Royal Borough of Kensington & Chelsea (23 010 383)

Category : Adult care services > Assessment and care plan

Decision : Closed after initial enquiries

Decision date : 28 Mar 2024

The Ombudsman's final decision:

Summary: We will not investigate a complaint about a move of care home following a change to continuing healthcare funding. This is because we are unlikely to find fault by the Council. It is too early for us to consider a complaint about a continuing healthcare decision because it has not been through the relevant appeals process.

The complaint

  1. Mrs X complains on behalf of her late uncle, Mr Y. Mrs X complains about the decision by NHS North West London ICB (the ICB) to stop Mr Y’s Continuing Healthcare (CHC) funding. Mrs X also complains about Royal Borough of Kensington & Chelsea (the Council) and its decision to move Mr Y to a different care home after the CHC funded ended. Mrs X considers Mr Y’s health was not properly considered and that he was moved for solely financial reasons.
  2. Mr Y died a week after he was moved. Mrs X considers Mr Y lost his life due to a cost cutting exercise. She is seeking an acknowledgment of fault and systemic improvements to ensure this does not happen again.

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The Ombudsmen’s role and powers

  1. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
  2. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
  3. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault, the fault has not caused injustice to the person who complained, or it is unlikely we could add to any previous investigation by the bodies. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)
  4. We will not generally investigate a complaint unless we are satisfied the matter has been brought to the relevant organisation’s attention and that organisation has had a reasonable opportunity to investigate and reply to the complaint. (Local Government Act 1974 section 26(5), as amended and Health Service Commissioners Act 1993, section 9(5))

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How I considered this complaint

  1. I considered information provided by Mrs X, the Council and the ICB. I also considered the Ombudsman’s assessment code.

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My assessment

  1. Mr Y had been receiving CHC funded care since 2021. He was living in a nursing home (Home A) which could meet his assessed needs. A review of Mr Y’s care needs in April 2023 found his needs had changed. The ICB therefore arranged for a full CHC assessment. This found Mr Y no longer had a primary health need and therefore did not qualify for CHC funded care. The assessor considered Mr Y could understand the decisions about his care and was involved in the assessment.
  2. As Home A normally only accepted people with CHC funded care, the ICB gave notice to Mr Y and advised he needed to find an alternative placement. The Council identified an alternative care placement (Home B) that could meet Mr Y’s care needs and he later moved there. The Council said Mr Y did not object to having to move. Mr Y’s health declined after he moved and sadly he died just over a week later.
  3. The Council completed a safeguarding investigation after Mr Y died. It concluded it was not possible to link Mr Y’s death to the move and the decision to move home to Home B was not abusive or neglectful. However, the safeguarding report recommend the Council review arrangements for when it can fund a placement at Home A (if it is not CHC funded). This was to allow a more tailored, flexible and person‑centred approach in future. It also recommended better training for NHS and adult social care staff around CHC eligibility decisions and appeals.
  4. With regards to the CHC assessment decision, if a person disagrees with the ICB’s decision that they are not eligible for CHC or nursing care, they can ask the ICB to review its decision. If they disagree with the outcome of the review, they can appeal to an Independent Review Panel (IRP) organised by NHS England. The third stage is to refer the case to the Health Service Ombudsman for independent investigation.
  5. Mr Y did not appeal the decision and Mrs X has not pursued this since either. The complaint about the CHC decision is therefore too early for us to consider. The Health Service Ombudsman can consider this part of the complaint after this has completed the IRP process.
  6. The move from Home A was in line with local procedures which reserved for people funded by the NHS. The Council noted it would have kept funding the placement until an appeal was completed, but Mr Y/Mrs X decided not to appeal the decision. It also said it would have considered Mr Y’s views if he had objected to the move to Home B and Mr Y was not unwell at the time he moved. It is therefore unlikely we would find fault by the Council in relation to its involvement in arranging Mr Y’s move to Home B.

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Final decision

  1. Mrs X’s complaint about the CHC decision is too early for us to consider.
  2. We are unlikely to find fault about the Council’s decision to move Mr Y to Home B, which was in line with local policy. Also, I consider we would be unlikely to achieve more or make different recommendations to those already made in the Council’s safeguarding investigation.

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Investigator's decision on behalf of the Ombudsman

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