Summary: We will not investigate this complaint about the Council charging Mr C for care he received on discharge from hospital in 2022. This is because further investigation by us could not add to the Council’s response.

The complaint

1. Mrs B complained she was told her husband’s care would be free of charge for the first 4 weeks following discharge from hospital in May 2022. Mrs C says the funding pathways were very confusing, and she only knew about having to pay for care when she received an invoice for over £14, 000 in November 2023. Mrs C says the Council and the hospital submitted a wrong Continuing Health Care (CHC) checklist and should agree to pay for Mr C’s care between 8 May and 27 July 2022.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start an investigation if we decide the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. The Council’s case notes from 13 April 2022 record a telephone call to Mrs C explaining Discharge to Assess (D2A) funding for the first 4 weeks followed by a financial assessment. A further telephone call to Mrs C on 27 April 2022 records Mr C is not going to be discharged to assess and will have to be financially assessed to see if he should pay or contribute towards his care on discharge from hospital. The record states it will wait for an assessment from the care home then complete a financial assessment for funding. A letter sent dated 18 May 2022 enclosed a financial assessment form for Mrs C to complete. Further investigation by us could not add to this or make a different finding of the kind Mrs C wants.
6. While Mrs C initially believed the first 4 weeks of Mr C’s care on discharge from hospital would be free of charge, she knew following the telephone call on 27 April that it would not. The record acknowledges Mrs C was upset and angry and felt they were missing out on funding. It records Mrs C wanted a CHC assessment for Mr C as she had been told he would get healthcare funding. The Council explained this was not being looked at by the hospital and will need to be explored in the community if it is found Mr C had healthcare needs. Mr C was discharged from hospital on 7 May 2022.
7. Mr C was assessed for CHC funding in July 2022. The NHS confirmed Mr C was not eligible for CHC funding but was eligible for Funded Nursing Care (FNC) from June 2022.
8. FNC is usually a payment made directly to a care provider by the NHS for providing some health care. It is not an administrative function of the Council to decide whether a person is eligible for CHC funding, nor can the Council decide not to provide CHC funding. In the absence of evidence from the NHS confirming Mr C was eligible for CHC funding between May and July 2022, there is no fault with the Council for charging Mr C for care it provided during this period. If Mrs C has evidence that Mr C would have been eligible for CHC funding between the dates she disputes she can ask the NHS to consider a retrospective application.

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Final decision

9. We will not investigate Mrs C’s complaint because we could not add to the Council’s response or make a different finding even if we investigated.

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Investigator's decision on behalf of the Ombudsman