Summary: We will not investigate Mrs X’s complaint about the care provided to her husband, Mr X, by Cambridgeshire County Council and Cambridge University Hospitals NHS Foundation Trust. This is because we consider it unlikely an investigation would find fault with the care these organisations provided to Mr X.

The complaint

1. Mrs X is complaining about the handling of her husband, Mr X’s, discharge from hospital by Cambridgeshire County Council (the Council) and Cambridge University Hospitals NHS Foundation Trust (the Trust) in June 2025. She is also complaining about the care provided to Mr X at home by a care provider acting on behalf of the Council.
2. Mrs X complains that:

• the decision to discharge Mr X home was poorly made and did not take proper account of her concerns;
• Council and Trust staff gave her contradictory information about the arrangements for discharge. This included staff telling her Mr X would be discharged to residential care;
• professionals involved in the discharge failed to explain that Mr X’s care in the community would be chargeable;
• she was not provided with a written care plan for Mr X despite repeatedly requesting one;
• Mr X was discharged without the necessary equipment (such as a hoist) being in place; and
• the care provided to Mr X at home by the care agency was inadequate, leaving her to cancel the care package.

3. Mrs X says these events placed Mr X at risk and caused her great frustration and distress.

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The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
5. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault, or it is unlikely we could add to any previous investigation by the bodies concerned.
6. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the relevant available evidence and decide what was more likely to have happened.

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How I considered this complaint

7. I considered evidence provided by Mrs X and discussed the complaint with her. I also considered information and records provided by the Council and Trust, as well as relevant law, policy and guidance.
8. Mrs X had an opportunity to comment on my draft decision. However, I did not receive any comments from her.

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What I found

Relevant legislation and guidance

Hospital discharge

9. The Department of Health and Social Care issued statutory guidance entitled Hospital discharge and community support guidance (the National Discharge Guidance) in April 2022. This provides guidance to NHS bodies and local authorities on discharging adults from hospital.
10. The National Discharge Guidance sets out several discharge pathways for patients being discharged from hospital. This can include:

• discharge home with a package of care;
• discharge to a community bed-based setting for short-term care and assessment; and
• discharge to a residential or nursing home placement on a long-term basis.

11. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. 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, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))

Mental Capacity Act 2005

12. The Mental Capacity Act 2005 (the MCA) applies to people who may lack mental capacity to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity to make a specific decision.
13. Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.

Reablement care

14. Intermediate care and reablement support services are provided to people after they have left hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. These services are provided in the person’s own home by a team of mainly care and support professionals.
15. Regulations require reablement services to be provided without charge for up to six weeks. 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.

Charging for social care services

16. Under the Care Act 2014, a council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment.

Background events

17. Mr X had a diagnosis of dementia, as well as hydrocephalus (a buildup of cerebrospinal fluid in the brain) and other health conditions. He was living at home with Mrs X, who was his main carer.
18. On 6 May, Mr X attended a GP appointment with Mrs X. The GP was concerned that Mr X’s continence and mobility had deteriorated since his previous appointment. The GP wrote a letter for Mr X and advised him to attend A&E at the local hospital.
19. The clinical staff completed a computed tomography (CT) scan and decided to admit Mr X to a ward.
20. During Mr X’s admission, there was an outbreak of Norovirus on the ward, which limited visiting. Mr X also contracted COVID-19 during his admission.
21. The Trust’s therapy team assessed Mr X during his admission. The therapy team found Mr X’s worsening cognition meant he likely required long-term care.
22. By 21 May, Mr X was considered medically stable for discharge. This meant there was no clinical reason for him to remain in hospital. The clinical team referred Mr X to the Council’s adult social care service as part of the planning for his discharge.
23. The social worker visited Mr X to complete an assessment on 29 May. The social worker found Mr X had eligible needs under the Care Act. The assessment found Mr X needed support with various activities of daily living, including personal care. continence care and moving and handling.
24. The social worker arranged for Mr X to receive a package of four care visits per day (by two care workers) to support Mr X on discharge.
25. Mr X was discharged home on 11 June. His care package began on the same day.
26. A social worker visited Mr X at home on 26 June to complete a review of his care and support plan. The assessing social worker found Mr X lacked the capacity to make decisions about his care. The social worker noted Mrs X continued to provide a high level of care for Mr X and that this arrangement would not be sustainable. The Council agreed to explore care home options for Mr X.
27. On 30 June, the Council wrote to Mr and Mrs X to confirm that he would be required to contribute towards his care.
28. Mrs X contacted the care provider on 2 July to cancel the care package.
29. Mr X moved into a temporary residential respite placement on 25 July. He subsequently moved into a permanent placement on 22 September.

My analysis

Discharge decision

30. Mrs X complained that the decision to discharge Mr X home was poorly made and did not take proper account of her concerns. She said she was given contradictory information about Mr X’s discharge destination.
31. The case records show that, by 21 May, Mr X was considered to be medically stable for discharge. By this point, the Trust’s therapy team had assessed him. The therapists noted Mr X’s mobility had been in decline prior to his admission and that he had experienced recent falls. The therapy team noted Mr X could move around on the ward with support. However, due to Mr X’s worsening cognition, the therapy team felt Mr X could not consistently engage with physiotherapy exercises.
32. A social worker spoke to Mrs X and her daughter on 22 May. The social worker noted that Mrs X was keen for Mr X to be admitted to a care home as she felt unable to care for him at home. The social worker noted that the family was unwilling to have carers visiting the home to support Mr X.
33. A social worker discussed the discharge with Mrs X again on 28 May. The social worker recorded Mrs X had told her that hospital staff had informed her Mr X would be discharge to a care home. The social worker advised this was not a decision for hospital staff to make and that Mr X’s discharge destination would be based on an assessment of his needs. The social worker explained that they would look to discharge Mr X home if possible as this was the east restrictive option for meeting his needs.
34. The social worker then visited Mr X on 29 May. Mr X told the social worker he was keen to return home. The social worker noted that Mr X’s capacity could be variable but felt he had capacity to decide on his discharge destination. The social worker concluded that Mr X did not need 24-hour residential care and that his needs could be met at home with an appropriate package of care.
35. The social worker spoke to Mrs X and her daughter later that day, and again on 3 and 4 June. On each occasion, the social worker made detailed notes of the family’s continued concerns about Mr X returning home.
36. The decision as to whether Mr X should be discharged home and, if so, what support he would receive was ultimately a matter of professional judgement for the health and social care professionals involved in his care.
37. The evidence I have seen suggests the Council appropriately considered Mr X’s capacity to decide on his discharge destination. This was in keeping with the requirements of the MCA. In addition, the case records show a social worker completed a thorough assessment of Mr X’s care needs prior to his discharge as required by the Care Act 2014.
38. I recognise Mrs X was concerned about her ability to provide the care Mr X required if he returned home. I also acknowledge that Mrs X recalls receiving contradictory information from hospital staff and found this understandably confusing. However, the available evidence suggests the Council and Trust took the family’s views into account when planning Mr X’s discharge and arranged for him to receive a package of care at home. The available evidence suggests the Council and Trust handled Mr X’s discharge appropriately, albeit I accept Mrs X does not agree.
39. In my view, it is unlikely further investigation of this issue by the Ombudsmen would find fault by the Council and Trust. I do not propose to investigate this issue further, therefore.

Charging information

40. Mrs X complained that professionals involved in the discharge failed to explain to her that Mr X’s care in the community would be chargeable.
41. The Council’s records contain a note of a conversation between a social worker and Mrs X on 29 May. The social worker noted “I explained I had left some information on the wards regards financial assessments…she said she will collect from the ward.”
42. On 4 June, a social worker met with Mrs X. She noted “I asked [Mrs X] if she had collected the information pack from the ward as have bought another one with me, explaining again that he will have a financial assessment that will determine contributions and whilst he was assessed at nil cost for day centre, he may still have to contribute to his care package”.
43. The Council confirmed this by letter on 30 June.
44. Reablement care is short-term support (typically four to six weeks) intended to help a person maintain or regain the ability to live independently. The evidence I have seen suggests Mr X would not have been eligible for reablement care services. This is because the professionals who assessed Mr X in hospital concluded that he had long-term care needs. As a result, the Council arranged a long-term package of care, to which Mr X was required to contribute.
45. I recognise this was a very difficult period for Mrs X. Nevertheless, the evidence suggests Council officers did provide Mrs X with charging information and explain that Mr X would be required to contribute towards his care. In my view, an investigation would be unlikely to find fault by the Council in this matter. I do not propose to investigate this issue, therefore.

Care plan

46. Mrs X complained that she was not provided with a written care plan for Mr X, despite repeatedly requesting one.
47. This issue was addressed by the Council in its complaint response. In that letter, the Council acknowledged there had been a delay uploading the care plan onto the Council’s electronic system. This in turn led to a delay sending a copy of the plan to Mrs X. The Council apologised for this.
48. This delay was understandably frustrating for Mrs X. However, I consider the Council’s apology to be an appropriate and proportionate remedy for this. I consider it unlikely that an investigation by the Ombudsmen would be unlikely to achieve anything further. For this reason, I do not propose to investigate this issue.

Equipment

49. Mrs X complained that Mr X was discharged without the necessary equipment (such as a hoist) being in place for him at home.
50. During the early part of his admission, Mr X was noted to be spending most of his time in bed. Staff were using a hoist to transfer him. Mr X also required assistance from staff to help support him to move around. Mr X’s condition was variable. This meant he sometimes needed support from one member of staff, and sometimes from two.
51. The Council’s care records show a social worker made a referral on 29 May for Mr X to be assessed for a hospital bed on discharge.
52. A physiotherapist reviewed Mr X on 3 June. The physiotherapist noted that Mr X could now stand from his bed with the assistance of two members of staff. He was also noted to be able to move around the ward using his walking frame with the assistance of staff.
53. The Trust ordered a hospital bed for Mr X on 5 June.
54. On 6 June, the social worker ordered falls sensors for Mr X’s bed and chair. The social worker also offered to have a key safe installed so care workers could access the property if Mrs X was out. However, Mrs X declined this.
55. On 10 June, the Council confirmed that a hospital bed and commode were in place for Mr X. The care records note that Mr X was no longer considered to require a hoist and therefore the social worker did not order this piece of equipment.
56. The evidence I have seen shows the social worker was active in arranging equipment to meet Mr X’s assessed care needs. I do not propose to investigate this issue as an investigation would be unlikely to find fault by the Council or Trust.

Home care

57. Mrs X complained that the care provided to Mr X at home by the care agency was inadequate. She said this led her to cancel the care package.
58. The case records show Mrs X was concerned about her ability to provide the care Mr X needed if he returned home. In addition, Mrs X was noted to be reluctant to have care workers in the house. In a conversation with a social worker on 29 May, Mrs X said she did not want care workers to prepare meals for Mr X or assist him with his medication and that she would do this. Mrs X expressed concern that frequent care visits would prove disruptive.
59. Mrs X contacted the Council on 19 June, around a week after Mr X’s discharge. Mrs X reported that she was regularly cancelling care calls as she was providing the necessary care to Mr X and there was nothing for care workers to do when they arrived.
60. The social worker who reviewed Mr X’s care on 26 June noted that Mrs X was struggling to cope and did not want carers in the property. The social worker noted that Mrs X continued to provide care independently and was reluctant to wait for carer workers to arrive.
61. On 2 July, Mrs X contacted the care provider to cancel the care visits. The care provider subsequently contacted the Council to explain that Mrs X was regularly turning care workers away and changing the call times. This led the Council to explore the possibility of a residential placement as professionals were concerned Mrs X would be at risk of carer burnout by providing the majority of Mr X’s care on her own.
62. The evidence I have seen suggests Mrs X was reluctant to receive regular visits from care workers and found this disruptive. Mrs X often preferred to provide Mr X’s care independently. This meant that, when care workers arrived, there was little for them to do. This ultimately led to the care package breaking down. However, I have seen no evidence in the records I have reviewed to suggest this was a result of errors or omissions on the part of the care provider. I do not propose to investigate this issue, therefore, as I consider it unlikely an investigation would find fault by the Council (on whose behalf the care provider was acting).

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Decision

63. We will not investigate Mrs X’s complaint. This is because we consider it unlikely an investigation would identify fault in the care provided to Mr X by the Council and Trust.

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Investigator's decision on behalf of the Ombudsman