Summary: We will not investigate Ms X’s complaint about the Council charging for the first six weeks of Mr Y’s care home stay because there is insufficient evidence of fault to justify our involvement.

The complaint

1. Ms X complained the Council charged for the first six weeks of her father, Mr Y’s, care, which she understood would be free of charge because it was reablement support before deciding if he could return home.

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The Ombudsman’s role and powers

2. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
3. We cannot investigate the actions of bodies such as the National Health Service (NHS). (Local Government Act 1974, section 25, as amended)
4. 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
• we could not add to any previous investigation by the organization.

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

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How I considered this complaint

5. I considered information provided by Ms X and the Council.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

7. Mr Y was admitted to hospital in 2023. When he was medically fit for discharge, the hospital occupational therapist (OT) suggested Mr Y needed a care home with rehabilitation using the Discharge to Assess pathway. Under that process a setting would be arranged and funded by the Integrated Care Board (ICB).
8. Ms X said the hospital refused a request for rehabilitation in an NHS setting and she has made a separate complaint to the NHS about that. She also said the Discharge to Assess team told her there were no care homes that could provide the rehabilitation support Mr Y needed. She therefore found a care home herself.
9. The records show the hospital OT told the Council the family did not want to proceed with the Discharge to Assess pathway as they had already identified a care home for Mr Y.
10. Mr Y moved to the care home Ms X had identified on 26 May 2023. The Council invoiced Mr Y for his assessed contribution to the care home fees from that date. Ms X complained. The Council explained why Mr Y was not entitled to free care for six weeks and later agreed it would not pursue the family for the care home costs until a decision was made about whether Mr Y was eligible for NHS Continuing Healthcare funding.
11. If a care home had been arranged through the Discharge to Assess pathway, it would have been funded by the health body for the first six weeks. Although it is unclear whether the hospital OT explained the consequences of not using that process, this would not amount to fault by the Council since the hospital OT was not acting on its behalf when discussing that with the family. We cannot investigate complaints about the NHS as that is not a Council service.
12. In effect, the family arranged the care home itself and outside of the Discharge to Assess process. Therefore, the Council is entitled to use the date Mr Y moved to the care home as the start date for adult social care charges.
13. Therefore, we will not investigate further because there is insufficient evidence of fault and nothing we could add to the Council’s own investigation.

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Final decision

14. We will not investigate Ms X’s complaint because there is insufficient evidence of fault and nothing more we could add to the Council’s investigation.

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Investigator's decision on behalf of the Ombudsman