Summary: There was fault by the Council. It did not communicate properly with Ms K when it decided not to continue with holiday payments for her disabled grandson. The Council also did not take into account that it had agreed to continue with these payments. The Council has apologised to Ms K. It has also agreed to backdate the discretionary payments, but end these in 2022. This is an appropriate way to settle this complaint.

The complaint

1. Ms K complains on behalf of her grandson, Mr B that the Council failed to pay discretionary holiday payments as agreed and failed to respond to her contact about this in good time.
2. This put Ms K to time and trouble chasing the Council for a response despite a written agreement that the Council would make the payments, and meant that she had to find funds for her grandson to visit his extended family.

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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. 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

5. I considered the information provided by Ms K and discussed the issues with her. I considered the information provided by the Council including its file documents. I also considered the law and guidance set out below. Both parties had the opportunity to comment on a draft of this statement. I considered any comments received before issuing my final decision.

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What I found

6. NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
7. Mr B has complex needs relating to a disability. In 2017, the Ombudsman found the Council had among other things failed to pay an annual discretionary holiday payment in a timely way and this caused Ms K distress. The Council agreed to apologise to Ms K for this, make a payment to remedy this and other failings, and pay any future holiday payments in good time.
8. In 2019, the NHS found that Mr B was eligible for CHC funding and took over the funding of his care. An email from the Council to Ms K at that time set out the details for the change of funding and says the Council will honour the annual holiday payment despite the NHS now being liable for funding his care.
9. Ms K asked the Council for a holiday payment in 2020. The Council did not respond. Ms K again asked for a holiday payment in 2022, and for this to be backdated for the last two years.
10. The Council said that as Mr B’s care needs were now being met by the NHS, it would be responsible for making holiday payments. It apologised to Ms K for not telling her this sooner. However, the Council has since established the NHS is not responsible for holiday payments as they are not to meet Mr B’s primary health need.
11. The Council has offered to make the payments for the years 2020, 2021 and 2022. It will then cease to make any further payments for holiday expenses.

Was there fault by the Council causing injustice to Mr B and Ms K?

12. The Council has acknowledged that it did not respond to Ms K’s request in 2020 and it has apologised to her for this. It has also acknowledged that it did not explain properly to Ms K why it would stop the payments.
13. It seems to me that the Council did not properly take into account that it had agreed to make the holiday payments, and it should have been clear that these would not be met by the NHS funding. This is further fault.
14. The Council’s shortcomings have had a financial impact on Ms K, and have caused her distress and frustration, as well as putting her to time and trouble chasing the Council and the NHS for information.
15. However, the payments are discretionary. The Council has no legal responsibility to make them and the Ombudsman cannot insist that it does. The Council has now given notice that the payments will cease. Its apology to Ms K and its offer to pay for the years missed, up to its giving notice, is an appropriate remedy.

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Agreed action

16. The Council has offered to:
• Apologise to Ms K; and
• Make the holiday payments for the years 2020, 2021 and 2022.
17. The Council should provide us with evidence it has complied with the above actions within one month of the date of this decision.

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Final decision

18. I have completed my investigation. There was fault by the Council causing an injustice to Ms K and Mr B.

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Investigator's decision on behalf of the Ombudsman