Summary: We will not investigate Ms X’s complaint the Council charged her late mother for her care placement. This is because there is insufficient evidence of fault by the Council to warrant an investigation.

The complaint

1. Ms X complained the Council charged her mother, Mrs Y, fees for her care home costs after she was discharged from hospital. She said she wants the care home fees refunded.

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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. (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.
5. I considered the National framework for NHS continuing healthcare and NHS-funded nursing care.

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My assessment

6. In March 2024, Mrs Y was discharged from hospital. As part of this process, relevant professionals completed a discharge assessment and decided that Mrs Y was not eligible for NHS Continuining Healthcare (NHS CHC).
7. NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
8. Integrated Care Boards (ICB) have formal responsibility for informing individuals about eligibility for NHS CHC and of their right to request a review of any decisions.
9. As Mrs Y was not eligible for full NHS-funded care, the Council charged her for care home fees in-line with its social care charging policy.
10. Ms X complained to us on behalf of Mrs Y. She said the Council should have disputed the NHS CHC decision and tried to seek costs from the NHS, instead of from Mrs Y.
11. We will not investigate Ms X’s complaint the Council did not participate in Mrs Y’s discharge process. Ms X states in her complaint to us the Council attended discharge assessments and meetings. Therefore, it is unlikely we would find fault by the Council.
12. Nor will we investigate Ms X’s complaint the Council charged Mrs Y for care home fees. Once the ICB decided she was not eligible for a care package arranged by health services, the Council arranged social care for her. There is no evidence of fault by the Council for charging Mrs Y for social care in line with its policy. It was not the responsibility of the Council to ask the ICB to review its decision.

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Ms X Final decision

13. We will not investigate Ms X’s complaint because there is not enough evidence of fault by the Council to warrant investigation.

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Investigator's decision on behalf of the Ombudsman