Summary: We will not investigate this complaint about information provided by the Council for a Continuing Healthcare assessment. That is because the complaint is late. In addition, the decision not to award funding was made by the Clinical Commissioning Group, not the Council. Therefore, it is outside our jurisdiction.

The complaint

1. Mr X complained the Council did not give sufficient information to evidence his mother’s, Mrs Y’s care needs for a Continuing Healthcare (CHC) assessment. He said the Council incorrectly said Mrs Y was not know to its services, when hospital records indicated she was. Mr X wants Mrs Y’s care fess reimbursed.

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The Ombudsman’s role and powers

2. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
3. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. We cannot investigate complaints about actions which are not the administrative function of a council. (Local Government Act 1974, section 26(1) as amended).
5. 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:

• we cannot achieve the outcome someone wants.

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

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How I considered this complaint

6. I considered information provided by the complainant and the Council.
7. I considered the Ombudsman’s Assessment Code.

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My assessment

8. We will not investigate Mr X’s complaint the Council did not provide sufficient information to support Mrs Y’s CHC assessment. That is because the complaint is late. The Clinical Commissioning Group (CCG) assessed Mrs Y’s eligibility for CHC funding in 2018. It decided she was not eligible. Mr X has spent the subsequent years challenging that decision. He did not complaint to the Ombudsman until 2024. If he was unhappy with the information provided by the Council, it was reasonable for him to complain sooner.
9. In addition, the CCG has the overall responsibility for deciding whether Mrs Y was eligible for CHC funding, not the Council. Therefore, the substantive complaint that the decision was flawed, is not for the Council. Because of that, we cannot achieve the outcome that Mr X wants. As the Council was not responsible for the CHC funding, it is not its responsibility to provide a reimbursement of Mrs Y’s care costs. We have no jurisdiction to investigate complaints about CCGs (replaced by Integrated Care Boards since 2022).

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Final decision

10. We will not investigate Mr X’s complaint because it is late, and the substantive matter is outside our jurisdiction.

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Investigator's decision on behalf of the Ombudsman