Summary: We will not investigate Mrs X’s complaint about care charges for her relative, Mr Y. An investigation would be unlikely to lead to a different outcome.

The complaint

1. Mrs X complains the Care Provider has refused to reduce her relative, Mr Y’s care fees despite him recently being awarded Funded Nursing Care (FNC). She says this has caused distress and financial loss. She wants the Care Provider to deduct the FNC contribution from Mr Y’s care fees.

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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 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 Care Provider.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. Mr Y is a resident in a care home run by the Care Provider. The care home provides both residential and nursing care. At the time of admission, Mr Y was admitted as a residential care resident and was charged accordingly at the residential care rate.
6. In early 2025, Mr Y was awarded Funding Nursing Care (FNC) by the NHS. Mrs X asked the Care Provider to deduct the amount from Mr Y’s care fees. However, the Care Provider reviewed Mr Y’s needs and increased his care level to nursing care, leading to an increase in his care fees. So despite Mr Y receiving the FNC contribution, Mr Y’s care fees increased.
7. Mrs X complained to the Care Provider. She said that despite the FNC award, Mr Y’s care needs had not changed and so his care level and charges should remain at the residential rate. She asked the Care Provider to reinstate his residential care level and residential charges. The Care Provider did not agree to this so Mrs X brought the complaint to us.
8. Since bringing her complaint to us, the Care Provider has agreed to reinstate the residential care fee rate for Mr Y deduct the FNC contribution from his care fees. This is the outcome Mrs X was seeking.
9. We will not investigate this complaint. We do not investigate all complaints brought to us and are less likely to investigate where an investigation would be unlikely to achieve a significantly different result. Although I accept this matter is likely to have caused Mrs X distress, the Care Provider has now agreed to her request. We will not investigate as it is unlikely an investigation would lead to a different outcome.

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Final decision

10. We will not investigate Mrs X’s complaint because it is unlikely an investigation would lead to a different outcome.

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Investigator's decision on behalf of the Ombudsman