Summary: We will not investigate this complaint about failure to provide free reablement care because there is not enough evidence of fault. The Council carried out a proper assessment of needs and explained the care was chargeable before the care started. The Council missed opportunities to explain why free care was not available in this case. But that is not significant enough to justify investigation and would not alter the outcome; the complainant received care which they must pay for.

The complaint

1. Ms B says the Council has charged her relative, Ms C, for care that should have been free after a hospital stay. Ms B also says the care was unsuitable. Ms B wants the Council to waive these charges.

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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 injustice is not significant enough 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))

3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)

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How I considered this complaint

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

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My assessment

6. Ms C had a hospital operation. The Council was then responsible to assess Ms C’s needs under the Care Act 2014 to decide what care and support she needed. When the Council assesses someone needs support it also must assess what, if anything, they can afford to pay toward that support.
7. Ms B cannot understand why the Council could not agree in advance some support for Ms C at home after her operation. But the Council cannot assess future needs, it must assess the persons needs at the relevant time.
8. The Council completed Ms C’s assessment of need while she was still in hospital. The Council involved Ms C and a relevant member of hospital staff in the assessment. The Council decided Ms C’s needs would be best met in a temporary residential placement. It telephoned Ms B and explained this and explained it would charge Ms C in full for the care because she had capital over the government’s upper capital limit, currently £23,250.
9. When the Council found a suitable placement, it spoke with Ms B again and confirmed the cost. So, before the care started the Council had explained the cost and that Ms C would be required to pay in full.
10. I can see in both telephone conversations Ms B raised that she thought the care should be free because Ms C was coming out of hospital. The Council missed opportunities here to explain why Ms C did not qualify for free care, it only told her to complain if she was unhappy about being charged. The Council later confirmed to Ms B in its response to her complaint the reason Ms C was not eligible.
11. The NHS and local authority may provide support that is free for up to six weeks after a hospital stay, but this is not an automatic entitlement following all hospital stays. The Council explains Ms C’s needs were too high to be safely met at home with free reablement support, and she needed a residential stay.
12. Ms B argues the placement was not suitable for Ms C. The Council made its decision on how to meet Ms C’s needs following an assessment completed with relevant people and by a suitable professional. The Council completed a review of the placement which found Ms C could then return home. The Council did not find the placement had not met Ms C’s eligible support needs. There is no reason for the Ombudsman to question or criticise the Council’s decision on how best to meet Ms C’s needs, even though Ms B disagrees.

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Final decision

13. We will not investigate Ms B’s complaint because there is not enough evidence of fault by the Council. It assessed Ms C’s care needs at the relevant time and followed a proper process. It told Ms B before the care started that it was chargeable, and that Ms C was required to pay the full cost. There is nothing to suggest Ms C was eligible for free reablement care. The Council missed opportunities to clarify to Ms B why reablement care was not available to Ms C, which may have avoided a complaint. But this does not cause a significant injustice to justify an investigation, and investigation would not reach a different outcome as Ms C received care which she must pay for.

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Investigator's decision on behalf of the Ombudsman