Summary: There was no fault by the Council. The client contribution towards care fees was based on the financial assessment of Mrs Y's income not the cost of the care home fees or whether or not she was eligible for Funded Nursing Care. The fact that Mrs Y was eligible for Funded Nursing Care would not have reduced her contribution to costs.

The complaint

1. The complainant, who I shall call Mrs X, complaints on behalf of her late mother, Mrs Y. Mrs X complains the Funded Nursing Care (FNC) payment has been used to reduce the payments made by the Council towards nursing care, rather than reducing the client contribution made by her mother.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’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. (Local Government Act 1974, section 34(3), 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 read the papers put in by Mrs X.
5. I considered the Council’s comments about the complaint and any supporting documents it provided.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

7. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
8. Where a council has decided to charge, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint resources. Each person much be treated individually. A council must not charge more than the costs it incurs to meet a person’s assessed eligible needs.
9. People receiving care and support other than in a care home need to retain a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014 )
10. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, 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.
11. Mrs X explained the Council carried out a financial assessment and decided that Mrs Y needed to pay about £270 towards the costs of her residential care. Mrs X does not complain about the financial assessment.
12. Mrs X says the total cost of the care was about £745. Initially the Council paid the remaining £475. However, once FNC was paid directly to the residential care home, the Council’s contribution reduced to £310. Mrs X says she thinks Mrs Y’s contribution should be reduced by the cost of the FNC rather than reducing the amount the Council pays.
13. I can find no evidence of fault by the Council. The FNC payment is what the care home charges the NHS and so it is solely between those parties. The cost to the service user does not change. The client contribution is based on financial assessment of Mrs Y's income not on the cost of the care home fees or whether or not she was eligible for FNC. The fact that Mrs Y was eligible for FNC would not have reduced her contribution to costs.

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Final decision

14. I have completed my investigation of this complaint. This complaint is not upheld as there is no evidence of fault.

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Investigator's decision on behalf of the Ombudsman