Summary: Ms H complained about the support her father received from a care home commissioned by the Council, and how they communicated with her. She said as a result he did not receive enough equipment, missed out on NHS funding, and she experienced distress. We did not find fault by the Council on the substantive parts of the complaint. However, there was some fault in the communication with Ms H which was not timely or clear. The Council will apologise to her to acknowledge the distress and uncertainty this caused.

The complaint

1. Ms H complained about the support her father (Mr X) received from a Care UK care home, which was commissioned by the Council. She said the care home:
• failed to make a fast-track application for NHS continuing healthcare when Mr X’s health deteriorated. She said as a result he did not receive sufficient support in his final weeks and caused financial loss to him.
• failed to refer Mr X to a continence nurse or provide continence products. She said this caused severe anxiety to him, and she incurred costs of approximately £800 to purchase continence products.
• called the funeral directors shortly after notifying her of Mr X’s passing. If she had not spoken with the funeral director shortly after, the family would not have had the opportunity to properly say goodbye to him.
2. Ms H also said the Council wrongly stated in its complaint’s response that there was an absence of family involvement, which caused her distress.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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)
4. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2) and 34C(2), as amended)

5. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone.
6. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
8. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as the NHS. (Local Government Act 1974, sections 25 and 34(1), as amended)
9. 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

10. I considered evidence provided by Ms H and Council as well as relevant law, policy and guidance.
11. Ms H and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

Assessment of need

12. 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.
13. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

NHS Continuing Healthcare Assessments

14. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
15. Individuals may need care and support provided by their local council and/or services arranged by ICSs. Councils and ICSs therefore have a responsibility to ensure the assessment of eligibility for care and support and for CHC respectively take place in a timely and consistent manner. If, following an assessment, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person’s health needs, either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both a council and an ICS, this is known as a ‘joint package of care’. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a council to meet.
16. A fast-track pathway can be used for individuals with rapidly deteriorating conditions who may be entering a terminal phase for immediate provision of NHS continuing healthcare. The intension is to minimise delays and can be completed by appropriate clinicians such as a registered nurse or a registered medical practitioner who is knowledgeable about the individuals health needs, diagnosis, treatment or care and able to provide an assessment of why the individual meets the pathway criteria.
17. It is the responsibility of the appropriate clinician to make a decision based on whether the individuals’ needs meet the criteria.
18. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman.

What happened

19. In 2024 Ms H’s father (Mr X) lived in his home and received care support from a care provider, commissioned by the Council, to meet his needs.
20. Ms H said she told the Council and the care provider continence support for Mr X was insufficient or inappropriate to him. She therefore purchased additional support for him to meet his needs to ensure he was comfortable.
21. In late 2024 Mr X was living in a Care UK care home commissioned by the Council. He was diagnosed with terminal cancer and Ms H was told he would not return home. Additional continence support was subsequently provided at the care home.
22. Ms H asked the care home to refer and assess Mr H for CHC funding due to his terminal diagnosis, which it confirmed it would consider.
23. The care home continued to provide care and support for Mr H. Over the following weeks, it found he was relatively well and supported to do his daily routines, had several family visits, and its registered nurse and his GP saw him. Shortly before Christmas a future care planning discussion was undertaken. It did not find CHC or the fast-track process for NHS funding was appropriate during this time.
24. In early 2025 Mr X started coughing and was seen by his GP who prescribed medicine for a chest infection. His health improved briefly. However, soon after he deteriorated and was again seen by his GP, who confirmed Mr X was dying. Ms H was informed.
25. Mr X passed away a few days later.
26. Ms H and the care home disagree about what happened next.
• Ms H said she was called by the care home and informed Mr X had died. She informed other family members and prepared to go to the care home to see Mr X. However, she then received a call from the funeral director who had been informed by the care home to collect Mr X. She said if this call had not taken place, the family would not have been able to see Mr X before he was taken away.
• The care home said it attempted to call Ms H but could not reach her. It subsequently called the agreed funeral director to arrange Mr X’s collection. It understood the funeral director would call Ms H.
27. Ms H spoke with the Council’s Adult Social Care to raised concerns about the care home’s handling of the CHC process, the lack of adequate continence support for Mr X, and the events regarding the funeral director. She was told it would look into it and get back to her.
28. Ms H said she continued to contact the Council to get a response to her concerns, but this did not happen. However, a different department handling the care bill agreed to pause the billing process.

Ms H’s complaint

29. In May 2025 Ms H complained to the Council. Her complaint and the Council’s response are set out below:
• The care home had failed to request or make referrals for appropriate incontinence support for Mr H throughout 2024. As a result, she had to purchase additional support for him. It was first in late 2024 adequate support was in place;

The Council found the care home had properly considered Mr X’s continence support. It explained he was receiving the support from the NHS. The care home had made further referrals for support during 2024, and it was aware Ms H was buying additional support. This was partly because Mr X wanted to have support changed more frequently compared with the amount of equipment he received.

• The care home had failed to consider and progress Mr X’s CHC entitlement since December 2024. She said it should have asked her GP to do so but she was told this was never done;

The Council found the care home had considered Mr X’s CHC entitlement, but found this was not required at the time. It explained its registered nurses and his GP had seen him. He was generally well and his condition only worsened in early 2025 when he contracted a chest infection which deteriorated his health rapidly.

• The care home wrongly contacted the funeral director and told them to collect Mr X. If the funeral directed had not called her after, the family would not have been able to see Mr X; and

The Council said the care home had contacted the funeral directors in the absence of family involvement, as it could not reach Ms H. This was in line with its procedures. The care home had also offered a call to discuss Ms X’s concerns.

• the Council had failed to respond to her concerns for several months.

The Council said it had sought information to her concerns and spoke with the care home. It apologised that this was not fed back to her in a timely manner, and would address this with the individual staff member through supervision.

30. Ms X asked the Ombudsman to consider her complaint. She also said she was upset the Council had referred to a lack of family involvement in its complaint response regarding the contact with the funeral director. She shared evidence of extensive family visits with Mr X and call logs from the care home.
31. In response to my enquiries, the Council provided evidence around the care home’s continence referrals for Mr X and how it reached its views around the CHC process.

Analysis and findings

Continence support for Mr X

32. Mr X was receiving continence support from the NHS throughout 2024. The evidence shows the care home did make several referrals to the NHS as the support he had was the incorrect type of equipment, and he was using more than what the NHS had found he needed.
33. I understand Ms H bought additional continence support for Mr X during 2024, which the care home also used to support him. However, I found the care home acted on the concerns and a total of four referrals were made since late 2023. This was what it was expected to do. I cannot fault the care home for any delays or amount of support provided by the NHS service.

Continuing Healthcare checklist or fast-track for Mr X

34. Ms H asked the care home to progress Mr X’s CHC entitlement in late 2024. However, no checklist referral or fast-track process was started. I have considered whether there was fault in the way the care home handled Mr X potential entitlement to CHC funding.
35. I have not found fault by the care provider. This is because:
• it considered Ms H’s request, its registered nurse saw Mr X several times, Mr X’s GP was involved, and a future care planning meeting took place;
• the decision about whether the CHC checklist or fast-track should be applied for is for the appropriate clinicians to make. In this case this would be the registered nurses and Mr X’s GP who knew about his care and treatment. However, they did not find it appropriate or relevant based on his circumstances at the time;
• it was first shortly before Mr X’s died a fast-track process was considered appropriate.
36. I can only consider the process the Council, or care provider, followed to consider and progress Mr X’s CHC eligibility. Without fault in the process, I cannot criticise the decision reached.

Contact with the funeral director

37. Ms H and the care home disagree about the events which occurred when Mr X died. It is agreed it informed the funeral director, who subsequently contacted Ms H. However, the care home said it could not reach Ms H beforehand.
38. I have considered the available evidence which shows the care home spoke with her. There were no missed calls or voicemail. On balance, I am therefore satisfied the care home did reach Ms H and informed her Mr X had died.
39. However, I cannot say it was fault by the care home to subsequently contact the funeral director. This is because it was the care home’s understanding the funeral director would also contact Ms H, which is what happened.
40. I understand the funeral director called Ms H as curtesy and not as a pre-arranged agreement. If they had not done so, they would have attended the care home and collected Mr X. However, I cannot say whether this was therefore a misunderstanding by the funeral director or the care home.
41. I understand this would have caused Ms H some distress at the time. However, as she and the family did manage to see Mr X before the funeral director collected him, there was no other injustice.

Communication with Ms H

42. The Council acknowledged it had not responded to Ms H’s concerns and communication from January 2025 in a timely manner, and apologised. This was fault.
43. Ms H also said the Council’s complaint response wrongly referred to that there was no family involvement, which was clearly not the case. My view is this was misunderstood. The Council’s comment related to the care home’s statement it could not reach Ms H when it called. While this could have been phrased better, I am therefore not satisfied this was fault.
44. I have also considered the care home’s communication with Ms H. I found the care home:
• should have shared more or clearer information about the referrals for continence support for Mr X in 2024. This may have included details about the NHS service she could address any concerns to about the level of continence support;
• should have explained its considerations and reasons for not progressing CHC in late 2024 for Mr X; and
• did speak with Ms H when Mr X died, contrary to what it later found.
45. I am satisfied Ms H experienced some distress and uncertainty due to the lack of timely and clear communication by the Council and the care home in these instances. As I have not found fault on the substantial parts of the complaint, I am satisfied an apology is appropriate.

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Action

46. To remedy the distress and uncertainty the Council and the care home caused to Ms H, the Council should, within one month of the final decision:
1. apologise in writing to Ms D to acknowledge the impact the lack of timely and clear communication caused her.

We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.

47. Within three months of the final decision the Council should also:
1.  
2. share this decision with the care home for it to review how it can ensure communication with relatives is clear. This includes when referrals are made or outcomes are known, and may also include guidance on who a relative can approach if they disagree with decisions made by other bodies.
48. The Council should provide us with evidence it has complied with the above actions.

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Decision

49. I have completed my investigation with a finding of no fault on the substantive parts of the complaint. However, there was some fault in the Council’s and care home’s communication with her. The Council will apologise to acknowledge the distress and uncertainty this caused.

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Investigator's decision on behalf of the Ombudsman