Summary: Ms X complained that Lancashire County Council carried out a faulty continuing healthcare checklist for her father, Mr X, in 2023. We consider the Council acted with fault. It did not share the checklist with the local NHS Integrated Care Board, which denied Ms X an opportunity to appeal the outcome. The Council also did not communicate clearly with Ms X when she requested another checklist in 2024. Ms X suffered confusion, frustration, uncertainty and time and trouble. The Council has agreed to make a symbolic payment to recognise her injustice.

The complaint

1. Ms X complains that Lancashire County Council (the Council) did not carry out a continuing healthcare (CHC) checklist for her father, Mr X, after January 2024. She says its initial checklist in November 2023 did not reflect his needs. Ms X says events have caused her stress, anxiety and time and trouble. Mr X has potentially missed support for his physical needs. He also may have paid care home fees unnecessarily, which should have been covered by the CHC. Ms X would like the Council to reimburse Mr X’s care fees if he was eligible for CHC in January 2024.

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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. We cannot decide what level of care is appropriate and adequate for any individual. This is a matter of professional judgement and a decision that the relevant organisation has to make. Therefore, my investigation has focused on the way that the body made its decision.
4. 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)

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How I considered this complaint

5. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
6. Ms X and the Council had an opportunity to comment on two draft decisions. I have considered any comments before making a final decision.

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What I found

Relevant law and guidance

7. The Department of Health and Social Care’s National Framework for NHS Continuing Healthcare and NHS funded Nursing Care (July 2022 (Revised)) (the National Framework) is the key guidance about CHC. It states that where an individual is eligible for CHC funding the Integrated Care Board (ICB) is responsible for care planning, commissioning services and case management.
8. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC checklist. The threshold for meeting the checklist is set low.
9. Practice Guidance 15.3 of the National Framework states: “Where a Checklist indicates that a referral for assessment of eligibility for NHS Continuing Healthcare is not necessary, it is good practice for the Checklist to still be sent to the relevant ICB for information, as the individual may wish to request the ICB to reconsider the Checklist outcome and the ICB will need a copy of the Checklist in order to do this.”
10. Paragraph 121 of the National Framework states: “There may be many situations where it is not necessary to complete a Checklist. These include where…it has been previously decided that the individual is not eligible for NHS Continuing Healthcare and it is clear that there has been no change in needs”.

What happened

11. In November 2023, Mr X fell at his supported living placement, so moved to hospital for care and treatment.
12. Later that month, he moved to a short-term rehabilitation placement, arranged by the Council, while it decided his long-term care needs. On 15 November, a Social Worker also completed a CHC checklist. The checklist contained details of two residents, including Mr X, and did not suggest Mr X would need a full CHC assessment. Ms X questioned this and the Social Worker completed a second checklist following an assessment of Mr X’s needs. Again, that checklist did not suggest Mr X needed a full CHC assessment.
13. On 23 November 2023, the Social Worker also assessed Mr X’s needs. As part of that assessment, she also considered Mr X’s needs under the CHC checklist. That highlighted an improved score in one of the domains. However, Mr X still did not meet the criteria for a CHC assessment.
14. In mid-December 2023, Mr X moved into a care home as a permanent resident. As the family had decided to self-fund Mr X’s care, the Council closed Mr X’s case.
15. On 25 January 2024, Ms X asked the Social Worker to carry out another CHC checklist, as she felt his needs had changed. The Social Worker said Mr X’s care plan did not suggest his needs had changed, so did not agree to carry out another checklist. Four days later, the Social Worker called and spoke to the manager at Mr X’s care home. The manager said Mr X’s needs had not changed since he arrived. So the Social Worker did not carry out another checklist.
16. Ms X complained to the ICB about the Council in May 2024, and the Council responded in September.
17. Ms X then approached the Parliamentary and Health Service Ombudsman (PHSO) in November 2024. PHSO passed the complaint to the Local Government and Social Care Ombudsman the same month.

My view

18. I consider the Social Worker acted with fault when she completed Mr X’s first CHC checklist on 15 November 2023. It contained the details of two residents, so did not fairly represent Mr X’s needs. That was fault, which would have caused Ms X frustration. But I am persuaded the Council has already remedied that injustice to Ms X. The Council has provided evidence it completed a second checklist soon in mid-November, which reflected just Mr X’s needs. Then again, the 23 November assessment measured Mr X’s needs against the checklist resulting in a slightly different score. Neither of those checklists indicated Mr X met the criteria for a CHC assessment. And I am persuaded those checklists appropriately reflected Mr X’s needs.
19. Ms X is not persuaded the Social Worker accurately represented Mr X’s needs in November 2023. The Social Worker did not share the second CHC checklist with the ICB. I consider that was fault, and not in line with Practice Guidance 15.3 of the National Framework. That fault meant Ms X lost an opportunity to challenge the outcome of the checklist with the ICB after December 2023. That has caused Ms X uncertainty. She will never know if the ICB would have taken any further action on that second checklist. Also, Ms X has shared evidence she has suffered avoidable time and trouble following up her concern with many organisations after January 2024.
20. Broadly, the Council has remedied Ms X’s frustration, uncertainty and time and trouble. It has accepted the faults, apologised to her and made improvements to its service (including training for the Social Worker). However, I consider the Council should take further action to remedy the injustice Ms X.
21. Ms X also says the Social Worker refused to carry out another CHC checklist in January 2024.
22. I cannot question the professional judgement of the Social Worker. But I have reviewed how the Social Worker made their decision.
23. I have reviewed the emails between Ms X and the Social Worker on 25 January 2024.
24. The Social Worker said: “We did discuss completing another checklist once he [Mr X] had settled at [the care home], however as stated above the case was closed to me as you are self‑funding”. I can understand how that gave Ms X the impression the Social Worker decided not to carry another checklist because of how Mr X funded his care. That communication was fault.
25. During my investigation, the Council told me the Social Worker decided not to carry out another checklist based on their conversation with Mr X’s care home manager on 29 January 2024. They both agreed his needs had not changed to warrant another CHC checklist. That was in line with Paragraph 121 of the National Framework.
26. However, four days earlier, the Social Worker told Ms X: “[Mr X’s] care plan at [the care home] does not reflect that he meets the criteria for CHC…If [Mr X’s] circumstances have considerably changed since moving to [ the care home] this should be reflected in the care plan”.
27. The Social Worker implied she had reviewed Mr X’s care plan and decided he did not meet the criteria for another CHC checklist. I am not persuaded that was true. I have not seen any evidence the Social Worker reviewed Mr X’s records on 25 January 2024. We know the Social Worker did not make their decision until 29 January. I consider that communication was misleading, and also fault.
28. I have found the Council’s communication with Ms X amounted to fault on 25 January 2024. I consider that would have caused Ms X confusion and frustration. The Council should action to remedy that injustice to Ms X.

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Action

29. Within four weeks, the Council should pay Ms X £150 in recognition of the frustration, uncertainty, confusion, and time and trouble it caused her.
30. The Council should provide us with evidence it has complied with the above actions.

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Decision

31. The Council acted with fault which caused Ms X an injustice. It should make a symbolic payment to Ms X to remedy that injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman