Summary: Ms X complains about her dealings with a social worker over funding for her late partner’s stay in a care home as well as the care her late partner received while in the home. I found fault by the Council.

The complaint

1. Ms X complains about her dealings with a social worker over funding for her late partner’s stay in a care home as well as the care her late partner received while in the home. Ms X says:
• She asked the social worker to make a claim for NHS health care funding for her partner but despite the social worker acknowledging her request nothing further was done by the social worker.
• The social worker and the manager of the care home where her partner resided went against their expressed wishes by recording choices that meant her partner returned to the care home from hospital against her will.
• She complained about conditions in the care home but the social worker did not act on her complaints.

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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. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I reviewed the complaint and background correspondence provided by Ms X and the Council. I discussed matters with Ms X by telephone. I made enquiries of the Council and considered the information it provided in response to my enquiries.

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What I found

NHS Continuing health care funding process

5. Some people with long term complex health care needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare. NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home
6. To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to the help a person needs; how complex their needs are; how intense their needs can be; and how unpredictable they are including any risks to their health if the right care is not provided at the right time.
7. A person’s eligibility for NHS continuing healthcare depends on their assessed needs, and not on any diagnosis or condition. If their needs change then eligibility for NHS continuing healthcare may change.
8. A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
9. Clinical commissioning groups, known as CCGs (the NHS organisation that commission local health services), must assess a person for NHS continuing healthcare if it seems that they may need it.
10. For most people, there is an initial checklist assessment, which is used to decide if a person needs a full assessment. However, if the person needs care urgently – for example, if the person is terminally ill – then the assessment may be fast-tracked.
11. The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. The person should be told that he or she is being assessed and should provide consent.
12. Depending on the outcome of the checklist, the person will either be told that they do not meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or they will be referred for a full assessment of eligibility.
13. Being referred for a full assessment does not necessarily mean the person will be eligible for NHS continuing healthcare. The purpose of the checklist is to enable anyone who might be eligible to have the opportunity for a full assessment.
14. The professional(s) completing the checklist should record in writing the reasons for their decision, and sign and date it. The person should be given a copy of the completed checklist.
15. If a person’s health is deteriorating quickly and the person is nearing the end of life, the person 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 – usually within 48 hours.

Ms X’s account

16. Ms X lived with her late partner in June 2018. Ms X’s father was dying and receiving palliative care at home. Ms X’s partner also had terminal cancer. Ms X could not cope with caring for both of them and so agreed that her late partner should go into a care home as an emergency respite measure.
17. Ms X met with two social workers at her home in June 2018. It appears the meeting was held because the Council was concerned that Ms X had administered an unprescribed amount of a controlled drug to her partner.
18. Ms X recalls the social worker telling her that her partner could remain in respite care and the Council would wait to see when her dad died and the help it could offer then.
19. Ms X says she was led to believe her partner’s stay in the care home would be free of charge for six weeks and then if she remained in the home the Council would apply for fast track funding. Ms X says she assured the officers that her partner would be at home or in a hospice as they had both agreed to this process and held power of attorneys for each other.
20. In early July 2018, Ms X asked the care home manager to apply for fast track funding as she was worried no one had been to see them about costs or given them any information on the home. Ms X says the manager assured her the social worker was dealing with it. The manager also told her the care home was in administration.
21. Ms X rang a Community Psychiatric Nurse (CPN) at the Council to tell her about the home going into administration. Ms X says the nurse told her she would check it out.
22. In the middle of July 2018, Ms X received two invoices from the care home for top up fees for June and July 2018. A few days later she met with a new social worker for her partner. Ms X says the officer agreed to apply for the fast track funding but advised her to pay the top up fees. Ms X says the officer told her she would resolve the safeguarding matter as she was being hassled by her bosses to do so.
23. A week later, Ms X says the social worker went to her home and made threats about the safeguarding matter. She says the social worker told her that if she agreed to leave her partner in the care home then the Council could sort out the funding through a fast track application and close the safeguarding case. Ms X says the officer said she could bring her partner home on odd nights and weekends and when too unwell a hospice bed would be arranged.
24. Ms X says another social worker telephoned her a few days later to say she should get her partner home and not be held to ransom by her partner’s social worker.
25. Ms X paid the top up fees at the end of July.
26. A finance officer from the Council’s financial assessment team visited Ms X in early August to conduct the financial assessment of Ms X’s partner as well as Ms X. Ms X told the officer not to visit with her partner’s social worker because the social worker had been rude and threatening.
27. Ms X’s partner had a fall while at the home. Ms X says the home did not call for an ambulance. She took photographs of her partner and a new area manager for the care home went to see her several times.
28. The social worker advised Ms X of a multi-agency best interests meeting that was to be held in Mid-August and at which the safeguarding matter would be resolved.
29. Ms X says the Council’s solicitor was very kind and assured her the Council would need to go to the Court of Protection if she disagreed with the decision made at the best interest meeting.
30. Ms X’s partner was admitted to hospital. While in hospital, Ms X asked hospital staff to make enquiries with the charity Macmillan Cancer Support about a bed for her partner. Ms X also made enquiries with a local hospice.
31. Ms X says the manager of the care home was visiting another patient in the same ward as her partner but the manager told the discharge nurse that the care home could cope with her partner. The hospital then agreed to discharge her partner back to the care home.
32. Ms X’s partner died a few days later. Ms X says she stayed at the care home to care for her partner. She says she had to do all the nursing for her partner including taking bedding from her own home for her partner and scrubbing her partner’s room.
33. The Council sent invoices for her late partner’s residence in the care home in November. This is because her late partner had been assessed as having the funds to pay for her stay in the care home. Ms X disputed the invoices on the basis that she had asked the social worker to apply for NHS funding.

The social worker’s account

34. The social worker says Ms X was aware there would be a financial assessment to determine the amount of contribution to ne made towards her partner’s care while in the care home. The social worker does not recall the discussions she had with Ms X around NHS funding but is confident that Ms X was aware that her partner did not qualify for full NHS funding at the time and this was made clear to her.
35. The social worker says NHS funding was discussed but she cannot recall where and the dates. The social worker does not recall any decisions being made to start the assessment process for NHS funding. The social worker stressed Ms X was aware there would be a financial assessment completed to determine any financial contribution towards her partner’s care.
36. The social worker recalls Ms X made several complaints about the care home but cannot recall the exact nature of the complaints save two. These involved the smell of urine during one of her visits and a male resident who had gone into her partner’s room. The social worker said she and the care home manager discussed Ms X’s concerns with her on more than one occasion. The social worker says the complaints were always responded to and resolved by the care home manager. The social worker recalls Ms X saying her concerns had been resolved satisfactorily.

The Council’s comments

37. The Council points out the first social worker who visited Ms X in June 2018 talked about NHS continuing health care funding with her but this was different from requests for information about fast track funding. Any need for fast track funding is linked to end of life care and is identified by and assessed directly by the NHS. It stressed there is no record of any discussions about fast track funding and no meeting about it took place.
38. The social worker’s case notes showed there was a discussion between Ms X’s partner’s social worker and Ms X about the possibility of NHS continuing health care funding in mid-July 2018. The social worker recorded in another case note a week later that she had advised Ms X that her partner did not meet the criteria but that a checklist would be completed.
39. A recording in the case notes states ‘funding for ongoing placement discussed… [Ms X] is currently arranging for payment of top up of £65 from [her partner’s] AA. Financial assessment discussed’.
40. Another recording states ‘financial obligations were discussed and [Ms X] is concerned about her ongoing financial stability because she and [her partner] have previously relied heavily on [her partner’s] private pension which Ms now understands will be used to finance [her partner’s] care. (leaflet for information left with Ms X). [Ms X] is requesting the financial assessment be completed as soon as possible and she will also require benefits advice’.
41. The social worker said that when Ms X realised her partner’s income would be used for her care at the home, she told the officer that she should bring her partner home because it was not a viable option. The social worker says she reminded Ms X that there was an ongoing safeguarding investigation and so returning her partner to her home was not an option until the investigation was completed. The social worker said she agreed to chase up a financial assessment.
42. When the financial assessment was done in August, the social worker recorded a withdrawal Ms X had made from her partner’s bank account to pay for a bathroom. The social worker said the Council would count that sum until the bathroom was installed and paid for and Ms X’s partner would remain over the capital limit until a time in September 2018.
43. The Council says Ms X agreed at the best interest meeting in August 2018 that the best outcome for her partner was to remain in the care home.
44. When Ms X’s partner was due to be discharged from hospital later that month, the Council says NHS staff liaised with the care home about the discharge and her partner’s nursing care requirements. It was already clear to its officers that her partner had not wanted to go into a residential/nursing placement for care but that issue had been addressed in the best interest meeting.
45. The Council says following the death of Ms X’s partner, it was in contact with Ms X by telephone when Ms X raised the issue of fast track funding and advised its officer that she spoke with the care home manager who told her the funding had to be applied for. The Council says it subsequently attempted to follow up whether any NHS service had assessed fast track funding in August 2018 but the responses from the hospital and Ms X’s partner’s GP showed there was no assessment.

Findings

Ms X asked the social worker to make a claim for NHS health care funding for her late partner but despite the social worker acknowledging her request nothing further was done by the social worker

46. It is evident the social worker considered Ms X’s request for NHS continuing health care funding in July 2018. The social worker told Ms X her partner was likely to be ineligible but she would complete a checklist.
47. The Council has not provided a copy of the checklist completed by the social worker, and it seems likely one was not done. The social worker should have completed the checklist, signed and dated it and sent it to Ms X. The social worker did not do so. This was fault, and clearly caused Ms X uncertainty and confusion about the funding arrangements. However, Ms X may make a retrospective application to her local Clinical Commissioning Group for retrospective CHC funding.
48. I also find Ms X’s confusion about the care costs was compounded by the delay in completing a financial assessment and notifying Ms X about the price of the placement. This did not happen until after Ms X’s partner had died. While there is evidence the Council discussed costs with Ms X at a meeting of 25 July, there is no evidence this was followed up in writing, or that the cost of placement was made explicitly clear to her.
49. Lastly, the Council is at fault for asking Ms X to pay a third-party top up. At the beginning of the placement, the Council should have established whether Ms X’s partner was required to pay the full cost of the placement and put a contract in place at the earliest opportunity. In the event, the Council appears to have met the cost of the placement and charged Ms X £65 as a third-party top-up. This was fault. Notwithstanding the fact there was no written top-up agreement in place, there was also no legitimate grounds to request a third-party top-up, as Ms X’s partner had sufficient funds to meet her own care costs. Again, this has added to Ms X’s confusion about the care costs.

The social worker and the manager of the care home where her partner resided went against their expressed wishes by recording choices that meant her partner returned to the care home from hospital against her will

50. I do not find fault by the Council for originally placing Ms X’s partner in the care home. The Council held a best interest meeting before Ms X’s partner was admitted to hospital. At that meeting, it was decided that a residential placement was in the best interest of Ms X’s partner, given her increased care needs and the safeguarding concerns. This decision was agreed by all parties in the meeting of 14 August.
51. However, there was a missed opportunity to review the situation when Ms X’s partner was subsequently discharged from hospital. Ms X had been clear that her partner did not wish to be in a care home, and that she wanted to enter a hospice or return home for her end-of-life. However, these options were not explored, and Ms X’s partner returned to the home.
52. There is also no evidence a Care Act needs assessment was carried out to establish whether the home was suitable for Ms X’s partner. This was fault, and adds weight to Ms X’s concerns that the home did not have sufficient resources, particularly nursing support, to ensure her partner’s increasing needs were being properly met.
53. Lastly, the Council did not act in a timely manner on the safeguarding concerns. It was not until 13 November (over a month after Ms X’s partner had died) that the Council decided Ms X did not present a risk. Had the safeguarding enquiries being concluded within a reasonable period, Ms X may have had more latitude to explore alternative care settings for her partner. This delay also meant Ms X had the stress of unresolved safeguarding concerns hanging over her, when she was dealing with the death of her father and partner.

Ms X complained about conditions in the care home but the social worker did not act on her complaints

54. The papers show Ms X made complaints about conditions in the care home and the care given to her partner directly to the care home as well as through the social worker. The social worker does not recall all the complaints, however.
55. This was fault. As the Council commissioned the placement it had overall responsible for standards of care and should have acted on the complaints accordingly.

Agreed action

56. Where we find fault by a council, we must go on to assess the injustice caused to the complainant and, where necessary, a remedy for the injustice.
57. In this case, it is uncertain whether Ms X’s partner would have been eligible for NHS continuing health care funding. The social worker did not follow the correct procedure meaning that Ms X couldn’t challenge matters earlier. However, Ms X may now put a retrospective application in, which will resolve this issue one way or another.
58. As matters stand, Ms X’s partner was liable for her care home fees, as her capital assets were above the statutory £23,250 threshold at which the Council begins to fund social care support. I therefore do not find fault with the Council for the bills it has issued. However, the Council got things wrong by failing to explain the costs to Ms X at the start of the placement, and by confusing matters through initially paying the costs, and asking Ms X to pay a third-party top up.
59. I recommended the Council pay £200 to Ms X for the time and trouble these faults have caused, and that it deducts any top-ups she paid from the overall cost of the placement.
60. The failure to carry out a needs assessment prior to placing Ms X’s partner in the care home, and the failure to review the suitability of the placement at the point she was discharged from hospital, meant there was a missed opportunity to explore other options, most particularly hospice care. I recommended the Council pay Ms X £500 to recognise the distress caused by this lost opportunity.
61. Lastly, I recommended the Council pay Ms X £500 for the distress caused by its failure to carry out the safeguarding enquiries in a timely fashion and failing to respond to the complaints fully.
62. This makes a total of £1200 payable to Ms X in addition to a deduction of any top up payments she made from the overall cost of the placement.
63. The Council accepted my recommendations.

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Final decision

64. There was fault by the Council which caused an injustice to Ms X. I closed this complaint because the Council agreed to provide a remedy for the injustice.

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Investigator's decision on behalf of the Ombudsman