Summary: Mr Y complained about the Council’s actions following his father’s (Mr X) discharge from hospital. Mr Y said the Council delayed Continuing Healthcare assessment, unlawfully charged for care services provided to Mr X, failed to reassess Mr X’s needs, failed to communicate with him and mishandled his complaint. We found fault with the delay in sending information needed for the Continuing Healthcare assessment and with the Council’s complaint handling. The Council’s fault caused injustice to Mr X and Mr Y. The Council has agreed to apologise, make a symbolic distress payment and carry out some staff training.

The complaint

1. Mr Y complains about:
• delays in his father’s (Mr X) Continuing Healthcare (CHC) process;
• carrying out Mr X’s financial assessment and issuing care charges during a CHC assessment;
• failure to reassess Mr X’s needs;
• poor communication;
• poor complaint handling.
2. Mr Y says the Council’s failings caused Mr X confusion and anxiety, resulting in the decline of his mental and physical well-being. Mr Y, as Mr X’s full-time carer and representative, for months struggled with the administrative burden. Fear of debt and stress affected Mr Y’s sleep and caused mental exhaustion. Mr Y spent much time contacting various teams of the Council.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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What I have and have not investigated

5. I have investigated only the Council’s actions. We do not have jurisdiction to investigate the Integrated Care Boards (ICB) or any other National Healthcare Service (NHS) bodies.

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How I considered this complaint

6. I considered evidence provided by Mr Y and the Council as well as relevant law, policy and guidance.
7. Mr Y and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Legal and administrative framework

Intermediate care

8. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Councils’ statutory duties

9. The Care Act 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 (Regulations) provide details of councils’ duties towards their residents with eligible social care needs and rules for charging for the services provided.
10. When exercising their social care functions councils must follow the Care and Support Statutory guidance (Statutory Guidance) issued by the Department of Health and Social Care, which is based on the Care Act 2014, unless they have very good reasons not to. They should also follow the Regulations.

Financial assessments

11. Where a local authority has decided to charge, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. This could be provided alongside a person’s care and support plan or separately, including via online means. (Care and Support statutory guidance paragraph 8.16)
12. Financial information and advice is fundamental to enabling people to make well-informed choices about how they pay for their care. The local authority service should include the following aspects of financial information and advice:
• understanding care charges;
• ways to pay;
• money management;
• making informed financial decisions;
• facilitating access to independent financial information and advice; and
• the cap on care costs, when preparing for its introduction in 2020 (Care and Support statutory guidance paragraphs 3.36 and 3.41)
13. Councils should ensure that information supplied is clear. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. Information and advice provided within the service should be accurate, up-to-date and consistent with other sources of information and advice. (Care and Support statutory guidance paragraphs 3.19 and 3.20)

Continuing Health Care

14. An individual should not be left without appropriate support while they await the outcome of the assessment and decision-making process. A person only becomes eligible for NHS Continuing Healthcare once a decision on eligibility has been made by the ICB. Prior to that decision being made, any existing arrangements for the provision and funding of care should continue, unless there is an urgent need for adjustment. If, at the time of referral for an NHS Continuing Healthcare assessment, the individual is already receiving an ongoing care package (however funded) then those arrangements should continue until the ICB makes its decision on eligibility for NHS Continuing Healthcare, subject to any urgent adjustments needed to meet the changed needs of the individual. (National Framework for NHS Continuing Healthcare and NHS funded Nursing Care, paragraph 135)
15. If the individual is known to a health or social care practitioner, they could ask that practitioner to complete a checklist. Alternatively, they should contact their ICB NHS continuing healthcare team to ask for someone to visit to complete the checklist, or if they already have a care home or support provider, they could ask them to contact the ICB on their behalf.

Adult Social Care complaints

16. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 sets out the process local councils and health care services must follow when responding to certain complaints.
17. The adult social care complaints process consists of a single stage. After the council has issued a decision complainants can come to the LGSCO without having to escalate their complaint further through the council’s processes.
18. The Council must acknowledge all complaints within 3 working days of their receipt. At the time of acknowledgement the council must offer to discuss the following with the complainant:
• how the complaint will be handled; and
• how long it will take to investigate and respond to the complaint.
19. If the complainant does not accept the offer of a discussion the council must tell them, in writing, of how long it will take to respond to the complaint.
20. The council must provide the complainant with a written response, signed by the “responsible person” which includes:
• a report setting out how it considered the complaint, what conclusions it reached and any action needed;
• confirmation the council is satisfied with any action taken or proposed to be taken; and
• the complainant’s right to complain to the LGSCO.
21. The council must respond to the complaint within six months starting from the date of receiving the complaint. The regulations allow the council to extend this timescale with the agreement of the complainant so long as this occurs within six months of the complaint being received.

What happened

22. Mr X is elderly and has Parkinson’s related dementia. He has complex medical history.
23. Mr X lived with his family in the property owned by his sons. Before his admission to hospital Mr X was independent with his care needs.
24. At the end of Mr X’s stay in hospital in November 2024 the Council’s hospital assessment team carried out a discharge assessment for Mr X. The assessment also included risk management. The Council decided Mr X, due to a decline in his mobility and personal needs, needed help of two members of staff four times a day. Mr X agreed to the proposed package of care. His family accepted it could not provide him with the support he needed due to their work commitments. The case notes state: “the details of the care package and Ealing charging policy were explained to [Mr X] and his son [Mr Y]. He understood that the reablement package of care is non-chargeable for up to six weeks; after the six weeks, care is chargeable following a financial assessment.”
25. Following a telephone call Mr X’s social worker (Social Worker 1) sent a list of care agencies to Mr Y and asked him to choose the one he would like to use for his father’s care.
26. Two days later Mr X left hospital. The Council commissioned the package of care agreed from the care agency (the Care Agency 1) chosen by Mr Y.
27. Mr Y raised concerns about the lack of carers’ consistency and not respecting Mr X’s wishes for at least one carer to be male. He asked for a change of the care agency, which happened in the second week of December 2024. Mr Y selected another care agency (the Care Agency 2).
28. Following Mr X’s repeated visits to hospital in the first part of December 2024, Mr Y asked for a full CHC assessment for his father. The next day the Reablement Assessment team told Mr Y to contact the Integrated Care Board (ICB) to complete the CHC checklist for Mr X.
29. The Reablement Assessment team booked an Occupational Therapy (OT) assessment for Mr X. Following the assessment the Council ordered some equipment needed by Mr X.
30. At the beginning of January 2025 Mr Y asked the Council to review Mr X’s care package and extend it beyond the first six weeks. Mr Y explained that his father’s condition had worsened since his assessment at the end of November 2024. In December he went to hospital three times.
31. The Reablement Assessment team worker told Mr Y that a social worker would complete a care review for Mr X. She also said the Council would carry out Mr X’s financial assessment to find out how much he should contribute towards his care. Mr Y was concerned to know when the reablement package of care would end. He also asked for the Council’s help to complete the CHC checklist.
32. At the meeting with the OT in the second week of January 2025 Mr Y expressed his frustration caused by the lack of communication from the Council about Mr X’s care package ending shortly. Care Agency 2 told Mr Y that his father’s package of care would end on 22 January 2025.
33. The Reablement Assessment team told Mr Y his father was on the waiting list for a social worker. This social worker would review his care package and, if Mr X continued to need care, the Council would carry out his financial assessment. Mr X would continue receiving his package of care until a new social worker reassessed his care needs.
34. In the fourth week of January the Council assigned a social worker (Social Worker 2) to Mr X. Mr Y agreed to complete the financial assessment forms online. Social Worker 2 arranged to visit to help Mr Y to complete the CHC checklist.
35. Mr Y sent a completed CHC checklist to Social Worker 2 at the end of January 2025. At the end of the first week of February Social Worker 2 told Mr Y she had referred Mr X’s CHC application to the community team. On 10 February the nurse assessor started an early CHC assessment.
36. Mr Y said that according to the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care financial assessments should not advance until a final CHC determination has been made. He asked Social Worker 2 to confirm that no financial assessment would be conducted until the CHC process was completed and that Mr X’s care would continue.
37. At the end of February Social Worker 2 told Mr Y that he needed to complete financial forms for his father’s financial assessment. If the Council did not receive financial information for Mr X, it would charge him the full cost of his care. The telephone call with further explanation followed.
38. At the beginning of March Mr Y completed and sent financial forms to the Council. He told Social Worker 2 that, after the early CHC assessment, Mr X met the criteria for a full CHC assessment.
39. In the second week of March the Council completed Mr X’s financial assessment and backdated charging to the beginning of the charging period. In a letter sent to Mr Y the Financial Assessment Officer provided details of how much Mr X would contribute to the cost of his care. The maximum weekly contribution was £104. The charging period started at the beginning of February 2025.
40. Because some of Mr X’s expenses needed amending, a month later the Council reassessed Mr X’s finances. The Council sent weekly fees and breakdown of the financial assessment to Mr Y. The Council calculated Mr X’s maximum weekly contribution as £46, starting from the beginning of February 2025.
41. At the end of April Mr Y asked Social Worker 2 to review Mr X’s care plan to accurately reflect what Mr X needed. This would allow including certain extra items in a financial assessment as expenses. The Council told Mr Y that his father moved to the locality team.
42. In a telephone call the locality team told Mr Y his father was awaiting a new social worker.
43. At the beginning of May 2025 Mr Y complained about Mr X’s financial assessment and care charges.
44. The Manager contacted the NHS team dealing with the CHC referrals to check progress of Mr X’s CHC assessment. At the end of June the NHS confirmed they had completed assessing Mr X’s CHC checklist at the beginning of March 2025 and he needed a full assessment.
45. At the end of May the Council’s Finance team responded to Mr Y’s complaint. The officer confirmed the Council followed the correct process but recognised it might have been confusing for Mr Y, for which she apologised. The Council explained why there were different invoices issued to Mr X. The Council’s officer said that if Mr Y remained unhappy, he could ask the Council to consider his complaint at stage two.
46. The Council sent its response to Mr X’s complaint on the same day of him raising his complaint again.
47. Mr Y complained again in mid-June 2025.
48. The Council responded at the beginning of July. The Council again apologised for any confusion caused by the Council’s actions, including the lack of response to some calls and emails and the redirection between different teams without a clear point of contact. The responding officer accepted that no means tested assessment or invoicing should take place while a CHC assessment is pending or under dispute. Mr X’s financial assessment, he said, had started before the CHC process began so the Council was right to continue the assessment. The officer explained again why there were several differing invoiced issued. Mr Y’s complaint was partially upheld and the Council decided:
• to suspend all invoicing and debt recovery actions until the ICB completed a full review and advise on the outcome of the CHC assessment;
• to carry out a review of Mr X’s financial records to ensure that charges were aligned with his assessed needs and care provision;
• Mr Y could contact the Locality team to carry out a review of Mr X’s care and support plan.
49. At the beginning of July 2025 Mr Y brought his complaint to us.
50. At the end of July 2025 the CHC panel decided Mr X was eligible for a full CHC effective from 8 March 2025.
51. Mr Y told us the Council was still requesting from Mr X the care charges incurred in February and March 2025.

Analysis

Delays in Mr X’s CHC process

52. Mr Y sought the CHC assessment for Mr X in mid-December 2024. The next day the Reablement Assessment team told Mr Y to contact the ICB to complete a checklist. This is acceptable.
53. At the beginning of January 2025 Mr Y asked the Council to help him to complete the CHC checklist. The Council delayed providing this support as it lasted some time before it assigned Social Worker 2 to Mr Y.
54. The Council was responsible for the delay of a few weeks in sending the CHC checklist to the NHS. This is fault.
55. The Council’s fault caused injustice to Mr X as there is uncertainty whether the earlier referral would mean the ICB would confirm Mr X’s eligibility for the full CHC assessment sooner and the whole process leading to the NHS taking over responsibility for funding Mr X’s care would have been shorter. It is unlikely, however, that if not for the Council’s fault, Mr X would have avoided any care charges. Because of the ICB backdating of funding to 8 March 2025 any negative impact of the Council’s delay was minimised.
56. The Council’s fault caused also injustice to Mr Y, who spent much time contacting the Council and trying to progress the assessment. He was distressed at the Council’s delays and struggled to understand the process.
57. Any further delays in the CHC assessment process were not the Council’s responsibility. As pointed out in paragraph five we cannot investigate them.

Mr X’s financial assessment and charging for care during the CHC assessment

58. The Council’s duty under the Care Act 2014 is to assess care and support needs of adults in its area who it knows may need support. If the Council assesses the person has eligible needs, then it must meet those needs. The Council must complete a financial assessment to decide if the person must pay any or all the care costs. There are no timescales set out for completing the care and support assessment or the financial assessment.
59. The period of Mr X’s intermediate care ended at the end of January 2025. A few days later the Council started Mr X’s financial assessment, having told him a few times before that after the reablement period it would charge him.
60. The Council should not have started charging Mr X for his care before telling him how much he would pay. This is fault. It did not, however, cause injustice to Mr X as from December 2024 he had known he would need to contribute to his care costs from the end of the intermediate care. Mr X needed support and it was not an option for him to discontinue the service. The Council carried out a financial assessment for him to ensure he contributed only as much as he could afford.
61. Mr Y complained the Council carried out Mr X’s financial assessment and started charging during the CHC assessment process. The CHC assessment process did not formally start before March 2025, when the ICB confirmed Mr X’s eligibility for a full CHC assessment. Because the Council started Mr X’s financial assessment, leading to charging, before the beginning of the CHC assessment, it could legitimately continue with the current care arrangements until the ICB decided Mr X’s eligibility for CHC. A person only becomes eligible for CHC once a decision on eligibility has been made by the ICB.I did not find fault with the Council’s charging.
62. The Council sent several invoices for Mr X’s care costs. Although issuing several different invoices for Mr X’s care charges were confusing, the Council explained in its responses to Mr Y’s complaint its reasons. I did not find fault in the way the Council issued care charges for Mr X.

Failure to reassess Mr X’s needs

63. At the end of April 2025 Mr Y asked Social Worker 2 to review his care and support plan as the plan needed updating to accurately reflect Mr X’s care needs. Social Worker 2 could not help at this stage as Mr X was transferred to another team where he was waiting for a new social worker. The Council did not review his care and support plan stage two complaint response.
64. The lack of the Council’s response to Mr Y’s request for a review is fault. This fault did not cause injustice to Mr X. The amendments to the care plan sought by Mr Y were to allow including extra expenses in Mr X’s financial assessment. Since Mr X received the CHC funding from 8 March 2025 the lack of these amendments did not affect Mr X.

Communication

65. In the response to Mr Y’s complaint from the beginning of July 2025 the Council accepted there were failings in the way it communicated with Mr Y and apologised.
66. I recognise Mr X’s circumstances were complicated as Mr Y had to secure services for him from both NHS and the Council teams. Although the Council failed to respond to some of Mr Y’s correspondence and telephone calls, generally the Council was engaging with Mr Y and advising on a complicated process. An apology is a suitable remedy for any injustice caused by the failure to provide satisfactory communication.

Complaint handling

67. The Council’s Adult Social Care Complaints Policy and Procedure states the Council will:
• acknowledge a complaint within three working days;
• carry out an early screening;
• the lowest impact complaints will be investigated by a team manager or complaints manager, who will respond within 20 working days;
• the higher impact complaints will be investigated by the relevant Service Head or a person named by the Service Head, who will respond within 25 working days. The maximum period for responding to these complaints is 65 working days.
68. When responding to Mr Y’s complaint in May 2025 the Council failed to follow the process for Adult Social Care complaints. The Council referred Mr Y to stage two of the Council’s complaint procedure, whereas, as explained in paragraph 17, Adult Social Care complaints should be investigated at a single stage.
69. The Council’s failure to apply the right complaint procedure is fault. The Council fault caused injustice to Mr Y as the Council did not explain to him how his complaint would be investigated and when he could expect the response. Mr Y spent much time communicating with the Council and was distressed at the delays in resolving the issues raised in his complaint.

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Action

70. To remedy the injustice caused by the faults identified, we recommend the Council complete within four weeks of the final decision the following:
• apologise to Mr X and Mr Y for the injustice caused to them by the faults identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended;
• pay Mr Y £100 to recognise injustice caused to him by the Council’s delays with starting the Continuing Healthcare process; and
• pay Mr Y £50 to recognise his time and trouble caused by the failings with complaint handling.

The Council will provide the evidence that this has happened.

71. We also recommend the Council within three months of the final decision:
• remind social workers, including the members of the Reablement Assessment team, of the Continuing Healthcare process so they can advise people and support them in completing checklists;
• remind the Adult Social Care staff of the details of the complaint procedure to follow when responding to ASC complaints and in particular for which complaints this procedure should be applied.

The Council should provide us with evidence it has complied with the above actions.

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Decision

72. I find fault causing injustice. The Council has accepted my recommendations so this investigation is at an end.

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Investigator's decision on behalf of the Ombudsman