Summary: There was fault by the Council. The Council delayed assessing Mrs X’s care needs, did not ask the NHS to reinstate funding until the assessments were complete and did not tell Mr X of the exact financial contribution his wife would need to make towards care costs for over 6 months. This caused Mr X avoidable stress and worry, although Mrs X stayed in her care home throughout. A payment of £500, along with waiving the financial contribution for 3 months, remedies the injustice from the Council’s actions.

The complaint

1. The complainant, who I shall call Mr X, complains for his wife. He complains the Council failed to ensure the Clinical Commissioning Group (CCG) continued to fund his wife’s care until alternative arrangements were in place. He also complains the Council delayed assessing Mrs X’s needs, producing a care plan and agreeing to fund her care.
2. Mr X says that he has been caused stress and worry, and does not agree they should have to contribute towards the costs of Mrs X’s care.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. If we are satisfied with an organisation’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

5. I read the papers put in by Mr X and discussed the complaint with him.
6. I considered the Council’s comments about the complaint and any supporting documents it provided.
7. Mr X and the organisation 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

8. The Care Act 2014 provides a single legal framework for charging for care and support under sections 14 and 17. It enables a council to decide whether to charge a person when it is arranging to meet a person’s care and support needs, or a carer’s support needs. The charging rules for residential care are in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
9. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care.

NHS Continuing Healthcare (CHC) Assessments

10. NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
11. Individuals may need care and support provided by their local council and/or services arranged by CCGs. Councils and CCGs therefore have a responsibility to ensure the assessment of eligibility for care and support and for CHC respectively take place in a timely and consistent manner. If, following an assessment, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person’s health needs, either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both a council and a CCG, this is known as a ‘joint package of care’. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a council to meet.
12. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman (PHSO).

Key facts

13. Mr X’s wife is in a residential care home, which was funded under CHC. In August 2020 the CCG decided that she was no longer eligible for CHC.
14. The CCG wrote to the Council to say it would end its funding of Mrs X’s care on 8 October 2020.
15. The Council has accepted it was at fault in how it handled matters surrounding Mrs X’s financial assessment once it was notified the CHC funding ended. The Council says it:
• Delayed assessing Mrs X’s needs.
• Did not ask the CCG to reinstate funding until the assessments were completed.
• Did not tell Mr X of the exact financial contribution his wife would need to make towards care costs until 20 April 2020.
16. The Council accepts that this caused injustice to Mr X. He was caused avoidable stress and worry between October 2020 and February 2021 when the funding for Mrs X‘s care was not arranged. Mrs X did remain in the same care home, who continued to care for her, until the Council paid the care home.
17. The Council has said that it told Mr X in a telephone call on 10 December 2020 that ‘all adults are financially assessed to determine how much an adult has to pay towards their care and support’. The Council also sent Mr X a leaflet on charging for residential and nursing care.
18. On 20 April 2021 the Council wrote to Mr X to say the financial assessment had determined that Mrs X would need to pay £148 per week from 8 October 2020. After a letter from Mr X’s MP, the Council said Mr X did not have to pay from 8 October to 10 December 2020 (£1418) as there was no evidence the Council had told him about the charge during this time.
19. The Council has said that Mr X has not contributed towards care home costs. Mr X has complained to the PHSO about the CCG’s decision to stop CHC funding.

My Analysis

20. The Council has accepted it was at fault. My role is to decide a suitable remedy for the injustice resulting from the Council’s fault.
21. Mr X has explained that he wants the CCG to restore funding for his wife’s care. This is not in the Council’s power to do, as it is the CCG that decides this. Mr X’s is challenging the CCG’s decision by complaining to the PHSO.
22. Mrs X has remained in her care home throughout and the Council has now paid the care home. So, her care has been consistent.
23. There has been injustice to Mr X. The Council’s faults caused him avoidable stress and worry. I consider that a payment of £500 to Mr X remedies this injustice.
24. The Council has already waived the financial contribution towards Mrs X’s care from 8 October 2020 until 10 December 2020. This was the date the Council told Mr X that they would need to contribute financially towards Mrs X’s care. However, Mr X was not aware of the exact charge until 20 April 2021. After this date, the Council told Mr X of the financial contribution calculated after a financial assessment. According to the Care Act, the Council is entitled to charge a contribution towards Mrs X’s care.
25. I considered whether the Council should waive the charge from 10 December 2020 until 20 April 2021. The Council’s view is that it was not appropriate for the Council to waive these charges as Mr X was aware that a charge would be made and could have put aside money for this from December.
26. As the Council has already waived three months of the financial contribution and will make a payment towards Mr X’s avoidable stress and worry, I do not consider the Council should waive the financial contribution from December to April. Although the Council delayed the financial assessment, Mr X knew there was going to be a charge. I am not persuaded the Council should waive any further contributions

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Agreed action

27. The Council should pay Mr X £500 towards his avoidable stress and worry within one month of the date of the decision on this complaint.
28. The Council should waive the financial contribution towards care charges from 8 October until 10 December 2020. (The Council completed this part of the remedy before the complaint was investigated by the Ombudsman.)

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Final decision

29. I have completed my investigation of this complaint. This complaint is upheld, as there was fault by the Council which caused injustice to Mr X. The payment to Mr X remedies the injustice caused by the Council’s fault.

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Investigator's decision on behalf of the Ombudsman