Summary: The Council failed to ensure the appropriate funding was approved for Mrs X when she was discharged from hospital. It ordered the recommended equipment for her but could not explain why some of it was not delivered. The Council’s response to Ms B’s complaint was inadequate. The Council agrees to apologise to Mrs X, reimburse the amount of funding it failed to secure for her, and pay a sum which recognises the distress caused.

The complaint

1. Ms B (as I shall call her) complains the Council failed to ensure the promised payment of funding for her mother Mrs X when she was discharged from hospital; did not ensure all the equipment she needed was supplied; and cancelled the whole of her reablement care package. She also says the Council failed to respond properly to her complaint. As a result, Mrs X lost out on funding and services.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I considered the information provided by Ms B and the Council. I spoke to Ms B. Both Ms B and the Council had the opportunity to comment on a draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

5. In March 2020 the government put a hospital discharge plan in place to ensure patients could be discharged quickly from hospital beds and receive funding to pay for care home beds for a limited period (4 weeks at the time of the events described here). The Covid 19 hospital discharge service requirements guidance said, “The discharge to assess pathways …will only be successful if NHS organisations work hand in glove with adult social care colleagues, the care sector and the voluntary sector.”
6. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014

7. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

What happened

8. Mrs X lived alone. In August 2021 she fell at home after suffering a stroke. She was admitted to hospital next day when her family found her lying on the floor.
9. In October a social worker visited Mrs X on the ward. Ms B was also present. The social worker explained the discharge process if Mrs X returned straight home, and the availability of reablement care and equipment. Ms B said she had concerns about her mother falling out of bed. Mrs X agreed she would like to go to a care home for some weeks before she went home. Ms B says the social worker explained they would get non-means-tested Covid funding towards the cost of the care home.
10. Ms B says at a meeting with the ‘Life’ team on the ward they were promised substantial amounts of equipment for when Mrs X returned home, including a hospital bed, sensor mats, a commode, a ‘sara stedy’ (to enable transfers), a careline alarm system, a ramp, a wheelchair and a high-seated chair.
11. The Council’s records show the social worker met Mrs X and Ms B again on 20 October: “I explained to (Ms B) that given that (Mrs X) has capacity and consented to a temporary period in a care home she can be discharged via the D2A pathway under Covid funding for 4 weeks”. The notes continue: “Once (Mrs X) is deemed ready for discharge an NNA will need to be completed with a view that the placement team need to be informed of the family's choice of placement”.

Failure to process the funding request

12. Mrs X was discharged to the care home on 2 November 2021. The Nursing Needs Assessment (NNA) was not processed.
13. The next day the social worker emailed the relevant funding team. He wrote, “please find attached NNA for RH placement for the client I was making reference to asking if the first four weeks can be under Covid funding as the NNA was missed somehow by the ward until client was discharged yesterday”.
14. The funding team replied: “Unfortunately we would not be able to help with the placement and cannot accept this D2a request, as this client has been placed already and is no longer in hospital. If the NOK need help funding the placement, please advise them to contact Croydon Social Services and make a request for help with funding the Care Home Placement”.
15. The social worker emailed again. He said, “I understand that the client was meant to benefit from covid funding just like any other irrespective of them being self-funding. I understand that the covid funding is not means tested either. It wasn't the family problem that the NNA wasn't done before discharge and I don't think that should be used as a penalty either…. I am sure the family will raise this as a concern at some point knowing that they have been deprived of accessing funding that is accessed by everyone else irrespective of their funding status soon after hospital discharge. I think this decision should be reviewed as (Mrs X) will need support from the locality team at some point after a period in a care home to hopefully go back home.”

Equipment order and the reablement service

16. Mrs X was readmitted to hospital on 4 November after a fall at the care home during which she fractured her hip. She returned to the care home on 26 November after recovering from surgery. The community stroke team started physiotherapy with her. Ms B says she had no contact from the Council about the equipment promised to enable Mrs X’s return home so asked the Occupational Therapist (OT) on the stroke team to look into it. The OT placed an order for the equipment as she said she could not find any evidence of an order.
17. The reablement team leader contacted Ms B on 16 December asking to assess Mrs X’s needs and any equipment for her return home. Ms B explained Mrs X was still in the care home and said the stroke team had ordered the equipment already. The reablement team leader arranged instead to visit Mrs X at home on 4 January on her discharge from the care home. She said Mrs X would get a package of care for 6 weeks with 4 calls a day. She said someone would call Ms B on 2 January to confirm.
18. The Council’s records show an order was placed on 17 December for a “low electric profiling bed, high risk foam mattress, cantilever table with wheels, two bed crash mats, a sarah steady, a shower commode chair, two bed rails, a mobile shower commode chair, 4 inch suit case ramp and an extended roller sheet’ .
19. Ms B says she eventually got a call from the reablement team late on 4 January (after Mrs X came out of the care home on 3 January) and was told care would start next day at 8am with four daily visits. She says on 5 January the carers came at 10.30 am, by which time Mrs X had been in bed for over 14 hours. They told Ms B they could not guarantee the call times, would not be able to provide an afternoon call that day but someone would come for the evening visit although they could not say when.
20. Ms B says the situation was too stressful for Mrs X and after consideration they cancelled the carers and Ms B moved in to look after Mrs X, with the help of a live-in carer. The reablement team then told her that because she had cancelled the carers, Mrs X would not be able to have the physiotherapy part of the reablement package either. The Council’s notes say, ‘On the 21/01/2022 daughter wrote an email cancelling all care that was provided saying the care call timings were not conducive to (Mrs X’s) needs and that she was providing the 24hrs care that she needs’.

The complaint and the Council’s response

21. Ms B wrote to the Council with a complaint on 6 January 2022; after a telephone call she wrote again on 13 January setting out in more detail what had happened since Mrs X’s admission to hospital in August 2021.
22. The Council’s locality team manager responded on 26 January.
23. In response to Ms B’s complaint about the inadequate support from the social care team, the team manager replied that a social worker had been allocated and been actively involved.
24. The team manager said she could not comment on Ms B’s concerns about inconsistent information.
25. In response to the complaint that Covid funding had not been processed, the team manager said this was because Mrs X had been discharged privately before the request was sent to the Placements team.
26. The team manager said the reablement package was stopped because Ms B turned down the carers.
27. In response to complaints that none of the promised equipment was supplied, the team manager wrote, ‘Equipment was ordered and so unsure why stopped’.
28. The team manager said the social care team had not contacted Ms B after Mrs X’s discharge as it was a private placement.
29. Finally the team manager said Mrs X was ‘unsuitable for reablement’ due to the effects of her stroke and hip fracture.
30. Ms B complained to the Ombudsman. She said her complaints had been largely misinterpreted or ignored by the Council. She said it was not the family’s responsibility but that of the hospital and social work team to make the funding application, and the intention to transfer Mrs X to a care home had been communicated well in advance. She said overall her concerns had been stonewalled by the Council.
31. The Council has provided a copy of the Nursing Needs Assessment (NNA) which was completed by the discharge facilitator on 2 November, the date Mrs X was discharged. There is a note on the pro-forma stating that the form should be used for all placements. The form contains the social worker’s confirmation that ‘Once (Mrs X) is deemed ready for discharge an NNA will need to be completed with a view that the placement team need to be informed of the family’s choice of placement’.
32. The Council says after the conversation about funding Mrs X was discharged ‘without the Nursing Needs assessment (NNA) referral document being sent to the placement team to start the process of placement finding or the placement team contacting …the home of family choice’. It says this was followed up (the email of 02 November requesting a review) but no further action was taken as Mrs X was readmitted on 4 November after a fall.
33. The Council cannot say what happened to the equipment which was ordered. It says it is ‘usually’ followed up by the life team workers or the social worker. Ms B says some equipment was delivered in the end but not the sensor mats or call system. She says they had to obtain a wheelchair privately for use at the care home.
34. The Council says when Ms B cancelled the care calls by the reablement team it cancelled the entire package as Mrs X was already receiving physiotherapy form the stroke team.
35. Ms B says she employed a live-in carer and between them they managed Mrs X’s care until July this year when it became clear Mrs X’s needs would be better met in a care home setting.
36. Ms B says she knew her mother’s finances were above the threshhold amount at which she would fund her own care, but she had been promised the Covid funding which was not means-tested and then denied it through no fault of their own.

Analysis

37. There was a failure to ensure the correct Covid-19 funding was in place when Mrs X was discharged from hospital. The discharge to the care home was not a surprise so it is unclear why it was missed. As a result Mrs X lost the assistance of several weeks’ funding of her care home costs. The fact she was readmitted shortly afterwards should not make a difference to that: she was discharged again to the same care home some weeks later. That failure to ensure the funding was provided was fault which caused her injustice.
38. The Council cannot explain why the equipment order was misplaced or why it took so long for the necessary equipment to be delivered (and why some items remained missing throughout, such as the sensor mats).
39. There was poor communication from the reablement team. When Ms B decided to cancel the carers because they could not guarantee being able to attend at the right time, there was no reason for the Council to cancel the associated physiotherapy sessions: it must have (or should have) known she was already receiving community physiotherapy and yet was willing to provide a package of care including that.
40. The Council’s response to Ms B’s complaint was unhelpful, incomplete and failed to provide any proper explanation or give evidence for its conclusions. At times it was abrupt. Some responses did not make sense – that Mrs X was being discharged on a privately-arranged basis had no bearing on the eligibility for Covid funding. The response said Mrs X was ‘unsuitable for reablement’ and yet it had put a package in place.

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Agreed action

41. Within one month of my final decision, the Council will apologise to Mrs X and Ms B for the way it handled this matter;
42. Within one month of my final decision the Council will pay to Mrs X a sum the equivalent of the Covid 19 funding she should have received;
43. Within one month of my final decision the Council will make a payment of £500 to Ms B: £250 in acknowledgement of the distress caused by its poor communication and £250 in recognition of the time and trouble she has been put to in making this complaint;
44. Within one month of my final decision the Council will review the equipment ordering system to ensure it can follow the process through correctly;
45. Finally, within one month of my final decision, the Council will review the way in which area teams address complaints and provide training if necessary to ensure that responses reach a minimum quality level which was not achieved here.

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Final decision

46. I have completed this investigation: I find there was fault which caused injustice to Mrs X and Ms B: completion of the recommendations at paragraphs 41 – 45 will remedy that injustice.

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Investigator's decision on behalf of the Ombudsman