Summary: We will not investigate this complaint about whether Ms C’s son may have been eligible for healthcare funding sooner if the Council had contacted the health authority before it did. The local health authority is responsible for considering eligibility for healthcare funding for past periods of care where an individual has not been assessed. The health authority is better placed to consider the period of care in dispute.

The complaint

1. Ms C complains the Council should have completed a continuing healthcare checklist sooner so her son could be considered for healthcare funding by the local health authority. She says because the Council failed to do this when her family moved to its area her son lost out on care, and he had to contribute his care costs. Ms C says as well as the impact on her son the situation also impacted adversely on her mental wellbeing. As an outcome Ms C wants the Council to refund all contributions to care her son paid. Ms C also seeks a financial remedy for the impact the events had on her mental wellbeing and time taken to pursue the complaint.

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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:

• 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 another body better placed to consider this complaint.

(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’s son received care and support from the Council in the form of direct payments. Direct payments are cash payments the Council makes to individuals to allow them to arrange and pay for their care and support to meet assessed eligible needs.
6. Ms C complained to the Council as she felt the Council was not allowing her son to use direct payments flexibly. She also complained about other matters including questioning why the Council had not referred her son to the health authority sooner so the health authority could have considered his eligibility for healthcare funding.
7. The Council replied to the complaint and accepted direct payments are intended to be used flexibly. It said it did have to apply some boundaries to how direct payments could be used to ensure fairness for its residents. The Council apologised as it found it had delayed responding to Ms C’s request to use direct payments for a break for her and her son. We cannot add to the previous investigation.
8. The Council said when it completed a reassessment of Ms C’s son needs the assessment did not indicate it should make a referral to the health authority so it could consider healthcare funding. Following further discussion with Ms C the Council completed a healthcare funding checklist which led to a full assessment by the health authority. Ms C’s son then became eligible for healthcare funding.
9. We will not investigate this complaint about whether Ms C’s son may have been eligible for healthcare funding sooner. The Council cannot decide whether a person is eligible for healthcare funding. The relevant health authority known as the Integrated Care Board (ICB) is responsible for assessing and deciding whether a person is eligible for healthcare funding.
10. If Ms C believes her son may have been eligible for healthcare funding when he moved to the Council’s area, she can ask the ICB to complete a previously unassessed period of care assessment which is commonly called a retrospective review. We cannot achieve the outcome Ms C wants. The ICB is better placed to consider this matter.

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Final decision

11. We will not investigate Ms C’s complaint because the health authority is better placed to consider whether her son may have been eligible for health funding sooner.

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Investigator's decision on behalf of the Ombudsman