Summary: Mrs B complains about what happened when her father, Mr C, was discharged from hospital after attending with a fractured collarbone, and about arrangements for putting a care package in place. We found the Trust was at fault for the lack of information given to Mr C and his family when he was discharged to ensure he could manage at home. We also found fault by the Council in terms of lack of communication about timescales in arranging a care package. The Trust and Council have agreed to take action to remedy the impact.

The complaint

1. Mrs B complains about what happened when her father, Mr C, was discharged from hospital after attending with a fractured collarbone. Mrs B says he was not properly assessed as to whether he would be safe on his return home, where he lived alone, and that appropriate care was not put in place. Mrs B says she was given incorrect information about her father’s condition during a telephone call with the ward. She says Warrington and Halton Hospitals NHS Foundation Trust (the Trust) told her Mr C was ready to be discharged, and could sit up and move around by himself, as well as dress himself, but she said that this was not the case.
2. She also says he was discharged without any pain medication, and that when she later rang the hospital for help, staff were dismissive and advised her to consult her father’s GP.
3. Mrs B also complains there was a lack of communication between the Trust and Warrington Council (the Council), and she contacted the Adult Social Care team herself after Mr C had been discharged. Mrs B says there was then a delay in anyone coming to assess his needs, and a further delay before care was put in place.
4. As a result of these events, Mrs B says her father experienced avoidable distress as he did not get the support he needed after leaving hospital. She also said he experienced unnecessary pain, and that this should have been managed when he was discharged. Mrs B added the situation also caused distress and worry to the family, as well as costs for care aids they bought themselves before the care package began.
5. Mrs B would like the Trust and Council to acknowledge failings in the care and support provided to Mr C, and to improve services. She would like the Trust or Council to reimburse Mr C for the costs he incurred when paying for care during this time.

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The Ombudsmen’s role and powers

6. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. If there has been fault, the Ombudsmen 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).
7. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
8. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)
9. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the Council and Trust followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.

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How I considered this complaint

10. During my investigation of this complaint, I have considered information provided to us by Mrs B and discussed the complaint with her. I wrote to the Council and Trust to tell them what I intended to investigate, and to request copies of relevant records. I considered the comments and documents they sent. I have also considered the law and guidance relevant to this complaint.
11. I also took advice from one of PHSO’s clinical advisers, a registered nurse.
12. I also considered comments from Mrs B, the Council and the Trust on my draft decision statement.

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What I found

Applicable legislation and guidance

Hospital Discharge

13. Department of Health guidance: Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care (March 2010) (the ‘Ready to go guidance’) is the core guidance around hospital discharge. It contains ten key steps for staff to follow during discharge planning, including:

• start planning for discharge or transfer before or on admission;
• identify whether the patient has simple or complex discharge and transfer planning needs and involve the patient and carer in your decision; and
• involve patients and carers so that they can make informed decisions and choices that deliver a personalised care pathway and maximise their independence

Hospital Discharge Service: Policy and Operating Model

14. This guidance, published in August 2020, sets out the hospital discharge service operating model for all NHS trusts at the time of the events complained of. The guidance gives details of the discharge to assess pathways model, based on four pathways (0-3) for discharging people from hospital.

Medically fit for discharge

15. Department of Health guidance: Definitions – Medical Stability and ‘Safe to Transfer’ (2003) (the ‘Safe to transfer guidance’) gives guidance on when a patient can be safely considered to be ‘medically fit for discharge’. This lists three key criteria for making this decision and stresses professionals should address them at the same time, if possible. According to the protocol, a person is considered to be safe for discharge when:

• a clinical decision has been made that the patient is ready for transfer;
• a multidisciplinary team decision has been made that the patient is ready for transfer; and,
• the patient is safe to discharge/transfer.

16. A patient can be defined as clinically or medically stable if tests (such as blood tests and observations) are considered to be within the normal range for the patient. A patient is ‘fit for discharge’ when all relevant physiological, social, functional, and psychological factors have been taken into account. This can require a multidisciplinary assessment.

Care and support

17. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and, where suitable, their carer or any other person they might want involved.

Carers’ Assessments

18. Department of Health guidance for the Care Act 2014: ‘Care and Support Statutory Guidance 2014’ says that where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carers assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult. Where the local authority is carrying out a carer’s assessment, it must include in its assessment a consideration of the carer’s potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care.

What happened

19. In September 2020, Mr C fell at home and injured his left shoulder. He was taken by ambulance to A&E, and had an X-Ray which identified a fracture. Mr C had existing left-sided weakness following a previous stroke. Mr C was then moved to the clinical assessment unit, and reviewed by the Rapid Response Team. He was assessed as medically fit for discharge and discharged home the next day.
20. On 3 September, the day after Mr C had been discharged, Mrs B contacted the Council’s adult social care team for help. Mrs B had been supporting her father, but was concerned as he was in pain and struggling to manage. Mrs B also had to return to work. Mr C had previously had a care package of one tea-time care call a day to support him with preparing meals. This had been arranged through the Council but paid for by Mr C. However, in April 2020 the family had asked for this to be temporarily stopped because they were worried about the risk of COVID-19 to Mr C.
21. On 11 September, a duty social worker visited Mr C to discuss options for support, including domiciliary or respite care. Mr C was assessed as needing domiciliary care to support him at home. Ten days after the assessment, a care package of two daily calls to support Mr C was put in place. This was gradually reduced over the next few weeks as Mr C improved, with one tea-time call remaining in place.

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Analysis

Assessments done before discharge from hospital

22. Mrs B complained that Mr C’s mobility was not accurately assessed before he was discharged, and that he was not safe to be discharged home. The records show that the Trust’s Rapid Response Team (RRT) reviewed Mr C three times during his hospital admission. The Trust’s discharge policy describes the RRT’s role as supporting frail older people in avoiding unnecessary admission to hospital.
23. The first RRT review of Mr C involved assessment by a physiotherapist, and covered his social circumstances, mobility, functional abilities including meal preparation, personal hygiene needs and managing medicines. The notes show the RRT also confirmed there was equipment in place at home, including a toilet frame and riser-recliner chair. It is also noted that Mr C had support from his daughters. It is documented in the notes that the therapist contacted Mrs B, who said she and her sister had been supporting Mr C at home since the daily care call had been stopped because of COVID-19. It is also noted that Mrs B said there was enough family support at home to help Mr C with getting out of bed, washing and dressing.
24. Regarding Mr C’s pain level, at the time of this assessment the therapist was not able to transfer him to sit up from lying down, as he was in considerable pain when he moved. The therapist noted he was not at a functional level to return home at that time because of his level of pain. The therapist reported back to nursing staff that Mr C would need further pain relief.
25. Mr C had a second RRT review later the same day, after pain relief had been given. He told the therapist he would not be able to manage at home with this level of pain. The therapist agreed, and advised a further day of mobility practice. The therapist contacted Mrs B to update her. It is also noted they told Mrs B it might be useful to consider purchasing some urinal bottles for Mr C, and that a commode for overnight use could be provided on discharge if needed.
26. During the second review, Mr C reported his pain had improved slightly. However, the therapist documented he was too unsteady on his feet to try to use a stick and he was not at a functional level to return home.
27. The RRT reviewed Mr C again the next day. This time it was noted he needed “minimal assistance” to move into sitting position from lying on the bed. They said other transfers and mobility were completed independently, with Mr C using a crutch on his right side. The notes say Mr C could undress himself and use the toilet independently without any issues, and “his pain has been managed since yesterday”. The same day, nursing staff noted that Mr C was independent with all hygiene needs and mobilising independently using a crutch.
28. Based on this information, I found the assessments were in line with the relevant guidance, and Mr C’s mobility was appropriately assessed.

Trust communication with Mrs B

29. Mrs B says she was given incorrect information about her father’s condition during a telephone call with the ward on the day he was discharged. She says the Trust told her Mr C was ready to be discharged, and could sit up and move around by himself, as well as dress himself. However, Mrs B said this was not the case. The notes show several telephone discussions with Mrs B, where it is recorded that family members would be able to support to Mr C at home. Mrs B says she agreed to this based on the information she was given about her father’s condition by Trust staff, but she said that later it became clear this information was not accurate.
30. Although we are not able to comment on what was said at the time, the notes of the telephone conversations reflect the information in the records about Mr C’s condition. The Trust apologised that it had misinterpreted Mrs B’s comments and had documented that Mr C would not accept support from carers when this was not the case. The Trust said as a result of Mrs B’s complaint, it had held discussions with the team with the aim of improving communication about discharge with patients and their relatives. I am satisfied the Trust has provided a reasonable response to this part of Mrs B’s complaint.

Assistance with mobilising at home

31. Mrs B complained the Trust should have referred Mr C for a social care needs assessment, given his injury and that his arm was in a sling. She said that after he arrived home, he was not able to mobilise, manage with the sling, or dress himself.
32. Mr C needed to wear the sling at home until he had been reviewed at the outpatient clinic a week later. Therefore, it was likely he would have difficulty managing with washing and dressing during this period. The relevant guidance in place at this time was the policy referred to above in paragraph 13 ‘Hospital Discharge Service: Policy and Operating Model’. This guidance included four discharge pathways for patients (pathways 0-3). Mr C was discharged under pathway 0, which the guidance defines as “simple discharge, no formal input from health or social care needed once home”. The guidance says that people should be discharged under pathway 0 only if they are considered well enough to self-care on discharge home. Mrs B said Mr C could not get changed on his own, or remove his sling, once he was home. In its response to Mrs B’s complaint, the Trust accepted that Mr C was not taught how to remove his sling for washing and dressing as he should have been.
33. The Trust apologised to Mr C for not teaching him how to manage his sling for washing and dressing. It said it would give further training to staff to prevent recurrence. However, given that Mr C did not have the information about how to manage his sling, it is not clear how the Trust was satisfied that he would be able to care for himself at home. That should have been the case for patients discharged under Pathway 0, particularly as Mr C had previously had a care package at home which had stopped because of COVID-19.
34. Mrs B also raised her concerns about Mr C not being able to mobilise to reach the bathroom on his first night home from hospital. When Mr C was first assessed by the RRT on the day he went into hospital, the team contacted Mrs B and advised her to consider purchasing some urinal bottles for Mr C. They said RRT could also provide a commode for overnight use if required. However, there is nothing to indicate that a follow-up conversation was held with Mrs B before Mr C’s discharge from hospital, to check whether the family had purchased urinal bottles or whether a commode needed to be supplied on the day of discharge. The records state that on the day of discharge, Mr C had been walking independently to the toilet using a crutch, transferring on and off the toilet independently and self-managing his clothing prior to and after using the toilet. While this may have indicated he may not have needed the equipment at the time of discharge, this should have been followed up with his family, as they were going to be supporting him once he was home.
35. The Trust failed to have a follow-up conversation with Mrs B about whether urinal bottles or a commode might be needed. Had these been in place, it may have prevented Mr C’s distress and discomfort at not being able to get to the toilet the night he was discharged. I have made recommendations about this, below.

Pain relief

36. On arrival at hospital, the records indicate Mr C had been given intravenous paracetamol and intravenous morphine (a strong opioid painkiller used for moderate to severe pain) by the ambulance service prior to admission, and his pain score was recorded as 3 out of 10, indicating mild pain. Therefore, he was not given any further pain relief at the time of admission. Nursing observations were done that afternoon but no pain assessment or score were recorded. Later that afternoon, the RRT attended to review Mr C but were unable to carry out an assessment due to Mr C’s level of pain.
37. Entries in the nursing records indicate pain reviews took place, and pain relief medication was given as 1g of paracetamol orally four times per day. On the day of discharge, it is noted that Mr C was given pain relief and was “not in pain at present”. Later that morning, it is recorded that he was given further pain relief and was “pain free and settled”. Therapy notes made the same day record he was not in pain but was in some discomfort. A consultant reviewed Mr C that afternoon and noted he was “feeling much better – pain under control” and was medically fit for discharge.
38. Four days after Mr C was discharged from hospital, Mrs B telephoned the RRT. She said Mr C was still in pain, and requested pain relief for him, as he had been discharged with none. The Trust advised her to consult the out of hours GP or 111 service.
39. The records indicate Mr C’s pain was adequately assessed prior to discharge. There is nothing to indicate that he required strong opioid pain relief to take home with him, as it is documented that his pain was managed with the paracetamol he received during his in-patient stay. There is no indication that Mr C raised any concerns that he needed more pain relief on the day of discharge. However, there is nothing to indicate that nursing staff confirmed with him or his family that they had paracetamol to take when he arrived home, although the Trust would not be expected to supply this as national guidance recommends that over the counter medicines are supplied only in exceptional circumstances (NHS Improvement 2016, Rapid Improvement Guide to optimising medicines discharge to improve patient flow).
40. The Trust’s discharge policy includes information on what should be communicated to patients about medication, for example, who to contact, when they are discharged. The Hospital Discharge Service: Policy and Operating Model also says that at the time Mr C was in hospital, patients should have been given a leaflet entitled “Hospital Discharge Information”, explaining why they are being discharged home and what to expect, including contact details of who to speak to if with any concerns. However, I have seen no indication that the Trust gave this information leaflet to Mr C.
41. In its response to Mrs B’s complaint, the Trust acknowledged Mr C was discharged without pain relief, and gave a reasonable explanation for this based on the clinical records. There was no indication in the records that Mr C required further opioid-based analgesia, and that at the point of discharge it appeared that his pain was well-controlled.
42. I recognise that once at home, Mr C experienced increased pain, but this could not have been predicted at the time of discharge when his pain was noted to be well-managed. However, before Mr C was discharged from hospital, the Trust should have given him advice on who to contact should his pain worsen at home. The Trust accepted it did not give Mr C this information, and appropriately apologised for this. In its response to Mrs B’s complaint, the Trust said it would share feedback to staff that they should advise patients to contact their GP for pain management once home.

Care and support after discharge from hospital

43. As noted above, the Council was not involved during Mr C’s time in hospital, as he was discharged under Pathway 0 with no involvement from social care. In its response to Mrs B’s complaint, the Trust accepted it should have given contact details for the adult social care team should Mr C need them once he was home. The Trust said training would be given to staff on this issue.
44. Regarding the Council’s response to the complaint, the Council said Mr C would not have been eligible for rehabilitation, as his arm was still in a cast, and he would not have had rehabilitation potential until his cast had been removed. Based on the information I have seen, this was a reasonable response to Mrs B’s concerns that Mr C should have been offered rehabilitation when he was discharged.
45. The Council also said: “Any services arranged at this time would have been a chargeable service had a social care referral/assessment taken place”. However, had Mr C been referred to social care and discharged under Pathway 1 (able to return home with help from health/social care), care over and above the care package he had previously would have been funded for up to six weeks, through the extra government funding available for patients needing care on discharge from hospital. We are not able to say whether Mr C should have been discharged under Pathway 1, but the Trust’s failure to give him the information he should have had has added to the uncertainty around this.
46. The Council accepted it should have advised Mr C that once his sling was removed, he could have been reassessed to establish whether he could have accessed rehabilitation then. The Council also said it did not explain this to Mr C at the time because it was felt it would be too disruptive for him to have a change of carers to provide rehabilitation. Mrs B said this was not the case, and her father would have been happy to accept rehabilitation.
47. The Council also acknowledged it should have offered rehabilitation to Mr C once his sling was removed, so he could decide for himself what to do. The Council apologised and took steps to prevent recurrence by sharing learning from the complaint with staff. I am satisfied this was a reasonable response to this part of Mrs B’s complaint and therefore, I have not recommended further action on this point.
48. Regarding the time taken to arrange the care package, the records show that Mrs B first contacted the adult social care team two days after Mr C was discharged from hospital. She told them he was struggling to get up and not managing his personal care. A duty social worker rang Mrs B back the same day to discuss his specific needs. Mrs B said two care calls a day would probably be needed to help him with personal care and meal preparation. During this call, it was noted that Mrs B and her sister were helping Mr C with these tasks before and after work. Mrs B was advised that the case would be allocated to a social worker for assessment, but I have not seen anything in the notes to say that Mrs B was given a time frame for this.
49. Six days later, Mrs B contacted the Council again to find out what was happening. It is documented she was concerned as Mr C was unable to get out of bed, wash, or make meals, as he was still wearing a sling following his injury. Mrs B asked if a carer could be provided as soon as possible, as it was becoming difficult for her and her sister to provide this care because of their other family and work responsibilities. The case had not been allocated at that stage, and a more urgent allocation was requested. Mrs B was also given the number of the duty social work team to contact if needed.
50. The following day, the case was allocated for assessment, and the Council contacted Mrs B that day. Again, Mrs B told the Council it was difficult to manage supporting Mr C alongside their other work and family commitments.
51. The Council visited Mr C at home the next day to assess his needs. Mr C and his daughter (Mrs B’s sister) said that Mr C was still in pain and now had stronger pain relief, but he was still finding it difficult to move his arm and complete personal care tasks and meal preparation. The assessment found Mr C needed a package of care with two care calls per day.
52. Mr C’s daughter asked whether respite care would be best. The Council said any admission to a care home would be likely to involve a 14-day isolation period, owing to the COVID-19 rules in place at the time. It also said there were also likely to be restrictions on visits. It is noted that Mr C and his daughter both agreed that a package of care provided in his home would be their preferred option. Mrs B said her recollection was that the Council told them Mr C would be better at home, even though Mr C would have been happy to go a respite placement. Mr C’s daughter reiterated that she and Mrs B were struggling to provide support, but it is documented “family will continue to support until care is put in place”. In her comments on the draft decision, Mrs B said the family agreed to continue supporting Mr C because “there was no other choice”.
53. Four days after the assessment, Mrs B contacted the Council to ask whether a care package had yet been arranged, and was told that it had been requested to start within 48 hours of the assessment. A care package was confirmed the same day and started six days later.
54. The events complained of took place in September 2020, when restrictions relating to COVID-19 were still in place. However, LGSCO’s Guide to Good Administrative Practice during COVID-19 says Councils still had a duty to carry out an action as soon as reasonably practicable, having regard to the vulnerability and needs of the situation.
55. The Council provided details about the time taken to arrange Mr C’s care package. It said Mrs B first contacted them on a Thursday, and its next allocations meeting was not until the following Thursday. The request for care for Mr C was presented at this meeting. Although Mrs B had to follow this up in the meantime, I note the Council presented the case at the next available allocations meeting, and the home visit was carried out the next day, a Friday. The Council commissioned the care package the following Tuesday, but the provider was not able to start until six days later.
56. The Council said that at the time of the events complained of, it faced significant challenges to its ability to deliver services to the community. The Council explained this was because large numbers of staff had to self-isolate as a result of COVID-19. This applied not just to its own staff. Domiciliary care providers also faced a reduction in staff numbers because of the self-isolation rules, which the Council said was outside its control. The Council said the reduction in domiciliary care staff had a direct impact on its capacity to start new packages of care. Other factors cited by the Council as having an impact were an increased push to discharge patients from hospital, and admissions to care homes requiring a 14‑day isolation period and a negative COVID-19 test.
57. Section 10.84 of the Care and Support Statutory Guidance says “While there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion, proportionate to the needs to be met. Local authorities must ensure that sufficient time is taken to ensure the plan is appropriate to meet the needs in question, and is agreed by the person the plan is intended for. The planning process should not unduly delay needs being met”.
58. As noted above, in planning Mr C’s care, the Council presented his case at the first available allocations meeting after Mrs B first made contact with them. The Council then commissioned a domiciliary care package two working days after Mr C’s assessment. Based on this information from the Council, it did not unduly delay Mr C’s needs being met. Although it was a further six days before the provider could start, the Council said this was down to the pressures of COVID-19 on domiciliary care providers, as set out above, and a wider shortage of domiciliary care providers.
59. In view of the further information from the Council, I do not find fault with the Council for the time taken to arrange the care package.
60. However, I note that several times, Mrs B had to follow up with the Council to ask when the care package could be expected to start. In doing so, Mrs B explained she was struggling to provide the care Mr C needed. The LGSCO’s Guide to Good Administrative Practice during COVID-19 states that any new timescales should be clear to service users and staff. If it is going to take significantly longer than usual to put a service in place, it is important that this is communicated in a clear and realistic way to the service user.
61. I recognise the Council was experiencing significant challenges as a result of COVID‑19 at the time of the events complained of. However, the records do not show the Council explained to Mrs B that it was likely to take longer to put the care package in place as a result. As noted above, Mrs B had to contact the Council on further occasions to follow up and ask when the care package could be expected to start. If something is going to take significantly longer than it usually would, we would expect to see the Council had provided Mrs B with clear and realistic information about the likely timescale. However, the records indicate it did not do so. This breakdown in communication was fault.
62. Mrs B explained to the Council on several occasions that it was difficult for her to provide care because she was working full time and had other caring responsibilities. I found the lack of communication around when care could be expected to start caused injustice to Mrs B, by adding to her worry and uncertainty about when the situation would be resolved.

Summary

63. I found fault by the Trust in not ensuring Mr C had the information he needed to care for himself at home (lack of information about how to manage his sling, lack of follow up to ensure he had a commode and urinal bottles), when he was discharged under Pathway 0. There is not enough information for me to conclude whether Mr C was discharged on the correct pathway. However, the Trust has not shown how it was satisfied that he was able to care for himself and therefore suitable for Pathway 0, given he did not have all the relevant information about managing at home. There was also a lack of information about who to contact with any concerns once he was at home. While the Trust has taken steps to improve services by providing training, these failings caused avoidable distress to Mr C and Mrs B. The lack of follow up about a commode or urinal bottles also had an impact on Mr C’s dignity, as he was not able to mobilise to reach the bathroom on his first night home from hospital.
64. I also found fault by the Council in terms of the lack of communication about timescales for the care package to be put in place and Mrs B having to follow this up several times. I recognise the challenges the Council faced at the time because of COVID-19. However, the lack of communication about likely timescales meant Mrs B had to pursue this on several occasions, and caused her uncertainty and unnecessary stress.

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Agreed Actions

65. Within one month of my final decision statement, the Trust will:

• Apologise to Mr C and Mrs B for the lack of information provided to help Mr C manage on his return home, and for the impact of this;
• Pay Mr C £250 and Mrs B £250 in recognition of the distress this caused; and

Within three months of my final decision statement, the Trust will:

• take steps to prevent recurrence by reviewing relevant policies, and providing guidance or training to staff on communication with patients and their families/carers on discharge from hospital, to ensure people have the information they need on managing at home. The Trust will provide the Ombudsmen with evidence it has completed this work.

Within one month of my final decision statement, the Council will:

• Apologise to Mrs B for the lack of communication in arranging a care package for Mr C, and for the impact this had.
• Pay Mrs B £250 in recognition of the distress and uncertainty this caused.

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Final decision

66. For the reasons explained in the Analysis section, I have found fault with the Trust for a lack of information provided to Mr C and Mrs B on discharge, and with the Council for a lack of communication with Mrs B about timescales for arranging care. However, I did not find fault with the Trust for the therapy and pain assessments, or pain management while Mr B was in hospital; or with the Council for the time taken to arrange the care package.
67. The actions the Trust and Council have agreed to undertake represent a reasonable and proportionate remedy for the injustice caused to Mr C and Mrs B.
68. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman