Summary: Mr X complained the Council unnecessarily delayed his mother’s discharge from hospital as it would not provide a 24-hour residential care home placement. Based on current evidence we have found no fault by the Council.

The complaint

1. The complainant, Mr X, complains the Council has unnecessarily delayed his mother’s discharge from hospital as it will not provide a 24-hour residential care home placement. Mr X says his mother’s needs cannot be safely met at any of the alternatives the Council offered, even with a care package.
2. Mr X says because of the Council’s fault his mother has spent longer than necessary in hospital which has caused them both distress and affected their mental well-being.

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The Ombudsman’s role and powers

3. 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)
4. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
6. 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(1), as amended)

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How I considered this complaint

7. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
8. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Background and legislation

9. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs. The NHS can claim money back from councils that have caused delays transferring patients. The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment.
10. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
11. On receiving an assessment notice, the council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.
12. To avoid any risk of having to pay back money, the council must start a needs assessment and put in place any care arrangements for meeting eligible needs before the ‘relevant day’. The relevant day is either the date when the NHS proposes to discharge the patient or the minimum period (two days after the council has received the assessment notice), whichever is the later.
13. The NHS body should tell patients and carers the discharge date at the same time as, or before the council does. Hospital staff may give the council early warning of when discharge is likely, to help their planning.
14. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
15. Shared Lives schemes provide an alternative to traditional social care accommodation and support for adults. Under Shared Lives schemes service users who cannot live independently receive care and support from ordinary family households called Shared Lives carers. Shared Lives carers share their home and family life with an adult who needs care or support to help them live well. 

Key events

16. The following is a summary of key events. It does not include everything that happened.
17. Mr X’s mother, Mrs C, lived with Mr X and his wife. Mrs C was fully independent. In July 2024 Mrs C was admitted to hospital and underwent an emergency amputation of her right leg.
18. An assessment was completed on 2 September by a therapist at the hospital which noted that Mrs C could not be discharged home. This was because Mr X’s property was not wheelchair friendly and he did want adaptations. It was noted Mrs C’s bedroom and the bathroom were upstairs in the property and there was no space downstairs for a bedroom. Mrs C would not be able to access upstairs and there was a step at the property entrance with no ramp. The assessment recorded that Mrs C wanted to move into a care home and her family agreed with this as their home was not suitable. It was recommended that Mrs C was discharged to a home. Mrs C was assessed as being moderately frail. The Council received the referral the same day.
19. The case was allocated to a social worker on 3 September and it was noted the referral did not indicate night-time needs. The social worker contacted ward staff and arranged activity charts to establish if 24-hour support was required.
20. The Council met with Mrs C on 4 September to discuss the referral and she explained she wanted to move to a care home. The alternative of an adapted flat was put to Mrs C but she declined this option and explained she would feel unsafe.
21. The Council received activity charts for Mrs C on 5 September which recorded she did not require support overnight.
22. The Council met with Mrs C on 6 September to discuss her discharge and advised the information available did not indicate she was eligible for residential care. The Council suggested an independent flat with carers as an option. Mrs C declined this suggestion. The Council explained it would continue to liaise with the hospital about her needs.
23. The Council received information from the hospital on 9 September that suggested Mrs C needed repositioning at night. The Council sought clarification as it was not clear if Mrs C was managing this independently or with assistance. The Council sought an updated assessment from the hospital on 13 September.
24. The Council received an updated assessment on 18 September. This suggested that Mrs C would require a care package of four calls a day when she was discharged. The Council met with Mrs C and Mr X and advised the available information did not indicate a residential placement was required. It was agreed to make a referral to Housing.
25. The Council contacted Shared Lives on 19 September as an alternative short-term option to facilitate discharge while the Housing referral was progressed.
26. Mr X complained on 18 September.
27. Mrs C confirmed she was willing to explore Shared Lives on 7 October. Shared Lives confirmed they could not meet with Mrs C until the end of October.
28. The Council responded to Mr X’s complaint on 15 October. The Council explained the multi-disciplinary team had established Mrs C did not have 24-hour care needs with activity charts provided by the hospital evidencing she was sleeping at night. The Council highlighted that as returning to Mr X’s property was not an option for Mrs C a referral had been made to Housing. The Council was also exploring an alternative short term option of Shared Lives accommodation. The Council noted the hospital assessment had recommended a care home placement but explained such an assessment was to describe an individual’s needs to allow a multi-disciplinary team of Health and Adult Social Care professionals to work together and undertake discharge planning. The assessment should not prescribe what the therapist considered was required on discharge as the discharge planning process allowed for more detailed information about an individual’s needs to be obtained and discussed. The Council had provided feedback to the hospital about the content of therapist assessments.
29. A visit with Mrs C and Mr X was arranged with Housing for 29 October. The hospital advised the Council Mr X had declined to make an application to Housing for Mrs C.
30. The hospital provided an update at the end of October about the Shared Lives visit which had highlighted access and privacy issues and was not felt to be a suitable option.
31. The Council met with Mrs C in early November and she confirmed she would not apply to Housing. The hospital records indicated there were no night needs. The Council discussed the situation with Mr X and he maintained he wanted to pursue the option of a care home for Mrs C.
32. A discharge planning meeting took place on 12 November where Mrs C’s needs were reviewed and discussed. The Council advised there was still no evidence Mrs C had night-time needs. Mrs C had expressed anxiety about living alone as she had always lived with her son. The hospital advised Mr X had completed an application to Housing. The hospital confirmed on 25 November that Mr X had not completed an application to Housing and it was to provide an updated assessment to support the application.
33. The Council identified a particular Supported Living placement for Mrs C as a potential discharge option at the end of November and made initial enquiries. The Council also contacted an independent living and supported living organisation in mid-December for information about the service offered.
34. The Council completed an assessment of Mrs C’s care and support needs on 17 December. This noted Mrs C’s anxiety about being on her own overnight as she had lived with her son for so long. It was explained that many people with similar needs were supported in the community which would allow Mrs C to rebuild her life and she could be supported with the social activities she enjoyed. It was noted a care home setting was unlikely to be suitable given the likely cognitive impairment of other residents and it would not provide Mrs C with social interaction. This assessment found Mrs C had eligible care needs and would require a package of care of four calls a day.
35. A multi-disciplinary meeting was held on 9 January 2025. The Housing team advised Mr X had stated he was not willing to provide supporting information as he believed Mrs C required a care home placement. Mr X advised he had completed the housing application and would provide supplementary information.
36. The Council received an updated assessment and therapy report on 20 January. A professionals multi-disciplinary meeting was held on 24 January. The Council noted there was still no evidence of night-time needs and continence needs could be managed through the use of pads and continence management was not in itself an indicator of night-time needs. Housing confirmed it had now received all the required information. The hospital would maintain activity charts to evidence any support provided at night. An occupational therapist (OT) would reassess Mrs C’s functional ability and provide an updated report. A follow up meeting was arranged for 29 January.
37. A further professionals multi-disciplinary meeting was held on 29 January. The OT advised Mrs C was frightened about living alone and felt she needed support at night. The OT advised the activity charts did not support this but noted any accommodation would require adaptations and considered Mrs C had 24-hour care needs. The Council advised Mrs C’s needs would require further assessment as those previously discussed could be managed through equipment and pads to support continence needs. Housing confirmed Mrs C was at the top of the list for a ground floor flat but could not provide a timescale for when one be available. Further professionals multi-disciplinary meetings were held on 4, 11 and 25 February and 4 March.
38. A suitable property was identified by Housing on 10 March. The OT was to complete an access visit and provide a report to the Council about adaptations. The hospital advised the Council on 18 March that Mrs C had declined the offer.
39. A further professionals multi-disciplinary meeting was held on 18 March. The OT advised the access visit found the property was suitable with adaptations. The hospital advised Mr X had visited the property and declined it on his mother’s behalf. The hospital advised Mrs C still wanted a care home placement.
40. A letter was delivered to Mrs C on 20 March to advise a wheelchair accessible property had been found. A multi-disciplinary meeting took place with Mr X and Mrs C on 24 March. Mr X was to visit the property that afternoon and proposed adaptations were discussed. Mr X said they would reject the property and intended to obtain an independent assessment of his mother’s needs.
41. A professionals multi-disciplinary meeting was held on 2 April. It was noted Mrs C had declined the housing offer. Housing confirmed the property was no longer available on 2 May.
42. Further professionals multi-disciplinary meetings were held on 23 and 30 May. It was noted at the second meeting that a different property was available and an OT access visit was scheduled for 9 June. This visit found the property was suitable.
43. A professionals multi-disciplinary meeting was held on 13 June which confirmed the property was suitable and the hospital was to support Mrs C to visit the property. Mrs C visited the property on 18 June.
44. A discharge planning meeting was held on 20 June. Mrs C accepted the property and would sign a tenancy agreement and agreed to a care package to support her with daily activities. Mr X explained he needed time to prepare the property. Mrs C’s discharge was planned for 2 July.
45. Further multidisciplinary meetings were held of 24 June and 3 July. Mrs C’s discharge was rescheduled due to delays in some equipment being delivered and installed. Mrs C was discharged on 9 July to the property in a sheltered housing development.
46. The Council checked with Mrs C on 10 July and she confirmed she was in her flat and had slept well and the care package had started. The Council completed a review towards the end of July and it was recorded Mrs C was happy and making progress in terms of her independence.

My consideration

47. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether you disagree with the decision the organisation made.
48. It is clear from the information provided that Mrs C and her son both wished for Mrs C to move into residential care and disagreed with the Council’s assessment that she did not require 24-hour care. There is also no dispute that Mrs C spent a considerable time in hospital. This was largely due to the disagreement about whether Mrs C had 24-hour care needs and needed a residential care home placement or could live in the community with an appropriate package of care.
49. It is not the Ombudsman’s role to decide if Mrs C required 24-hour care and a residential care home placement which is a matter of professional judgement. My role is to consider whether the Council properly reached its decision.
50. I have considered the steps the Council took to consider the issue, and the information it took account of when deciding Mrs C did not have 24-hour care needs and could live in the community with a package of care. There is no fault in how it took the decision and I therefore cannot question whether that decision was right or wrong. I appreciate Mr X may disagree, but I am satisfied the Council took appropriate steps in its discharge planning for Mrs C.

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Decision

51. I find no fault.

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Investigator's decision on behalf of the Ombudsman