Summary: We will not investigate this complaint about the Council’s contribution to an assessment for Continuing Healthcare funding. This is because further investigation would not lead to a different outcome.

The complaint

1. Mr X complained the Council did not complete an assessment of his needs, before attending a Multidisciplinary Team (MDT) meeting about his NHS Continuing Healthcare (CHC) funding.
2. Mr X said the Council signed a recommendation that he does not have a primary health need. He said this caused him distress and anxiety. Mr X wants the Council to raise a dispute with the Integrated Care Board (ICB).

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The Ombudsman’s role and powers

3. 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 further investigation would not lead to a different outcome. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
4. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
5. We cannot investigate complaints about actions which are not the administrative function of a council. (Local Government Act 1974, section 26(1) as amended).

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How I considered this complaint

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

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My assessment

8. Mr X complained that his social worker did not complete an assessment prior to a MDT meeting to discuss the Decision Support Tool (DST) completed as part of an assessment for NHS CHC.
9. The Council completed an investigation into its involvement into the NHS CHC process. It accepted that it would have been best practice for the social worker to meet with Mr X before the meeting to better understand his condition. The Council apologised to Mr X and said in future social workers would be required to meet with people before the DST.
10. We will not investigate this complaint. The Council has apologised and made service improvements to address any failings identified. Further investigation by the Ombudsman would not lead to a different outcome.
11. Mr X said at the meeting, the social worker signed a recommendation that he does not have a primary health need meaning he is not eligible for NHS CHC.
12. NHS CHC is a package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a primary health need. Mr X has appealed the outcome of the DST which is for the NHS to review and issue a decision. We do not investigate complaints about the NHS, therefore, Mr X’s complaint about the outcome of the MDT meeting is outside our jurisdiction.  

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Final decision

13. We will not investigate Mr X’s complaint because further investigation would not lead to a different outcome.

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Investigator's decision on behalf of the Ombudsman