Decision : Closed after initial enquiries
Decision date : 17 Mar 2021
The Ombudsman's final decision:
Summary: We will not investigate Mrs Y’s complaint that the Council‑commissioned care provider did not reduce her late mother Mrs X’s care fees once they started to receive NHS Funded Nursing Care payments. There is not enough evidence of fault by the care provider in the way it dealt with this matter to warrant our investigation.
- Mrs X was Mrs Y’s late mother. Mrs X lived at Lakeside for several years, a residential care home placement arranged and partly funded by the Council. In 2019, Mrs X was awarded NHS Funded Nursing Care (FNC).
- Mrs Y complains the Council refused to reduce Mrs X’s care costs by the amount received by the home from the NHS FNC payment.
- Mrs Y says the Council’s decision has resulted in a financial loss to Mrs X’s estate, of which she is an executor. She says she has spent time and trouble researching the matter and contacting the parties involved and her MP, all at a time when she is grieving her mother.
- Mrs Y wants the Council to:
- reimburse the FNC equivalent overpayment of care to Mrs X’s estate, plus interest, and any relevant increases in the weekly rate;
- adjust the charges on the deferred payment agreement to reflect the reduced loan sum;
- compensate her for time, trouble and distress;
- apologise to her;
- train its staff so the same situation does not happen to others.
The Ombudsman’s role and powers
- 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’. 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
- it is unlikely we could add to any previous investigation by the Council, or
- it is unlikely further investigation will lead to a different outcome.
(Local Government Act 1974, section 24A(6), as amended)
How I considered this complaint
- As part of my assessment I have:
- considered the complaint and documents provided by Mrs Y and the Council;
- taken account of our guidance to care providers on complaints about FNC;
- issued a draft decision, inviting Mrs Y to reply.
What I found
- Our advice to care providers says we expect them to make it clear in their contracts how they will deal with any monies received from the NHS under FNC. We would not find fault with a provider where their contract with the service user makes it clear how it will deal with any FNC awarded. If the contract clearly states the provider’s receipt of such money will not change the sum paid for the social care element of the person’s provision, it would not be fault for them to do so.
- The care provider has been clear on that issue. Paragraph 2.5 of its 2015 contract with Mrs X says:
‘2.5 The element of nursing care paid directly to the Proprietor [of the care home] by the Health Authority Agency and/or Primary Care Trust will be retained by the Proprietor and the fees referred to in this Agreement exclude these payments.’
- The provider’s terms and conditions are clear in the contract put in place from the date Mrs X entered the home in 2015. I have not seen enough evidence of fault by the Council in how it made its decision there would be no reduction in Mrs X’s care fees once the care home received FNC for her. There is not enough evidence of fault here to warrant our investigation.
- We will not investigate this complaint. This is because there is not enough evidence of fault by the Council to warrant our investigation.
Investigator's decision on behalf of the Ombudsman