Summary: We will not investigate this complaint about how the Care Provider treated Funded Nursing Care in relation to care charges. Any injustice is not significant enough to justify our involvement.

The complaint

1. Mr X complained a Care Provider did not deduct Funded Nursing Care (FNC) from his father, Mr Y’s care bills. He said his father’s income no longer covered his care fees which has caused much stress to Mr Y and the family. Mr X would like FNC funding to be deducted from his father’s care fees and alter terms in their contracts which are unfair according to Competition and Markets Authority (CMA) guidance.

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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:
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)

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How I considered this complaint

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

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My assessment

6. Mr Y is a resident at a care home run by the Care Provider. The care home provides both residential and nursing care. When Mr Y moved into the home, he required residential care.
7. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. If a person does not qualify for NHS Continuing Healthcare, the need for care from a registered nurse must be determined. If the person has such a need and it is determined their overall needs would be most appropriately met in a care home providing nursing care, then this would lead to eligibility for NHS-Funded Nursing Care.
8. In early 2025 Mr Y was awarded FNC by the NHS. Mr Y’s fees were also increased by 10%. Mr X asked the Care Provider to deduct the FNC funding from Mr Y’s care fees.
9. The Care Provider told Mr X the care home fees did not include clinical staff or equipment and the FNC was used to fund nursing care for Mr Y. It said that
   Mr Y’s contract was clear there were residential care fees, plus FNC where applicable. Therefore, the FNC funding would not be deducted from Mr Y’s care fees.
10. The Competition and Markets Authority (CMA) has issued guidance clarifying that terms related to FNC must be clear about how such payments affect the residents’ overall fees. In this case, Mr Y’s contract states that FNC funding is in addition to the residential care fees.
11. If we were to investigate this complaint, we may have found fault in the terms of Mr Y’s contract because it does not state what services Mr Y’s contribution pays for, and what is covered by FNC. Additionally, while the contract states that fees will increase yearly, there is no reference to how an increase is calculated. However, we could not conclude based on this that Mr Y should be paying less for his care, so any fault was not the cause of the injustice Mr X claims.
12. We will not investigate this complaint because any injustice to Mr Y is not significant enough to justify our involvement. While the terms of the care home contract might be unclear about FNC and annual fee increases, Mr Y would still be paying the same amount but for any fault.
13. The LGSCO can interpret contracts on an ordinary reading; we can examine how it appears to the reasonable member of the public. Any question of whether there is a breach of contract is a matter for the courts.

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Final decision

14. We will not investigate Mr X’s complaint because any injustice is not significant enough to justify our involvement.

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Investigator's decision on behalf of the Ombudsman