Summary: We will not investigate this complaint about charging for residential adult social care. There is not enough evidence of fault in the Council charging for care which Ms C received and was told she would need to pay for. The delay in billing does not mean the charges are not due. There is not a significant enough injustice caused by delays to justify an Ombudsman investigation.

The complaint

1. Ms B says the Council has wrongly charged her relative, Ms C, for two weeks of residential respite care. Ms B says the Council failed to respond to her complaint when she asked it to look at the case again. Having not heard anything Ms B thought the matter was resolved, until she received an invoice several years later. This came as a shock and she does not think Ms C should have to pay and also believes the care should have been funded by the NHS.

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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))

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How I considered this complaint

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

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My assessment

5. Ms C left hospital under the ‘Discharge to Assess’ model. So, Ms C temporarily went to a residential care home to have her long-term care needs assessed. The Council assessed Ms C needed residential care, so returning to live in her own home would not be a safe option.
6. The Council had a telephone conversation with Ms B in which it explained Ms C’s residential care was funded for the first four weeks, after which it would charge for the placement. Ms B confirmed that Ms C would be responsible to fund the full cost of her placement.
7. After the first four weeks the Council has charged Ms C for a further two weeks that she stayed in the residential care home, before she moved to a care home arranged by Ms B. There is no evidence of fault by the Council in making this charge for care which Ms C received and was told she would be charged for. Had Ms C moved anywhere else, she would also be paying for that care.
8. There was a delay of several years by the Council before it chased for payment. But that delay does not mean the charges are not still due. It would come as a shock receiving an invoice after so long, but that shock does not in itself justify an Ombudsman investigation.
9. The Council also failed to send a complaint response it had drafted. But it is not a good use of public resources to look at the Council’s complaints handling if we are not going to look at the substantive issue complained about. We will not therefore investigate this issue separately.
10. Ms B believes Ms C should have received NHS funding. Ms B can apply for this retrospectively, but that does not prevent the Council from invoicing for the care it provided. If the NHS decides to fund Ms C’s care, then the Council can refund any overpayment caused by backdated NHS funding. Given the NHS was involved with the hospital discharge, there is no evidence of fault by the Council not applying for NHS funding because the NHS should have considered if it was appropriate.

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Final decision

11. We will not investigate Ms B’s complaint because there is not enough evidence of fault casing a significant enough injustice to justify an Ombudsman investigation. The Council told Ms B about charging for residential care and has charged accordingly. The impact of the delayed billing and failures in complaint handling do not justify an Ombudsman investigation.

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Investigator's decision on behalf of the Ombudsman