Summary: the Council failed to act promptly to ensure Mrs X’s son D received an early referral for NHS funding of his needs. As a result there was a delay of nine months between the review meeting which agreed his needs and the funding being made available, while Mrs X continued to pay for his support. The Council will explain how it has reviewed its processes since then, apologise to Mrs X and offer a sum which recognises the distress caused to her and to D over that time.

The complaint

1. Mrs X (as I shall call her) complains about the way the Council failed to act in a timely way when her disabled son D’s needs increased as his college placement ended. She says as a result there was a long delay before his NHS funding became available and she suffered considerable stress and anxiety as well as funding some additional care for him.

Back to top

The Ombudsman’s role and powers

2. 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)
3. 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)

Back to top

How I considered this complaint

4. I considered the information provided by the Council and by Mrs X. I spoke to Mrs X. Both Mrs X and the Council now had an opportunity to comment on a draft of this statement before I reached a final decision.

Back to top

What I found

Relevant law and guidance

5. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS 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.

What happened

6. Mrs X’s son D is an adult with complex needs and learning disabilities. He lacks capacity to make his own decisions about his care and treatment and Mrs X is his court-appointed deputy for that purpose. D finished college in July 2023 and lives in a residential placement..
7. A newly allocated social worker arranged to attend D’s face-to-face CHC review on 20 July 2023. His residential placement manager and Mrs X were requesting additional support hours for D to replace the hours he had previously spent in college. The social worker’s assessment following the meeting was that D required 100% health funding because of his complex health needs. She noted the nurse assessor in attendance agreed the NHS should provide additional funding. The social worker noted she was unable to dispute this (partial not complete) suggestion as the meeting was a review and not a CHC funding assessment.
8. Following the meeting the manager of D’s residential placement contacted the social worker to say he wanted to increase staffing and resources for D as soon as possible but needed an agreement in principle from the funding body. The social worker replied it would take 2-3 weeks of urgent work to complete as the package of care would require management approval because of the funding amount.
9. The social worker wrote to Mrs X on 8 August apologising for the delay and said she expected to complete the paperwork that week. She wrote to the local CHC manager and asked for a CHC assessment. She later sent Mrs X an assessment which Mrs X responded to with amendments.
10. In September Mrs X wrote to the Council to complain about the delay. She said the review had been held on 20 July but 55 days later she still awaited an outcome, communication had been poor, the manager of D’s residential placement could not plan and there had been no increase in D’s hours. The placement manager also emailed the social worker asking for an update about the increase in D’s hours.
11. The social work manager sent Mrs X a revised assessment following her corrections. Mrs X responded with a list of inaccuracies she had already corrected and asked why there was still such a delay and why she had to complain to obtain an outcome.
12. The Council responded to Mrs X’s complaint. It upheld her complaint about the unacceptable delay and the poor communication. It offered £ 250 to recognise her distress.
13. By the beginning of October Mrs X wrote again to the social worker manager thanking him for his further work and saying she hoped a satisfactory outcome was now close. She said “For clarity, satisfactory means new allocation of staffing hours that closely reflect what provider is requesting.”
14. However, on 1 November the social worker received an email from the local CHC manager saying the nurse assessor had not seen a significant change in need at the July review and she asked the social worker for evidence to trigger a fresh assessment. The social worker wrote to Mrs X, the residential placement manager and director asking for any information they had. Mrs X replied “My objective is to ensure (D)'s needs, wishes and views (broadly speaking) are met. And currently, they are not or are yet to be met. And certainly not in a timely manner.” The social worker replied, “It is my error this has not been completed in a timely manner and I sincerely apologise”.
15. Mrs X emailed the social worker on 2 November. She said while she acknowledged the apology, she was “so angry at the lack of a solution when you recommend the input but don’t provide it”. She said the goal had been to have the extra provision in place by September but despite everyone agreeing extra support was needed, nothing was in place. She said D had gone from meaningful days in college to days with no content and his behaviour as a result had been ‘off the scale’.
16. Mrs X also complained to the Ombudsman. She said D desperately needed the hours to be funded which everyone had agreed he needed. She said his behaviours had deteriorated and the stress was unbearable. She said she despaired of how to make the Council provide the support it had agreed was needed.
17. In an internal note on 2 November, the strategic lead for adult learning disabilities noted that because the proper process for requesting an unscheduled CHC assessment had not been completed, it had not been possible to make progress. She said as a result the residential care provider was providing extra support which was not funded. She asked for the proper referral to be completely urgently. The social worker completed it the same day.
18. The residential placement manager also emailed the Council. He expressed concern about the delay and said, “I would like to formally express that I believe that (D)’s placement is at risk of breakdown should we not have the additional support approved now. We, and (D), have been waiting 3-4 months for an outcome here.”
19. The CHC review meeting took place on 20 November. On 27 November Mrs X wrote to the social worker manager and said she had been assured there would be a resolution by 24 November but that date had passed and there was no communication. The manager replied he needed more time to put together a support package. He also asked the CHC clinical management to agree interim funding until the decision was made.
20. Mrs X complained again in December about the delay. The manager explained that the proper process for reassessing D’s eligibility for CHC funding had not been completed in July. He said although he had proposed that social care should fund D’s needs until the CHC decision was made, it was effectively unlawful for the Council to fund health needs.
21. In December Mrs X made a complaint to the CHC funding management about the further delay. She said the November meeting with CHC had turned out not to be the promised reassessment. She said “I am not happy with the current lack of assessment, any outcome and lack of provision of care. It's like we attend all these meetings and then they turn out not to be reviews/assessments at all and therefore wasting particularly my time. (D) has complex health needs and all other needs arise from this.”
22. In January 2024 a further meeting, which Mrs X attended, was held to discuss D’s needs. It was agreed he was eligible for CHC. Mrs X received written confirmation of his eligibility, backdated to 1 September 2024. In April Mrs X was reimbursed the client contributions she had paid for D during that time.
23. The Council confirms that the reason for the lengthy delay was because the correct process for requesting a CHC assessment had not been completed after the July review meeting.
24. Mrs X says she went through nine months of severe anxiety, and her son suffered from the lack of appropriate provision, while they were waiting for the Council and the CHC management to resolve the issue even though they all agreed D required the recommended extra provision. She says in her view it is wrong for the Council to allocate complex cases like D’s to pool social workers.

Analysis

25. It was the failure to follow the correct process in requesting a CHC reassessment which was the root cause of the delay in funding the appropriate provision for D. The Council acknowledges that was fault. That led to considerable anxiety and distress for Mrs X as well as the lack of provision for D.
26. There was also poor communication which meant that Mrs X spent considerable time and effort having to chase up progress. I have seen little evidence among the Council’s case recordings of a proactive approach to updating her on what was happening.

Back to top

Agreed action

27. Within one month of my final decision the Council will review the way in which it ensures that CHC requests are made according to the correct protocols and in a timely way. It will also review the way in which the progress on such requests is monitored to ensure they do not slip through the net as D’s did here;
28. Within one month of my final decision the Council will apologise formally to Mrs X and offer the sum of £1000 to her in recognition of the significant distress and anxiety caused by its delay;
29. Within one month of my final decision the Council will also offer £1000 for the benefit of D, in recognition that he was left without services it agreed he needed and he suffered injustice as a result during that time;
30. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

31. I have completed this investigation. There was fault on the part of the Council which caused injustice to Mrs X and D, which the completion of the recommendations in paragraphs 27 to 29 will remedy.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman