Summary: We will not investigate Mr X’s complaint about charges for his mother’s care home stay because there is insufficient evidence of fault by the Council to justify our involvement..

The complaint

1. Mr X complained the Council charged his mother for a reablement package following a discharge from hospital. He said he was not told there would be a charge and reablement after hospital stays had previously been free for the first six weeks. He said the Council had initially paid the care home, but later recovered the money paid, following which the care home sent an invoice.

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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 investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as health bodies. (Local Government Act 1974, sections 25 and 34(1), 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.

(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 Mr X and the Council.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

What happened

7. Mr X’s mother, Mrs Y, spent some time in hospital in late 2022, following which she had a period of reablement care, which was funded by the health body under the Discharge to Assess process. Mrs Y returned home in early November, but the Council said it was not informed. This meant it did not record an end date for the Discharge to Assess process, nor did it review Mrs Y’s care needs.
8. Mrs Y had a further hospital stay in March 2023. Mr X complained there was no contact from the Council before Mrs Y was discharged from hospital and it did not offer care at home.
9. Council records indicate the hospital discharge team initially asked the Council to arrange a care package at home, but later informed the Council Mrs Y would be privately funding a residential care placement.
10. In mid May, Mr X spoke to the Council. He said Mrs Y would need a care package on her return home. He confirmed Mrs Y had capital over £23,250. The Council said that because Mrs Y was paying for her own care, he could arrange a care package without its involvement. Mr X said Mrs Y had not had the option to return home when discharged from hospital and the Council confirmed its record said Mrs Y had chosen to move to the care home and agreed to pay for this herself.
11. In late May, Mr X told the Council Mrs Y had returned home and he had arranged a care package. The Council advised him to contact it if Mrs Y’s capital fell below the capital threshold to request a financial assessment.
12. In June 2023, the hospital discharged team confirmed the Discharge to Assess funding dates, following which the Council updated its records.
13. In November 2023, the care home contacted Mr X about the cost of Mrs Y’s stay in April and May that year. In its complaint response, the Council said it had spoken to the care home manager, who understood Mrs Y was paying privately but the care home had not sent an invoice because the Discharge to Assess funding was still “live” on the system during Mrs Y’s stay.
14. Mr X said he tried to resolve the matter informally with the Council but was unable to do so. He made a formal complaint in late April 2024 and the Council responded in late June.

My assessment

15. The Council did not amend its records in November 2022 when Mrs Y returned home. Although this led to a delay in the care home sending an invoice for the costs of Mrs Y’s care home stay, this was not due to fault by the Council because it was not told Mrs Y had returned home. We will not investigate this complaint further because there is insufficient evidence of fault.
16. In April 2023, the Council was told Mrs Y had chosen to be discharged from hospital to a care home and had agreed to pay privately. Since this was a private arrangement, the Council did not need to get involved. We will not investigate this complaint further because there is insufficient evidence of fault. And we cannot investigate the actions of the health body in relation to the hospital discharge because we have no remit over health bodies.
17. The Council correctly advised Mr X that, because Mrs Y had capital over £23,250, she would need to pay for the full cost of her care and that he should contact it to request a financial assessment if her capital fell below that amount.
18. Although there was a delay by the Council in responding to the complaint, we do not investigate complaints handling unless we are investigating the underlying matter.

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Final decision

19. We will not investigate Mr X’s complaint about charges for his mother’s care home stay because there is insufficient evidence of fault by the Council to justify our involvement.

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Investigator's decision on behalf of the Ombudsman