• The complaint
• The Ombudsman’s role and powers
• How I considered this complaint
• What I found
• Final decision

The Ombudsman's final decision:

Summary: The Council cannot show it discussed the funding for domiciliary care with Mr X before he was discharged from hospital. It now offers to reimburse the charges incurred, which will remedy any injustice caused.

The complaint

1. Ms A (as I shall call the complainant) complains the Council did not fund Mr X’s reablement care after he left hospital and did not carry out a financial assessment before it charged him for the care.

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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. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

3. I considered the information provided by Ms A and by the Council. We spoke to Ms A. Both Ms A and the Council had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

4. A council must assess a person’s financial resources and any amount the person would be likely to pay towards the cost of meeting the needs for care and support once it has decided on eligibility.
5. The Care and Support Statutory Guidance says:

There is a tendency for the terms 'reablement', 'rehabilitation' and 'intermediate care' to be used interchangeably. The National Audit of Intermediate Care categorises 4 types of intermediate care:

crisis response - services providing short-term care (up to 48 hours)

home-based intermediate care - services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists

bed-based intermediate care - services delivered away from home, for example, in a community hospital

reablement - services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals

'Intermediate care' services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently - as such they provide a link between places such as hospitals and people's homes, and between different areas of the health and care and support system - community services, hospitals, GPs and care and support

6. The Council says there are two elements to the Intermediate Care services it provides:

“The Home First and Reablement Service is able to provide support services following discharge, this is for a variable length of time ranging from 2 or 3 days up to a maximum of 6 weeks depending on assessment and progress.

This service is not only available to people who will recover from illness but there needs to be evidence that the person is able to engage with the service and has reablement goals – these are normally be set by a therapist in the hospital who has worked with the client.”

It points out that Intermediate Care is an assessed need and not automatically agreed on discharge from hospital.

What happened

7. Mr X was admitted to hospital in 2018. Ward staff and therapists who attended him believed he should be discharged into a 24-hour care placement, given the extent of his needs at that time. They said he needed two carers at every care intervention. A social worker assessed Mr X and agreed he could return to his own home with a care package. The Council arranged a care agency to provide his care as the Home First service could not provide two carers at a time.
8. Ms A, who Mr X asked to act as his representative, says before he was discharged, she asked the social worker, the ward staff and the care agency about funding for the care package. She says no-one was able to answer her question.
9. A finance officer wrote to Mr X before his discharge from hospital to arrange to carry out a financial assessment. She wrote, “there may be a charge to you for any care provided by Herefordshire County Council”.
10. The financial assessment determined that Mr X was self-funding and would be charged the full cost of the care package.
11. Ms A complained to the Council on Mr X’s behalf about the charges which were levied. She said no-one had been able to tell them about the funding available for Mr X’s care. She asked why he had not been eligible for free care. She said she understood from her own research that the first six weeks’ care would be free of charge.
12. The Council replied to Ms A. It said ward staff and therapy staff did not believe Mr X had any reablement potential and so they would not support an application to the Reablement Team. It said the social worker would not have known who would fund Mr X’s care until the financial assessment had been completed.
13. Ms A complained to the Ombudsman. She said Mr X had improved considerably since his discharge and now only needed the support of one carer.
14. The Council says Mr X was not deemed eligible by hospital staff for reablement care. It says the letter arranging the financial assessment raised the possibility of charges.
15. However, the Council acknowledges there is no evidence that charges for the care and support Mr X received were discussed before his discharge. It says therefore it is “willing to raise a credit note for the charges raised for care and support during the six-week period ending on 16 December 2018 totalling £1,296.00 to remedy any injustice that may have been caused”.

Analysis

16. The Council did assess Mr X’s finances: there is no fault there.
17. There is no evidence the Council was at fault in arranging a care package for Mr X rather than Intermediate Care: at the time of his discharge the professional opinion was against reablement.
18. As there is no evidence that Mr X was properly notified of charges before the care package was arranged, the Council has agreed to reimburse those charges.

Agreed action

19. Within one month of my final decision the Council will raise a credit note for the charges.

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Final decision

20. Mr X suffered some injustice which the action agreed by the Council will remedy.

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Investigator's decision on behalf of the Ombudsman

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