Summary: Mr D complained the Council transferred Ms E to a care home without a hospital discharge plan and without consultation with the family. We find the Council was at fault for not sharing copies of Ms E’s care plan and assessments with her family. It also delayed sending charging information to the family. The Council has agreed to our recommendations to address the injustice caused by fault.

The complaint

1. Mr D complained the Council transferred Ms E to a care home without a hospital discharge plan and without consultation with the family. He says the Council failed to provide the family with a copy of Ms E’s care plan. He adds the Council did not communicate effectively with the family about Ms E’s ongoing care. Finally, he says it was unacceptable for the Council to send financial assessment forms.
2. Mr D says the lack of information and updates has caused distress and upset.

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The Ombudsman’s role and powers

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’. 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)
4. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
5. If we are satisfied with an organisation’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 considered information from Mr D. I made written enquiries of the Council and considered information it sent in response.
7. Mr D and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Charging and financial assessments

8. The Care Act 2014 provides a single legal framework for charging for care and support under sections 14 and 17. It enables a council to decide whether to charge a person when it is arranging to meet a person’s care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
9. When a council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care.
10. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person is entitled to access council support to meet their eligible needs. People who have over the upper capital limit are expected to pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.

The COVID-19 Hospital Discharge Service Requirements

11. In response to the COVID-19 pandemic and the need to keep hospital beds free, the government introduced temporary measures for the NHS to pay for some care costs. The guidance started on the 19 March 2020 and was withdrawn on 25 August 2020. It said the NHS should:

• Discharge all patients as soon as it was safe to do so.
• Fully fund the cost of new or extended out-of-hospital health and social care support packages for those who would otherwise remain or be admitted to hospital; and
• Not assess individuals for NHS Continuing Healthcare funding until the end of the COVID-19 emergency period.

12. On 21 August 2020 the government issued revised guidance on hospital discharge. For people who were discharged from hospital between 19 March 2020 and 31 August 2020 with a care package, it said health, care or financial assessments for longer-term care needs should be carried out as soon as practicable. The cost of care for those awaiting an assessment would be met meanwhile from a ringfenced fund.

Care plans

13. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has.

What happened

14. Ms E had a stroke and went into hospital. She was transferred to another hospital in March 2020 for rehabilitation. The Council was not involved in this process.
15. The hospital referred Ms E to the Council’s social work team in April to assess her under the COVID-19 Hospital Discharge Service Requirements. The nurses stated it was likely Ms E would have care and support needs on discharge that could not be met at home.
16. A social worker assessed Ms E on 13 April. She tried calling Ms E’s daughter (Miss F), but she could not get through.
17. The social worker noted Ms E needed 24 hours nursing care and it would not be safe if she returned home. She made a referral for Ms E to have a nursing care placement.
18. The social worker spoke to Miss F on 15 April. She gave her an update on Ms E’s care needs and that she would be moving to a nursing care placement. Miss F was upset but agreed with the move. The social worker explained she would need to complete a financial assessment and Ms E would have to pay towards her care. Miss F explained Ms E did not own a property and she had little money.
19. The Council found a care home for Ms E and sent it a copy of her care plan. It phoned Miss F and provided her with the contact details of the care home.
20. The social worker phoned Miss F again and confirmed Ms E has been successfully discharged to the care home. She told her if she had any concerns, she should speak to the care home.
21. The Council’s recording system states the social worker sent Miss F copies of the financial assessment forms and charging information on 24 April. However, it has not been able to produce a copy of the letter and Miss F has no record of receiving it.
22. The Council reviewed Ms E’s care and support needs in June. The social worker noted her condition had not improved, and she needed a full-time placement. The social worker tried to contact Miss F, but she could not get through.
23. The Council wrote to Miss F on 29 March and 11 May 2021 and asked for information to assess Ms E’s finances.
24. Mr D is Miss F’s advocate. He called the Council on 25 May and asked for information about Ms E’s care package.
25. Mr D contacted his local MP and said the Council failed to consult with the family about the hospital discharge and there was no care plan in place. He also said a social worker had failed to update the family about Ms E’s care. The MP sent Mr D’s concerns to the Council.
26. The Council spoke to Mr D on 3 June. Mr D said it was not right for the family to complete a financial assessment when they did not agree to the placement. He also said the Council failed to consider whether Ms E could return home with a care package.
27. The Council called Mr D on 22 July to arrange a review of Ms E’s care and support needs.
28. The social worker visited Ms E on 10 August. The care home said she could not live independently, and she needed 24 hours care.
29. The social worker visited Miss F and Mr D two days later. Mr D explained the Council had failed to keep them informed of the process. Miss F said she wanted Ms E to return home. The social worker explained Ms E could not return home because she needed 24 hours care. He also said the care home agreed to keep the family updated.
30. The Council sent Mr D a copy of Ms E’s care plan on 13 August.
31. The Council responded to Mr D’s complaint on 19 August. It said the social worker did speak to Miss F about Ms E’s discharge to the care home. It also said the social worker tried to contact Miss F to complete a review of Ms E’s care needs, but she could not get through. It apologised the family was not part of the review process.
32. Miss F provided the Council with some financial information in March 2022. The Council says it is incomplete, and therefore it has not been able to complete a financial assessment.

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Analysis

33. The Council told Miss F in April 2020 about the plans to discharge Ms E to a care home. It also told her Ms E’s needs could not be met at home. Therefore, I am satisfied the Council spoke to Miss F and she was aware of the discharge plans. The Council was working under the COVID-19 Hospital Discharge Service Requirements, and so it had to work as quickly as possible to ensure Ms E’s safe discharge from hospital. These requirements also suspended the usual guidance on the choice of care home.
34. The Council provided the care home with a copy of Ms E’s care plan before she was admitted. Therefore, I do not accept Mr D’s assertion there was no discharge plan.
35. However, the Council failed to provide Miss F with a copy of Ms E’s care plan which is fault. This meant she was not properly informed about how the care home would meet Ms E’s care needs, which caused her distress.
36. Mr D says it was wrong for the Council to send financial assessment forms when it failed to provide a copy of the care plan at the outset. The Council must seek financial information to find out how much a person needs to pay towards their care needs, and so it was not unreasonable for it to send Miss F the financial forms.
37. The Council’s notes suggest the social worker sent Miss F financial information and forms to complete on 24 April 2020. However, the Council does not have any copies of the letters it sent, and Miss F says she did not receive anything. Therefore, I find it more likely than not the Council did not send Miss F the financial information forms at the outset. She only received the forms in 2021. This is fault which meant Miss F did not have sufficient information to progress the financial assessment for an unreasonable amount of time.
38. The NHS temporarily funded the costs of new health and social care packages under the COVID-19 Hospital Discharge Service Requirements. The Council’s notes suggest it completed the initial assessment under these requirements, and so I would have expected it to have confirmed the NHS funding arrangements with Miss F. There is no evidence in any of the correspondence it did so, which is fault. This has caused Miss F some uncertainty over a lack of clarity.
39. The Council says the social worker could not get through to Miss F in June 2020, and so completed a review of Ms E’s care needs without her. I do not consider one attempt at contacting Miss F to be satisfactory. The Council should have tried harder to involve Miss F in the review process. The Council also failed to send Miss F a copy of the review documents, which meant she had no information about Ms E’s ongoing care needs. This caused her frustration and upset.

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Agreed action

40. To address the injustice caused by fault, by 5 August 2022 the Council has agreed to:

• Apologise to Miss F.
• Pay Miss F £150 for the distress, upset and uncertainty caused.
• Write to Miss F and clarify whether any of Ms E’s stay at the care home is covered under the temporary NHS COVID-19 funding.

41. By 2 September 2022:

• Issue written reminders to relevant staff to ensure:

1. They share care plans with service users and their relatives without unnecessary delay.
2. They make a reasonable effort to involve a service user’s family in a review of their care and support needs.

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Final decision

42. There was fault by the Council, which caused Miss F an injustice. The Council has agreed to my recommendations and so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman