Summary: Mrs X complained that the Council refused to fund her father’s placement under the ‘Discharge to Assess’ pathway. The Council was at fault for how it assessed her father’s eligibility for funding. It gave Mrs X contradictory information, and its poor communication and record-keeping created avoidable confusion. This caused Mrs X inconvenience and distress. The Council will now take action to address her injustice.

The complaint

1. Mrs X complains that the Council did not fund the first six weeks of her father’s long-term nursing placement under the Discharge to Assess (D2A) pathway. She also says the Council delayed responding to her complaint, which caused her additional distress at an already difficult time.

Back to top

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. 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)

Back to top

How I considered this complaint

4. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
5. Mrs X and the Council now have an opportunity to comment on my draft decision. I considered any comments before making a final decision.

Back to top

What I found

Law, guidance and policy

Discharge to Assess (D2A) pathway

6. The D2A model is based on evidence that the most effective way to support people to ensure that are discharged safely when they are clinically ready, with timely and appropriate recovery and support if needed. It was introduced to support the transition from hospital to home and to avoid unnecessary stays in hospital, where there is a higher risk of acquiring infections of deconditioning and provide short-term funding whilst they are being assessed for their longer-term care needs.

Discharge Pathways

Pathway 0

7. Simple discharge home (to usual place of residence or temporary accommodation) co-ordinated by the ward without involvement of the care transfer hub.

Pathway 1

8. Discharge home (to usual place of residence or temporary accommodation) with health and/or social care and support co-ordinated by the care transfer hub.

Pathway 2

9. Discharge co-ordinated through the care transfer hub to a community bedded setting with dedicated health and/or social care and support, including bed-based intermediate care on a time-limited, short-term basis for rehabilitation, reablement and recovery in a community bedded setting (bed in care home, community hospital or other bed-based rehabilitation facility).

Pathway 3

10. In rare circumstances, for those with the highest level of complex needs, discharge to a care home placement co-ordinated through the care transfer hub.

NHS-Funded Nursing Care

11. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. If a person does not qualify for NHS Continuing Healthcare (CHC), the need for care from a registered nurse must be determined. If the person has such a need and it is determined their overall needs would be most appropriately met in a care home providing nursing care, then this would lead to eligibility for NHS-Funded Nursing Care.

The Council’s adult social care complaints procedure

12. The Council will generally respond to complaints within 20 working days. But for complex complaints, it may need more time. It will keep complainants informed of the progress of their complaints until a response is provided.

What happened

13. In March 2024, Mr Y suffered a fall resulting in a fractured pelvis. He was discharged home with reablement support of four calls a day, but this was gradually reduced to one call a day as he improved with physiotherapy.
14. In May 2024, Mr Y was admitted to hospital following a further fall and was diagnosed with fractures to the lumbar region of his spine.
15. In July 2024, a meeting was held with Mr Y’s family at which it was agreed that it would not be safe for him to return home. A short-term placement was discussed as an option to support Mr Y’s recovery outside the hospital environment. The occupational therapist advised that Mr Y would have goals to work towards and could improve if in the right setting.
16. Later that month, while Mr Y was still in hospital, an Assessment of Care and Support Needs was completed, taking into account his mental capacity. The assessment recorded: “A short term placement would allow Mr Y to improve in the correct environment providing monitoring and support throughout the day and night, as well as mental and physical stimulation.”
17. Mr Y was assessed as requiring 24-hour care. The assessment noted “Nursing placement to be considered and reviewed within 6 weeks to ascertain whether this is required long term. OT on the ward has seen a huge change since Mr Y’s last admission but does think that he has goals to improve if he was in the right environment where he could engage in activities.”
18. Later in July, Mr Y was discharged from hospital to a nursing home.
19. In August 2024, a Council case note records a staff query asking: “Is this a discharge-to-assess placement direct from hospital? (Family were unclear)”. The Council recorded “correct” in response.
20. Also in August, a separate case note states: “Telephone call to daughter, she was told it was a short-term placement for rehab so he can return home.”
21. In October 2024, Mrs X made a complaint to the Council regarding the funding of the placement and stating she had not received written confirmation of the charging decision.
22. The Council responded in November 2024 said written notifications had been sent. It apologised for confusion caused by the assessment letters Mrs X had received, acknowledging that the content of the two letters could have been combined to avoid misunderstanding
23. Later in November, NHS Continuing Healthcare (CHC) funding was awarded as Mr Y was still residing in a nursing home.
24. In December 2024, Mrs X wrote again to the Council questioning the funding arrangements, as she believed her father was entitled to up to six weeks of free intermediate care under the D2A pathway.
25. In January 2025, the Council issued a further response, stating that Mr Y was not eligible for D2A Pathway 2 funding because he had already been receiving care prior to his hospital admission.
26. In its response to our enquiries, the Council stated that all cases are considered for D2A funding and that some individuals already receiving services may still qualify. It added that those assessed as requiring a permanent placement are not offered D2A, as it has already been established that no further assessment is needed.
27. The Council also told us that Mr Y had been assessed as requiring a Pathway 3 placement, which under the guidance indicates a long-term placement.

My findings

28. In its complaint response, the Council informed Mrs X that Mr Y was not eligible for funding because he had been receiving care prior to his hospital admission. This, in itself, would not be a valid reason to exclude Mr Y from a D2A package.
29. The Council told us that individuals assessed as requiring a permanent placement are not offered D2A. But in Mr Y’s case, the Council determined that he only initially needed a short-term placement (which would then be reviewed to establish whether a long-term placement was necessary). As the Council had not, at that point, decided that Mr Y needed a permanent placement, this cannot have been the reason why he was not eligible for D2A funding.
30. Based on the Council’s case notes from August 2024, it is also likely that Mrs X was told that Mr Y would be eligible for D2A funding.
31. The Council also told us that Mr Y had been assessed as requiring a Pathway 3 placement, which would have been a long-term placement. This contradicts its own assessment, which clearly stated that the placement was intended to be short-term. This inconsistency, combined with the conflicting information recorded in the case notes about whether the placement was D2A or short-term rehabilitation, created avoidable confusion for Mrs X and demonstrates fault in the Council’s communication and record-keeping.
32. The Council’s published complaints procedure states it will respond within 20 working days or will keep complainants informed if it needs longer. In this case, the Council responded outside that timeframe but did keep Ms X informed of the delay in line with its procedure. It was not at fault for the delay.
33. Mrs X raised an additional query that had not been part of her original complaint, after her complaint was responded to. She emailed the Council on two further occasions to advise she had not received a response. The Council was again delayed in providing a response, for which it was at fault.
34. We are not the decision-making body in this case, and therefore I cannot say whether Mr Y should have received D2A funding. This, ultimately, was a matter for the Council to decide.
35. However, the amount of inconsistency and conflicting information in the Council’s records undermines its D2A funding decision to the extent that it is not entirely clear why the decision was made. This, potentially, means Mr Y may have suffered an injustice. Below, I have made a recommendation to address this.
36. I am also satisfied that the way the Council handled this case – and the failings I have identified above, in particular – caused Mrs X an injustice.
37. The Council has already apologised for the way it handled Mrs X’s complaint and her subsequent query. I have made further recommendations for her remaining injustice, which now follow.

Back to top

Action

38. Within four weeks, the Council has agreed to:
• Write to Mrs X, apologising for the contradictory information provided and for the way it assessed Mr Y’s funding for nursing care. We publish guidance which sets out what we expect an effective apology to look like. The Council will consider this guidance when writing to Mrs X.
• Make a symbolic payment of £250 to Mrs X to recognise that the way it assessed Mr Y’s funding for care and the delay in handling her correspondence likely caused her some inconvenience and distress.
• Make a new decision on Mr Y’s eligibility for D2A funding for his placement following his hospital discharge in July 2024. The Council will ensure that its decision is properly explained, with reference to (if applicable) national and local D2A guidance.
• If the Council decides Mr X should have been eligible for D2A funding, it will backdate that funding.
39. Within eight weeks, the Council will write to us, setting out how it will ensure in future that its social care staff are fully aware of D2A eligibility procedures.
40. The Council will provide us with evidence it has done these things.

Back to top

Decision

41. The Council was at fault. This caused injustice to Mrs X, which the Council will now take action to address.

Back to top

Investigator's decision on behalf of the Ombudsman