Summary: Mrs A complains about the way the Council, Trust, ICB and GP surgery treated her husband, Mr B, before his death. She complains Continuing Healthcare (CHC) funding was delayed and the family were not given enough information. We will not investigate this complaint because we cannot overturn a decision made by the ICB about CHC. For her other points of complaint, an Ombudsmen investigation is unlikely to find fault.

The complaint

1. Mrs A complains about how her husband, Mr B, was treated before his death by Essex County Council (the Council), Princess Alexandra Hospital NHS Trust (the Trust), South Street Surgery (the GP Practice) and NHS Hertfordshire & West Essex Integrated Care Board (the ICB) the organisations responsible for his care.
2. Specifically she complains;
• The social worker who conducted a continuing healthcare (CHC) assessment did so without empathy and compassion. Mrs A feels the social worker completed it wrongly which delayed the award of funding by the ICB.
• The Council did not help the family understand what equipment, such as specialist chairs, the family could get to help support Mr B.
• The family did not receive six weeks palliative care funding before his death.
3. Mrs A found dealing with all the organisations difficult. She had to confront poor behaviour at an already difficult time. The family struggled to cope financially and should have had more support.
4. Mrs A wants the ICB to backdate the CHC funding to five months before his death. She wants the physio who completed the assessment to receive training and financial recompense for the experience she and her family had.

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The Ombudsmen’s role and powers

5. We have the power to jointly consider complaints about health and social care. Since April 2015 a single team has considered these complaints acting for both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
6. The Ombudsmen provide a free service but must use public money carefully. They may decide not to start or continue with an investigation if they believe:
• it is unlikely they could add to any previous investigation by the bodies.

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How I considered this complaint

7. I considered all the information provided to us by Mrs A and the complaint responses from the organisations.
8. I considered the Ombudsman’s Assessment Code.

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What I found

Complaint about CHC decision

9. Mrs A complains the ICB only awarded CHC funding a few days before Mr B’s death, she would like the ICB to backdate the award five months to when Mr B’s health started to decline.
10. 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 Continuing Healthcare. It states that where an individual is eligible for Continuing Healthcare funding the Integrated Care Board (ICB) is responsible for care planning, commissioning services and case management.
11. If, after a full multidisciplinary assessment and DST, a person disagrees with the ICB’s decision that they are not eligible for CHC or nursing care, they can ask the ICB to review its decision. If they disagree with the outcome of the review, they can appeal to an Independent Review Panel (IRP) organised by NHS England.
12. The Ombudsmen cannot overturn a decision by the ICB to not award retrospective funding. Mrs A can go back to the ICB to challenge their decision if she remains unhappy with the outcome.

Complaints about social worker attitude

13. Mrs A complains the social worker who conducted the CHC assessment did so without empathy and compassion. Mrs A feels they completed the assessment wrongly which led to a delay in the ICB awarding the funding.
14. Mrs A said she spoke to the social worker’s manager after the events, and saw them go and speak to them, then the social worker’s approach was more compassionate to the family.
15. The Council responded to this complaint in its letter 22 August 2024. It said it had spoken to Mrs A and asked her for more details so it could identify the social worker. Mrs A could not recall any details to identify the social worker. The letter explains it reviewed Mr B’s records and could see he had had several assessments over a two-year period. The Council said “without this additional information, it is not possible to look into this point further”.
16. The Ombudsmen would not achieve anything more through further investigation. As Mrs A said, the manager spoke to the social worker at the time and this shows willingness on the part of the Council to accept feedback, this is what we would expect.

Complaint about suitable equipment

17. Mrs A complains the Council did not help the family understand what equipment, such as specialist chairs, the family could get to help support Mr B.
18. The Council has not investigated this complaint. The law says that, before investigating a complaint, the Ombudsmen must normally be satisfied the organisations you are complaining about know about the complaint and have had an opportunity to investigate and to reply. I cannot investigate this complaint without knowing what action the Council took.
19. I offered to send this as a new complaint to the Council when I spoke to Mrs A on the telephone, she declined. Mrs A should raise this issue as a new complaint to the Council and then come back to the Ombudsmen if she remains unhappy.

Complaint about palliative care funding

20. Mrs A complains the family did not receive six weeks palliative care funding before Mr B’s death.
21. I have been unable to discover where Mrs A got this information from but there is no known funding source for palliative care which would entitle the family to six weeks paid care. Mrs A may be confusing this with reablement care, which is referred to in such terms.

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Decision

22. We will not investigate this complaint because it is unlikely we would find fault.

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Investigator's decision on behalf of the Ombudsman