Summary: The Council was at fault for significant delays to its assessments of Mrs B’s needs and finances after she moved into a care home. It has already partly remedied any injustice to Mrs B and her son arising from the delays. It has now agreed to make a further remedy payment to recognise that, shortly after Mrs B moved into the care home, it told her son that it would pay her fees until it had completed her needs assessment. It will also take steps to improve its service.

The complaint

1. The complainant, whom I refer to as Mr C, complains that the Council significantly delayed assessing his late mother’s needs and finances after she moved into a care home in March 2022. I refer to Mr C’s mother as Mrs B.
2. Mr C says these delays caused Mrs B a financial injustice, because, after the Council eventually assessed her needs, it turned out she was eligible for the NHS to pay her care fees. He says she would have received funding from the NHS much earlier if there had been no delay to the Council’s needs assessment.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’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 information from Mr C and the Council.
6. I considered:
• The statutory guidance accompanying the Care Act 2014 (which I refer to as ‘the statutory guidance’).
• The October 2021 government guidance, ‘Hospital discharge and community support: policy and operating model’ (which I refer to as ‘the hospital discharge guidance’).
7. Mr C and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

The Council’s responsibilities

The statutory guidance

8. When someone has assets worth more than £23,250, they are not entitled to receive any financial assistance from their local council. And, if they are in a care home, councils are not allowed to pay for their care.

The hospital discharge guidance

9. This guidance – which was in force between October 2021 and March 2022 – set out how hospitals, councils and others were to deal with people who no longer met the government’s updated ‘criteria to reside in hospital’ – in short, people who did not need to be there.
10. The model applied to four groups of people – one of which was people who needed “recovery, rehabilitation, assessment, care planning or short-term intensive support in a 24-hour bed-based setting, ideally before returning home”.
11. The Government agreed to provide funding (for a maximum of four weeks) to cover the costs of additional care people needed on discharge from hospital. This allowed councils to put post-discharge services in place while they assessed people’s needs and finances. It also meant people did not have to wait in hospital for assessments to take place.
12. The government expected that, in straightforward cases, councils would complete needs assessments and decide ongoing funding arrangements within four weeks of discharge. If this did not happen, “the parties paying for the care [continued] to do so until the relevant care assessments [were] complete”.

What happened

13. In March 2022, Mrs B was discharged from hospital into a care home. Her care home fees were funded for four weeks under the terms of the hospital discharge guidance.
14. The Council wrote to Mr C. It told him Mrs B’s “capital, savings, investments and other assets are over £23,250. This means [she] will need to pay the full cost of [her] care. This is known as ‘self-funding’”.
15. The Council had not done a financial assessment at that point. It based its knowledge about Mrs B’s finances on a prior conversation with Mr C.
16. The Council did, however, tell Mr C that it would ‘do its best’ to assess Mrs B’s needs and finances before her funding ran out (four weeks after leaving hospital).
17. In early April, Mr C asked the Council when it was going to assess Mrs B’s needs. The Council said it would complete this the following week (by 15 April) and Mrs B would not be charged until the assessment was completed.
18. Over the next three months, Mr C contacted the Council twice more to ask about Mrs B’s needs and financial assessments, but he received no response.
19. The Council completed its financial assessment in late August. It decided Mrs B was liable for full care costs, which amounted to £762.02 per week. It wrote to Mr C to tell him this in early October.
20. Mr C told the Council that he could not pay the invoices because he could not access Mrs B’s accounts. He had applied for deputyship several months beforehand but was still waiting for the outcome.
21. The Council then completed Mrs B’s needs assessment in mid-November. One of the outcomes of the assessment was that a referral would be made to the NHS to decide if Mrs B was eligible for continuing healthcare (CHC) funding. This is when the NHS entirely funds someone’s care because their needs are primarily health related.
22. The Council made the referral to the NHS in mid-December. The NHS did the CHC assessment the next day and, in January 2023, decided Mrs B was eligible for the funding.
23. After Mr C complained to the Council about the delays, it upheld his complaint, and offered him (on behalf of Mrs B’s estate):
• An apology.
• £500 to recognise the significant delay completing a financial assessment.
• £2,286.06 (21 days of care home fees) to recognise the delay referring Mrs B for a CHC assessment after completing her needs assessment.
24. However, the Council told Mr C that, if he thought Mrs B would have been eligible for CHC funding earlier (had the Council completed its needs assessment earlier), he should follow the NHS’s established appeals process.

My findings

25. The Council was clearly at fault for a significant delay in assessing Mrs B’s needs. And it is understandable that this delay has led Mr C to believe that Mrs B missed out on months of CHC funding.
26. However, the Council is right to say that Mr C can access the CHC appeals process if he thinks the funding should be backdated. If he has not already appealed, he should do so, as I cannot make a decision on retrospective CHC eligibility.
27. The Council was also at fault for a significant delay to its financial assessment. However:
• Mr C was told in advance that Mrs B would likely be a self-funder, and it based this on information Mr C himself provided.
• Even had the financial assessment taken place sooner, it appears Mr C would have been unable to pay Mrs B’s invoices, as he could not access her accounts. This means the bills would still have mounted up over several months.
• The Council has already apologised for this and offered Mr C a suitable remedy.
28. Consequently, I do not consider Mrs B or Mr C to have any remaining injustice from the delayed financial assessment and I will not recommend any further action.
29. The Council has also offered Mr C a reasonable remedy for the delay to its referral for a CHC assessment. Again, there is no need for me to comment further.
30. However, the Council told Mr C in April that, after the expiry of the four-week government funding for Mrs B’s care, she would not pay for the care herself until a needs assessment had been completed. It said it would do this by 15 April 2022 – but it did not do it until mid-November.
31. It would not be reasonable to expect the Council to waive Mrs B’s care home fees for the whole duration of the seven-month delay, because she received the care and was liable for the fees.
32. But the Council should make a remedy payment to Mr C which recognises that, because of its failure to allocate a worker to Mrs B’s case for several months, it could not do what it said it would in early April 2022 (assess Mrs B’s needs by 15 April and waive her care home fees up to that point).

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Agreed actions

33. Within four weeks, the Council has agreed to make a payment to Mr C, on behalf of Mrs B’s estate, equal to what it has charged Mrs B for care home fees up to and including 15 April 2022. If the Council chooses to, it can make this payment by deducting it from what Mrs B’s estate owes.
34. Within eight weeks, the Council has also agreed to send us an action plan which sets out how it will ensure such significant delays to needs and financial assessments do not happen again.
35. The Council has agreed to provide us with evidence it has done these things.

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Final decision

36. The Council was at fault for significant delays to its assessments of Mrs B’s needs and finances.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman