Summary: We found no fault in the way the Council reached its decisions about Mr Y’s care placement on discharge from hospital, whether he needed a psychological evaluation or whether a social worker properly considered whether Mr Y met the criteria for fast-track Continuing Health Care (CHC).

The complaint

1. Ms X complains:
1. the Council unreasonably reached a decision that her father’s needs could met at home via visits from domiciliary carers. She considered this was unsafe. She stated no new assessment took place to inform this and her father’s condition had not clinically improved since a previous decision that he needed a nursing care home placement.
2. the Council failed to respond to the family’s concerns and requests for a psychological evaluation of her father and failed to escalate their concerns to NHS staff. She considered the Council had undermined the role of the family when reaching decisions under the best interests process.
3. that a social worker exceeded his remit when he did not agree to progress a fast-track Continuing Healthcare (CHC) assessment for her father, and decided the criteria was not met.
2. Ms X stated her father became severely ill while still in hospital demonstrating the proposal that her father was cared for at home was unsafe and this caused concern.

Back to top

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 recommend a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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

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

Back to top

What I found

NHS Continuing Healthcare (CHC)

7. 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.
8. Where it appears a person may be eligible for NHS Continuing Healthcare (CHC), councils must notify the relevant integrated care system (ICS).
9. Individuals may need care and support from their local council and/or services arranged by the NHS. Councils and the NHS 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.

NHS-Funded Nursing Care (FNC)

10. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing. It is to support the cost of nursing care delivered by registered nurses. If a person does not qualify for NHS Continuing Healthcare, 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 CHC Assessment Process

11. In most cases, an initial checklist assessment will be carried out to decide if someone needs a full CHC assessment. The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. 
12. The outcome of the checklist will either be that the individual does not meet the eligibility criteria for a full assessment, or they will be referred for a full assessment of eligibility. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
13. Full assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in an individual’s care.

Fast-track assessment for NHS continuing healthcare

14. If someone’s health is deteriorating quickly and they are nearing the end of life, they should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible.
15. Government guidance states that a fast-track pathway tool should only be used when an individual has a rapidly deteriorating condition and may be entering a terminal phase. It states that in fast-track cases an ‘appropriate clinician’ should determine that the individual has a primary health need and complete the relevant fast-track pathway tool. Other professionals are able to identify whether the individual has needs for which the fast-track pathway may be appropriate.

Mental Capacity Act

16. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
17. Complex decisions about mental capacity may involve referral to a general practitioner or consultant psychiatrist. However, generally, the Act allows the person assessing an individual’s capacity to be the person directly concerned with the individual when the decision needs to be made.

What Happened

Mr Y’s discharge planning

18. We refer to Ms X’s father as Mr Y in this statement. A Lasting Power of Attorney exists which appoints Ms X as an Attorney to act on her father’s behalf.
19. Parts a and b of Ms X’s complaint concern the way that decisions were made about Mr Y’s discharge from hospital, and more specifically where he should be discharged to and what level of support was required.
20. Mr Y was in hospital at the end of May 2025. A social worker was allocated to consider Mr Y’s needs on discharge from hospital. In June, occupational therapists at the hospital recommended Mr Y could be discharged home with the assistance of two carers providing four care visits per day. Ms X expressed concern that this would not be enough support. She noted her father’s condition and stated her father needed 24-hour care in a residential setting.
21. On 23 July the social worker noted the hospital recommendations, but he considered a care home would be appropriate. Ms X agreed with the social worker’s decision.
22. On 24 July the Council carried out a mental capacity assessment with the assistance of an interpreter. The social worker determined that Mr Y did not have capacity to decide on his discharge location.
23. The social worker began the process of finding a nursing home placement. However, when he submitted details to the hospital discharge hub, they queried whether nursing needs were needed, based on his hospital notes. They noted that he appeared to require little assistance.
24. At the end of July the social worker obtained the latest behaviour charts and nursing notes and reviewed the decision. He determined that the evidence of need no longer justified a care home placement. He decided Mr Y could be discharged home with a package of care instead.
25. We saw the needs assessment documents completed on 29 June and 11 July (when a care home was being recommended) and those from August and September (when a package of care at home was considered sufficient to meet Mr Y’s needs). When recommending a care home in July the social worker considered a package of care at home but decided a care home would help reduce risks. He also noted home care would not manage Mr Y’s apparent agitation in between care calls and at night. He also noted Mr Y was prone to infections and possible readmissions.
26. In August the social worker took account of Mr Y’s level of function and that his behaviour had improved. The social worker stated he no longer attempted to get out of bed and he was now compliant with his care. He stated, while in hospital Mr Y had been treated for a urinary tract infection (UTI) and delirium, and as these had resolved, there was a reduction in his restlessness and agitation. While other needs remained, he was of the view that Mr Y’s needs could be met at home with a package of care. This was the least restrictive way to meet Mr Y’s needs.
27. Mr Y’s health deteriorated at the end of August. NHS staff reported Mr Y was no longer medically fit for discharge, and he had required more treatment following possible sepsis and pneumonia. This decline in Mr Y’s health led to doubt about his likely discharge location.
28. A best interests meeting was held in September 2025. Ms X was invited to attend the meeting. She chose to send written comments instead. At the meeting it was determined by all the professionals in attendance that Mr Y’s needs could still be met at home with a large package of care. However, following further assessment, ultimately, the Council went on to find a placement for Mr Y at a care home during October.

Psychological Evaluation

29. In July 2025 Ms X asked the social worker to arrange a psychological evaluation of her father so she understood how to best act in his interests. She did not wish to take part in the mental capacity assessment the social worker needed to carry out until this was done. Ms X considered that a full psychological assessment was needed before decisions were made about her father’s care.
30. The social worker explained that he was aware of her father’s cognitive impairment but a psychological evaluation was not needed for the mental capacity assessment. He explained that a mental capacity assessment did not require input by a qualified psychiatrist. The Mental Capacity Act 2005 stated that it could be carried out by a competent professional. This included social workers.

Fast-track CHC assessment

31. On 24 July Ms X asked the NHS to carry out a fast-track CHC assessment for her father. She copied in the social worker. She said she considered Mr Y met the criteria due to his rapidly deteriorating condition, complex nursing needs and extreme vulnerability.
32. The social worker responded explaining his view that Mr Y did not meet the fast-track criteria but he asked NHS colleagues to consider what nursing needs Mr Y had as part of continued planning Mr Y’s discharge from hospital.
33. In August Ms X stated she had not received a response to her request for the fast-track CHC process. The social worker responded explaining that, while Mr Y was frail and elderly, the fast-track CHC pathway was intended for individuals who had a rapidly deteriorating condition and/or a poor prognosis, typically with an expected life expectancy of less than three months. This was not the case with Mr Y.

Ms X’s complaint

34. Ms X complained in early August. She stated the social worker had been inconsistent and contradictory when making decisions about her father’s needs and where they should be met. In addition to her concerns about discharge plans, Ms X complained that her father’s social worker had not agreed to arrange a psychological evaluation. She also complained the social worker had acted beyond his remit when declining to progress her request for a fast-track CHC assessment. She stated this should only have been decided by NHS clinicians.
35. The Council response to Ms X’s complaint stated:

• the initial recommendation for residential care was based on Mr Y’s high support needs and documented agitation and unsafe behaviour. While he still had high support needs, the significant stabilisation in his behaviours following treatment led the social worker to conclude that his needs could be met at home with a package of care.
• the social worker’s decision was informed by behavioral observation and the hospital ward’s records. The social worker’s role was not to decide what clinical assessments should be carried out, such as a psychological assessment. This was a matter for the NHS.
• it had confirmed Mr Y did not meet the criteria for fast-track CHC assessment. It stated this applies if a person is actively dying with a prognosis of less than three months. It stated Mr Y’s hospital records noted a doctor had recorded, ‘not a candidate for fast-track funding as life expectancy is longer than 3 months’.

36. The Council acknowledged Ms X disagreed with the social workers’ view. It stated it would arrange a further mental capacity assessment and it acknowledged her role as Mr Y’s Attorney.

Was there fault by the Council

37. Our role is not to ask whether an organisation could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did this, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome.
38. I looked at how the Council considered Mr Y’s care needs, and the appropriate place for him to be discharged to. I found no fault in the way the Council did this. The social worker’s decisions were based on Mr Y’s medical conditions and the way he was presenting. Although the social worker’s opinion changed about whether a care home placement was required, it is clear this was because of changes in how Mr Y was presenting. It was noted that Mr Y’s health and presentation fluctuated during his hospital admission. The social worker was entitled to take account of these changes. I appreciate Ms X may disagree with some of the social worker’s decisions, but there was no fault in the way he came to his view. As a result, I have no grounds to question it. I note the Council carried out several mental capacity assessments and a best interest meeting as part of its consideration.
39. The Mental Capacity Act does not require psychological assessments in order to decide whether someone has mental capacity to make decisions about their care. The Act allows a range of professionals to consider and decide whether someone has mental capacity. There was no fault in the social worker making this decision. The social worker does not have a remit to determine what assessments the NHS do to decide upon Mr Y’s healthcare more widely. This would be a matter for the NHS.
40. Ms X considered the social worker exceeded his remit by reaching a decision that her father did not meet the fast-track CHC criteria. Government guidance states while a clinician is required to complete the fast-track pathway tool and formally reach a decision on fast-track CHC eligibility, other professionals can indicate whether the fast-track tool is appropriate. We found no fault in the social worker advising Ms X that, in his opinion, her father did not meet the criteria for fast-track CHC assessment. The social worker explained how he had come to that view.
41. Government guidance confirms that the fast-track process is intended for individuals who are entering a terminal phase of their life. The social worker concluded this was not the case for Mr Y. The Council stated the hospital records confirmed a doctor held the same view. I note that the social worker referred to Mr Y’s life expectancy as part of his reasoning about Mr Y’s eligibility. This is not in accord with the government guidance which states strict time limits based on a specified expected length of life remaining should not be imposed. However, I do not consider this point warrants further investigation. This is because Mr Y was in hospital at this point, so it was open to Ms X to ask clinicians directly to complete a fast-track CHC pathway tool if she felt strongly that he was eligible. The social worker could not have reached the formal decision on eligibility himself.

Back to top

Decision

42. I find no fault by the Council.

Back to top

Investigator's decision on behalf of the Ombudsman