Summary: The Council acknowledged it was funding a health care service at Ms A’s previous care home as part of the home’s standard provision but that did not make a difference to the outcome here. The break in services was a consequence of long waiting lists and not the funding question.

The complaint

1. Mrs X (as I shall call the complainant) complains the Council failed to make suitable arrangements for Ms A’s physiotherapy and hydrotherapy services to continue when she had to move to a different residential home. As a result, she says Ms A has lost out on services she needs.

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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 Mrs X and by the Council. Both Mrs X and the Council had an 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. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. Councils have a duty to meet the needs of people who are assessed as requiring residential care services.
6. Health care needs, such as physiotherapy or hydrotherapy, are met through NHS funding and not by councils. Section 22 of the Care Act provides that “in meeting an adult's needs for care and support, a local authority may not provide any healthcare services which are the responsibility of the NHS.”

What happened

7. Ms A is an adult with disabilities who is a wheelchair user. Since 2014 she has lived in a residential home. The care home where she lived until 2021 provided physiotherapy and hydrotherapy services in-house, and the Council funded them as part of the total care package it funded for Ms A. It says the care home provided them as a standard package and it did not pay extra for physiotherapy and hydrotherapy about its usual rate.
8. Mrs X says she was notified in June 2021 that the care home was closing and that relatives had until the end of September 2021 to find alternative accommodation. She says that as the Council funded Ms A’s placement, she thought it would assist with finding a suitable alternative home. She says that the Council was unhelpful and delayed even organizing meetings with relatives until well into July.
9. Mrs X says she personally went and looked at care homes and, in the end, found the home where Ms A now lives, and moved into on 28 September. She says however that the new home does not provide the same facilities in-house that Ms A used previously. She says the hydrotherapy and physiotherapy services have to be provided at a Day Centre instead, but the Council did not fund them
10. In August 2021 Ms A’s then social worker asked the Council’s funding panel to fund Ms A’s attendance at the Day Centre. The Panel told the social worker to ask the home to put a ‘personalised activities plan’ in place for Ms A as it was contracted to do.
11. Mrs X complained to the Council in December 2021 about its failure to put the services in place for Ms A. She said none of the other residents at the care home has needs as severe as Ms A’s and yet their attendance at the Day Centre was being funded. She also complained about the number of different social workers who had been allocated to Ms A over the relevant period.
12. The Council replied to Mrs X. It acknowledged that the number of different social workers would have had an impact on the continuity of care provided to Ms A. It said the previous placement had provided hydrotherapy and physiotherapy services to residents, but these were health services which should have been funded by the local Clinical Commissioning Group (CCG) and not by the Council. It said, “This should have been picked up and rectified by the reviewing social worker at the time”.
13. The Council added that although the current care home had identified the Day Centre which could meet Ms A’s needs for physiotherapy and hydrotherapy, the Council’s funding panel had refused the social worker’s request to pay for the services as they were jointly the responsibility of the CCG. It said the social worker had approached the CCG for part funding.
14. Mrs X complained to the Ombudsman. She said the Council had grossly mishandled Ms A’s transfer and she had now missed several months of services because of its failings.
15. The Council says the care home where Ms A lived previously was closed down after a CQC inspection and a strict timetable had to be followed. It says the contract it has with care homes expects care providers to ensure a “holistic” support plan which will “address and meet all aspects of the individual’s needs including the need to engage in social activities and to participate in community activities”
16. It says “It is not our expectation nor our usual practice to separately fund a day care placement for individuals receiving 24-hour care in a care home placement. Where a client has a need to receive health services such as physiotherapy and hydrotherapy, we would expect their GP to refer them into such health services. Once the panel was made aware of the waiting list for physiotherapy service, the panel made an exception in (Ms A’s) case and agreed to fund most of the cost of (the) day care placement to enable her access physiotherapy service and hydrotherapy service whilst at the centre”.
17. The Council adds, “It would not have been possible to explore these options ahead of Ms A’s move due to the limited time available for the move prior to the closure of her previous home”.
18. The CCG agreed joint funding on 3 March 2022, but the Day Centre had limited staffing at the time and could not accept new referrals.
19. Mrs X says Ms A was unable to access her full package of care for many months and the situation had caused undue distress to Ms A herself, and to Mrs X in terms of the time taken to follow up the complaint.
20. In response to my draft decision, the Council says, “It was unfortunately the case that even after the CCG has accepted funding responsibility for Ms A’s health services, and the social worker had made contact with relevant services within the host authority, Ms A could still not have had immediate access to the services as there was a long waiting list for these services within the host authority”.
21. The Council adds, “it is the council’s normal practice not to deprive any client of needed services because of a dispute in funding responsibilities. The council would normally fund health services and invoice health for a reimbursement. Similarly, should these services had been available at the time of Ms A’s move, the council would have funded them to minimise the risk of a gap in service provision, until the relevant CCG takes over funding, after which the council would invoice the CCG for reimbursement”.

Analysis

22. The Council recognised it was funding health care services for Ms A.
23. However, even if the Council had acted sooner to alert the CCG to the provision of those services, it would not have made a difference to the outcome here. With the deadline of the enforced closure of the home, there would still have been a gap in service whichever body was funding them, because of the long waiting lists in the area.
24. In practical terms, the only difference would have been that Mrs X would have made a complaint to the CCG and not the local authority.

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Final decision

25. I have completed this investigation. Any fault on the part of the Council did not play a part in the wait Ms A had to access the services she had benefited from at the previous care home.

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Investigator's decision on behalf of the Ombudsman