Summary: The Council was not at fault for charging Ms B for her care from the day she returned home from hospital. It was entitled to do so under the Care Act. Ms B did not receive a period of free care under the government’s ‘discharge to assess’ scheme because her needs had already been assessed and planned for before she left hospital.

The complaint

1. The complainant, whom I refer to as Mr C, complains on behalf of his late aunt, whom I refer to as Ms B.
2. Mr C says that, after Ms B was discharged from hospital in January 2022, government guidance said the Council should not have charged her for new care she received for up to six weeks after she returned home. He complains that the Council charged her for care during that six-week period.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. 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

4. I considered information from Mr C and the Council, including Ms B’s social care documents and Mr C’s complaints.
5. I considered councils’ entitlement to charge for care under the Care Act 2014.
6. I considered the government guidance document, ‘Hospital discharge service: policy and operating model’.
7. I considered the Council’s own hospital discharge procedure for the period in question.
8. Mr C 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

Law and guidance

The Care Act 2014

9. Under sections 14 and 17 of the Care Act, councils have the duty to arrange care and support for those with eligible needs, and the power to meet those needs in places other than care homes (such as at a person’s home). Councils can choose to charge for non-residential care following a person’s needs assessment.

Government guidance: ‘Hospital discharge service: policy and operating model’

10. The government hospital discharge guidance – which was in force between September 2020 and March 2022 – was built around the ‘discharge to assess’ model. It set out how hospitals, councils and others were to deal with people who no longer met the government’s updated ‘criteria to reside in hospital’ – in short, people who did not need to be there.
11. The model applied to four groups of people – one of which was people who needed “support to recover at home; [and were] able to return home with support from health and/or social care” (which applied to Ms B).
12. The Government agreed to provide funding to cover the costs of additional care and support for all individuals on discharge from hospital (where required). This allowed councils to put post-discharge recovery and support services in place while they conducted assessments of ongoing care needs and financial eligibility.
13. This meant people did not have to wait in hospital for social care needs assessments to take place.
14. Under the provisions of this scheme, additional costs of post-discharge recovery and support services were funded until the person’s long-term care needs were assessed, up to a maximum of six weeks.
15. The government funding did not pay for:
• Long term care needs following completion of a Care Act assessment.
• Pre-existing (planned) council expenditure on discharge services.

The Council’s hospital discharge procedure

16. The Council’s own procedure – which also expired in March 2022 – set out how it would meet the requirements of the government guidance. It did not vary substantively from the guidance, other than to limit the duration of post-discharge funding to four weeks for people who needed social care support to return home.

What happened

17. Ms B was admitted to hospital in December 2021 after a fall. She previously had no care and support services in place at home. The hospital told the Council she was not medically fit for discharge.
18. The Council held a meeting at the hospital in January 2022 with Ms B and Mr C. At that point Ms B remained not medically fit for discharge. Ms B agreed to a package of care when she returned home.
19. The Council completed a Care Act assessment on the same day. It recorded that Ms B’s condition meant intermediate care was not appropriate – longer-term care was required.

20. The Council said it had:

Informed [Ms B and Mr C] that [Ms B] would have a financial assessment and depending on the outcome of this assessment may have to pay/contribute towards the cost of the care she receives.

21. Ms B’s social worker then referred her to the Council’s financial assessment team. He said, “[Ms B] is being discharged from hospital with a care package. Please liaise with [Mr C] regarding assessment”.
22. Ms B was discharged from hospital at the end of January. Her care package started the same day and continued beyond her first review in March, when she said she was happy with the care provided.
23. The Council told Mr C that Ms B would have to pay for her care from the day she returned home. Although he complained about this – and referred to the government guidance – the Council did not change its mind. It said all packages of care were subject to financial assessment.

My findings

24. The government’s hospital discharge guidance, based around the ‘discharge to assess’ model, was designed to provide councils with a platform to deliver short-term care for people at home while assessing their needs. This meant people no longer had to wait unnecessarily for assessments in hospital. The guidance was withdrawn in March 2022 but was still in force when Ms B was discharged.
25. Mr C feels Ms B’s care should have been free for up to six weeks after her discharge from hospital, because this was the period of free care allowed by the guidance.
26. However, the purpose of the government scheme was to pay for councils to deliver support before an assessment had been completed. The guidance said funding would not be paid either when support services were planned pre-discharge or when the support was needed for long-term care needs following completion of a Care Act assessment.
27. Both of these things applied to Ms B, for whom the Council completed an assessment a week before she returned home. Her needs had been identified and a long-term package of care arranged before she left the hospital.
28. This means the Council was not at fault for charging Ms B for her care, in line the Care Act, from the day she returned home.

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Final decision

29. The Council was not at fault for charging Ms B for her care from the day she returned home from hospital.

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Investigator's decision on behalf of the Ombudsman