London Borough of Bromley (22 003 710)
Category : Adult care services > Assessment and care plan
Decision : Upheld
Decision date : 23 Mar 2023
The Ombudsman's final decision:
Summary: We will not investigate Mrs X’s complaint about Mrs Y’s Nursing Home fees. We are unlikely to find fault with NHS South East London Integrated Care Board’s decision not to fund Mrs Y’s stay at a Nursing Home under the COVID-19 Hospital Discharge Service Requirements.
The complaint
- Mrs X complains on behalf of Mrs Y about NHS South East London Integrated Care Board (the ICB – previously NHS South East London Clinical Commissioning Group). She says the ICB refused to fund Mrs Y’s care at a Nursing Home under the COVID-19 Hospital Discharge Service Requirements (the COVID-19 Requirements). That meant London Borough of Bromley (the Council) wrongly charged Mrs Y for the care at the Nursing Home. She says the ICB should cover those costs. Mrs X would also like the ICB to change its process to avoid similar fault happening to others.
The Ombudsmen’s role and powers
- The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe it is unlikely they would find fault. (Health Service Commissioners Act 1993, section 3(2))
How I considered this complaint
- I have considered evidence from Mrs X, the ICB and the Council and spoken to Mrs X on the phone.
- Mrs X had an opportunity to comment on my draft decision. I have considered her comments received before making a final decision.
What I found
Relevant law and guidance
- In March 2020, the Government published the COVID-19 Requirements which set out some changes to the hospital discharge policy and operating model during the pandemic. That included changes to funding. Specifically, it said: “The Government has agreed to fully fund the cost of new or extended out-of-hospital social care and support packages, referred to in this guidance, for people being discharged from hospital or who would otherwise be admitted into it for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services”.
Key facts
- In April 2020, a Hospital Trust admitted Mrs Y after a fall and increased confusion. After two weeks, the Hospital Trust moved Mrs Y to the Rehab Placement to free up her bed on the acute ward due to the COVID-19 pandemic. Mrs X says Mrs Y did not have any rehabilitation or therapy needs.
- Mrs Y remained at the Rehab Placement for nearly two months. During that stay, the Council assessed Mrs Y’s needs and decided she could not return home due to the risk of falling. Instead, she needed 24-hour care and support at a Nursing Home. The Council confirmed in an email to Mrs X that Mrs Y’s care would be chargeable when she moved to the Nursing Home.
- Mrs Y moved to the Nursing Home in June 2020. During her stay, the ICB decided Mrs Y was eligible for NHS Funded Nursing Care (FNC). FNC is the funding provided by the NHS to residential nursing homes that also provide care by registered nurses.
- In September 2020, Mrs Y moved back home with support from carers, where she died a few months later.
- In November 2020, the Council sent Mrs X an invoice for Mrs Y’s care fees at the Nursing Home. Mrs X disputed that invoice first with the Council.
- In response to Mrs X’s complaint, the ICB said that Mrs Y was not eligible for funding under the COVID-19 Requirements. Mrs Y moved to the Nursing Home from a rehabilitation bed, rather than a hospital bed. The ICB said it was not responsible for paying the invoice in dispute.
Analysis
- I will not investigate Mrs X’s complaint against the ICB. I will explain why.
- The ICB said because Mrs Y moved to the Nursing Home from the Rehab Placement, she was not eligible for funding under the COVID-19 Requirements. That is not technically correct. Someone should receive that funding until the Council or NHS decide what that person’s longer‑term care needs are. It did not matter if that person was in a hospital or community setting. The funding should continue until someone’s longer-term care needs are clear.
- In Mrs Y’s case, the Council assessed her care and support needs at the Rehab Placement. That assessment determined what Mrs Y’s longer term care and support needs were (at the Nursing Home). So when Mrs Y moved to the Nursing Home, I agree her care became chargeable. I consider the ICB’s duty to fund Mrs Y under the COVID-19 Requirements ended.
- Therefore, while the ICB’s complaint response could have been clearer, I am unlikely to find it acted with fault by not funding Mrs Y’s care at the Nursing Home.
Final decision
- I will not investigate Mrs X’s complaint about the ICB. I am unlikely to find fault with the ICB’s decision to not fund Mrs Y’s stay at a Nursing Home.
Investigator's decision on behalf of the Ombudsman