funding. The Council cannot decide whether a person should remain in hospital. In the absence of evidence from the NHS confirming Mr C was eligible for CHC funding, there is no fault with the Council for charging care it provided.
9. It is the CCG’s decision whether to award CHC funding, so Mrs B can apply for a retrospective assessment. Mrs B as the applicant can tell the CCG why she disputes the Council’s view and say what nursing care Mr B received. But it is up to CCG to get all information it needs to decide an application. Information about the NHS CHC funding can be found on the website below.

https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

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Final decision

10. We will not investigate this complaint. This is because it is not an administrative function of the Council to award CHC funding. Mrs B can ask the NHS to consider a retrospective assessment for Mr C.

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Investigator's decision on behalf of the Ombudsman