Summary: We will not investigate this complaint about alleged failure to complete a checklist for NHS funding. This is because even if there was fault, we cannot say it caused injustice because we cannot say the person receiving care services would be eligible for NHS funding. There is no worthwhile outcome achievable from an Ombudsman investigation, and we cannot achieve the outcome the complainant wants. The complainant can make a retrospective application to the NHS for funding.

The complaint

1. Mr B says the Council failed to carry out a checklist for NHS funded care for his mother, Ms C, despite his repeated requests. Ms C has since died and there is an outstanding bill for over £7000 for her care fees. Mr B believes Ms C would have qualified for NHS funding and so the Council should waive the care costs.

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The Ombudsman’s role and powers

2. We investigate 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 continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, 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, or
• there is another body better placed to consider this complaint, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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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.

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My assessment

5. NHS continuing healthcare (CHC) is a package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a primary health need. 
6. There is a screening tool called a checklist to help identify individuals who may need a referral for a full assessment of eligibility by the NHS. Screening and assessment of eligibility for CHC should be at the right time and location for the individual, and when the individual’s needs are clearer. The checklist can be completed by various health and social care practitioners. There are no set criteria about when the checklist should be completed. There were health professionals involved in Ms C’s care, who could have completed, or asked a trained person complete, the checklist if they thought Ms C would be eligible for full assessment.
7. Whether the Council should have completed the checklist does not cause the claimed injustice of the outstanding care fees. Where a Council decides someone needs care and support, they must then assess what if anything the person can pay toward that care. The Council did this, and Ms C knew she was responsible to fund the full cost of her care.
8. We cannot know whether Ms C would have been eligible for CHC and cannot recommend the Council waives charges for Ms C’s care. Mr B can apply to the NHS for retrospective CHC. If the NHS funds the period in question the Council can refund any overpayment made for care charges.

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Final decision

9. We will not investigate Mr B’s complaint because there is no worthwhile outcome achievable by an investigation. The only body to decide and award CHC is the NHS. Mr B can make a retrospective application to the NHS for consideration of Ms C’s eligibility for CHC to achieve the outcome he wants of having care fees paid by the NHS. The Ombudsman could not recommend the Council waives fees for care it assessed Ms C needed, she received, and had funds to pay.

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Investigator's decision on behalf of the Ombudsman