Summary: We will not investigate Mr C’s complaint about the removal of funding for his mother’s care home fees. We are unlikely to find fault by the NHS provider and Council on the key issues. We also consider the NHS provider has taken appropriate action to improve, and an investigation by us would not add to this.

The complaint

1. Mr C complained about CSH Surrey (an NHS provider) and Surrey County Council. He complained about the decision to remove funding for his mother’s care home fees in August 2024, after she was taken off a “Delirium Pathway”. Mr C said he felt his mother’s needs had not changed and the NHS should have paid for her ongoing care. Instead, Mrs P had to use her savings to pay for her care.
2. CSH Surrey, the NHS provider responsible for deciding Mrs P no longer met the criteria for the Delirium Pathway, investigated and responded to the complaint. CSH Surrey also liaised with Surrey County Council as part of the complaint investigation, as the Council was responsible for assessing Mrs P’s ongoing need for care and support.

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The Ombudsmen’s role and powers

3. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
4. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
5. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we would find fault, or
• the injustice is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the organisations

6. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. 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, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
7. Similarly, we cannot decide what level of care is appropriate and adequate for any individual. This is a matter of professional judgement and a decision the relevant organisation has to make. We have looked at the way the organisations made their decisions.
8. When dealing with a complaint involving an NHS organisation and a council, if the distinction between their roles and responsibilities is unclear, we will not spend a disproportionate amount of time deciding on individual responsibilities.

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How I considered this complaint

9. I considered information from Mr C, the Council, the NHS provider, and the NHS Integrated Care Board (ICB) jointly responsible for the Delirium Pathway. I also considered the Ombudsman’s Assessment Code, and relevant law, policy and guidance. Mr C provided comments on a draft of my decision, and I took these into account before making my final decision.

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What I found

Law and guidance

10. The Department of Health and Social Care guidance, Hospital Discharge and Community Support Guidance (2024), provides guidance to NHS organisations and local authorities on discharging adults from hospital. It says systems should work together across health and social care to jointly plan, commission and deliver discharge services, pooling resources where appropriate.
11. Under the guidance, the Discharge to Assess model provides short-term care, rehabilitation or reablement after a hospital stay. A person’s longer-term care and support needs can then be assessed once they have reached a point of stability and recovery. Care is usually provided free of charge for up to six weeks under Discharge to Assess arrangements.
12. Under the Care Act 2014, Councils must carry out an assessment of any adult who appears to need care and support. Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high quality, coordinated assessment.

What happened

13. Mrs P went into hospital in April 2023 after a fall at home and suffering from confusion. She was discharged to a care home (the Care Home) in June 2023. She had delirium and confusion and was discharged on a Discharge to Assess “Delirium Pathway”. This meant her care was initially free of charge.
14. While Mrs P was still in hospital, the Council explained to Mr C that under the Delirium Pathway his mother’s care home placement would be for a short period of assessment until her delirium resolved, and would be free of charge. The Council explained that Mrs P would need to self-fund her care once the delirium had resolved, as she had capital over the limit of £23,250.
15. We have received conflicting information from CSH Surrey, the Council and the ICB about whether the Delirium Pathway and funding in this case was an NHS, local authority or joint responsibility. As outlined in paragraph 8, we have not spent a disproportionate amount of time trying to establish individual responsibilities. From the information we have seen, there were both NHS and local authority responsibilities involved in the issues Mr C has complained about.
16. After being discharged from hospital, Mrs P was referred to CSH Surrey to reassess her delirium in the Care Home. She was assessed in July 2023 and was found to have ongoing delirium. This remained the case during several re-assessments between July 2023 and January 2024, and meant her care home fees were still covered under Discharge to Assess arrangements.
17. In February 2024 Mrs P was assessed again for delirium and cognitive impairment, and the CSH assessor decided her delirium had resolved. Mr C queried this, and CSH agreed to carry out another assessment. This was done in March 2024, and reached the same conclusion - that the delirium had resolved, and that Mrs P should come off the Delirium Pathway.
18. There was a delay in making the final decision to take Mrs P off the Delirium Pathway until August 2024. It appears there was some confusion and disagreement between the Council and CSH about whether this was an NHS or council responsibility to sort out. The Council spoke with Mr C in August and confirmed that Mrs P would come off the Delirium Pathway on 16 August and would transition to privately-funded care. Mr C said he wanted to challenge the decision that his mother’s delirium had resolved.
19. In September 2024 Mr C complained about the decision to take his mother off the Delirium Pathway and the removal of funding for her care home fees. He said he felt his mother’s needs had not changed and that the NHS should pay for her ongoing care. There was a long delay before Mr C received a response to his complaint. He eventually received a response from CSH Surrey in mid-July 2025.
20. Mr C complained to the Ombudsmen. He said he wanted his mother to be reimbursed for her care home fees from August 2024 onwards, and for the NHS to pay for her ongoing fees.

Analysis

21. The evidence I have seen shows that Mrs P was assessed several times to determine whether she should stay on or come off the Delirium Pathway. The staff used recognised delirium screening tools, and considered information from Mr C and the Care Home. From March 2024 onwards the assessments showed Mrs P no longer met the criteria for the Delirium Pathway.
22. It was appropriate to re-assess Mrs P’s needs, and when they changed, to move her off the Delirium Pathway. I have not seen any indications of fault in how the delirium assessments were carried out or in the decision to move Mrs P off the Delirium Pathway.
23. There were numerous phone calls to Mr C to discuss his mother’s condition, and to obtain information from him as part of the ongoing assessments of Mrs P.
24. The Council spoke to Mr C about the Delirium Pathway while Mrs P was still in hospital, and explained that Mrs P would need to self-fund her care once the delirium had resolved. I have not seen any indications of fault here.
25. There seems to have been some confusion between the organisations about who was responsible for moving Mrs P off the Delirium Pathway and the transition to self-funded care. CSH Surrey acknowledged this in the complaint response, and outlined the work being carried out to address this including:
• Reviewing information available to patients and families about the management and assessment of patients on the Delirium Pathway and the process of discharge from it
• Effectively sharing information across health and social care providers, and ensuring oversight of how services work together
26. CSH Surrey has also apologised to Mr C for the delays in investigating and responding to his complaint.
27. I consider these actions are appropriate and we would not add to this through an investigation.

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Final decision

28. We will not investigate this complaint. This is because we are unlikely to find fault by the Council and NHS provider on the key issues, and investigation of the complaint is unlikely to achieve more.

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Investigator's decision on behalf of the Ombudsman