Summary: We will not investigate this complaint about funding for adult social care. There is not enough evidence of fault to justify investigating. It is unlikely the Ombudsman could add to the Council’s investigation or reach a different outcome.

The complaint

1. Mr B says his relative, Ms C, was told many times she would receive six weeks of funded care, but that has not happened. This has caused stress and financial pressure. Mr B wants the Council to waive all charges for the first six weeks of care.

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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 impact 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 or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused significant enough injustice to the person who complained to justify our involvement, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

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

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My assessment

5. Intermediate care (sometimes called reablement) is a free short-term service to help people get back to normal and stay independent after a hospital stay, illness or a fall. It is available for up to six weeks for those who are assessed as needing it. Many people do not need this care or return to their normal ability quicker than six weeks and no longer need this service. If the person then needs long term care that is a chargeable service and the Council will assess what, if anything, the person can afford to pay for their care.
6. Ms C received intermediate care in a care home when she left hospital. Mr B says he was told by both NHS and Council staff the care was free for six weeks. So, when Ms C returned home after two and a half weeks in the care home, Mr B thought she would still receive another three and a half weeks of funded care before Ms C would need to contribute.
7. The Council’s records show it discussed with Ms C and another relative before Ms C returned home, that when she did so she would need a package of care which would be a chargeable service. The Council told Ms C a financial assessment would find out how much she needed to pay. Mr B disputes this, but the Ombudsman would have no reason not to rely on the Council’s contemporaneous records as relevant evidence. The Council also sent information through the post about charging for care.
8. While Mr B may not have realised Ms C would not still receive a full six weeks of funded care, I cannot say that misunderstanding is caused by any fault of the Council. Ms C has received care which the Council has assessed she can afford to pay toward, and there is no fault in the Council charging for this service.
9. The Council has given a thorough response to Mr B’s complaint and apologised he had to complain. The relevant NHS body has committed to remind staff of the funding rules for intermediate care.

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Final decision

10. We will not investigate Mr B’s complaint because there is not enough evidence of fault to justify investigating. Even if there was some failure in the early information given about care funding, this was corrected before the chargeable service started so has not caused a financial injustice. The Ombudsman has no jurisdiction over NHS staff, and the Council told Ms C before she returned home that when she did the care was chargeable. Ms C has received care which she was told she would need to pay for and has been charged as such. It is unlikely an Ombudsman investigation could add to the Council’s investigation or reach a different outcome.

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Investigator's decision on behalf of the Ombudsman