Summary: We will not investigate this complaint about the Council’s involvement with NHS continuing healthcare funding decisions. it is unlikely we would find evidence of fault, we could not add to the Council’s investigation, and further investigation is unlikely to lead to a different outcome.

The complaint

1. Mr B says the Council failed to attend a meeting about continuing healthcare funding, had poor knowledge of his father’s care needs, and refused to meet him to discuss concerns. Mr B found the Council dismissive. Mr B says this caused him stress and anxiety. Mr B wants the Council to say sorry and admit it could have met with him.

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The Ombudsman’s role and powers

2. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants.

(Local Government Act 1974, section 24A(6))

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How I considered this complaint

3. I considered information provided by the complainant.
4. I considered the Ombudsman’s Assessment Code.
5. I considered the Care Act 2014 and associated statutory guidance.
6. I considered the ‘national framework for NHS continuing healthcare and NHS-funded nursing care’ issued by the Department of Health and Social Care.

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My assessment

7. Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare (CHC).
8. Mr B’s father (Mr C) was assessed by the NHS for CHC funding, and at first the NHS did not award it. Mr B thinks the Council’s actions contributed to this decision.
9. The role of the Council is to share information with the NHS about the person being assessed, such as the person’s assessment of care and support needs the Council has completed under the Care Act 2014. Council social workers may be asked to attend the multidisciplinary meeting where the NHS will decide if the person has a primary health need and is eligible for CHC funding.
10. In Mr C’s case the Council could not attend the multidisciplinary meeting, but shared relevant information with the NHS before the meeting. There is no evidence of fault by the Council, and we could not say the NHS would have made a different decision had someone from the Council attended.
11. Mr B disputes the Council’s care needs assessment and says the Council did not properly understand Mr C’s care and support needs. The Council met with Mr C and got information from relevant professionals involved in Mr C’s care to complete its assessment under the Care Act 2014. This is the correct process, so it is unlikely the Ombudsman would find fault by the Council, even though Mr B disagrees with the outcome of the assessment.
12. Mr B asked to meet with the Council to discuss his concerns. The Council declined the meeting on the basis the CHC multidisciplinary meeting had taken place the day before, so it was best to await the outcome of that and then review the situation. The Council considers this was a reasonable and proportionate response to the request for a meeting. Mr B is correct the Council could have met with him, but it is unlikely the Ombudsman would say it was fault not to meet. The Council has given a reasoned explanation why it would not meet with Mr B, this was a decision it was entitled to take even though Mr B disagrees.
13. The Council has apologised that Mr B found staff to be dismissive. The Council explains there is no evidence to uphold that, and it was not its intent. It is unlikely the Ombudsman would find evidence of fault. Even if we did, the Council’s apology is sufficient to acknowledge the impact on Mr B and we could achieve nothing further.

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Final decision

14. We will not investigate Mr B’s complaint because it is unlikely we would find evidence of fault, we could not add to the Council’s investigation, and further investigation is unlikely to lead to a different outcome.

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Investigator's decision on behalf of the Ombudsman