Summary: We will not investigate this complaint about failure to complete the checklist for NHS continuing healthcare funding. We have no powers to investigate NHS matters, so cannot achieve the wanted result of backdated NHS funding. It is also unlikely we would find enough evidence of fault in the Council’s decision not to complete a checklist.

The complaint

1. Ms B says the Council failed to complete a checklist for NHS funding to pay for Ms C’s care. Ms B wants care fees repaid as believes they 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
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is no worthwhile outcome achievable by our investigation.

(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. In late 2023 Ms C came home from hospital and has been paying privately for care support.
7. In September 2024 a checklist was completed to see whether Ms C might be eligible for full assessment for the NHS to fund her care. Ms B now says the Council should have done this sooner, and if it had the NHS would have paid for Ms C’s care. Ms B therefore wants a refund of the money Ms C paid.
8. Neither the Council nor the Ombudsman could say whether Ms C was eligible for NHS continuing healthcare funding earlier than September 2024. We therefore cannot achieve the outcome Ms B seeks. Ms B can apply retrospectively to the NHS for continuing healthcare funding, and if awarded and backdated that will achieve the outcome she wants.
9. The Council is not the only body who can complete the NHS checklist for continuing healthcare. The Council says there was nothing to suggest Ms C had a primary health need and that it needed to complete a checklist. Ms C came out of hospital and was visited by district nurses at home, and none of the professionals involved suggested a checklist might be needed over this time. It is unlikely the Ombudsman would find evidence of fault in the Council’s decision not to complete a checklist. But, as explained above, the claimed injustice and the outcome sought is not an outcome the Ombudsman can achieve.
10. Any failure by the Council to record reasons not to complete the checklist does not cause a significant injustice that would justify an Ombudsman investigation.

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Final decision

11. We will not investigate Ms B’s complaint because we cannot achieve the outcome she seeks of a back payment of continuing healthcare funding, that is a decision for the NHS.

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Investigator's decision on behalf of the Ombudsman