Summary: Mrs X complains about the lack of support getting a Continuing Healthcare Checklist completed for her sister after she left hospital. Although there are indications of fault by the organisations complained about, they have already accepted and remedied this. It is unlikely investigation by the Ombudsmen would achieve more.

The complaint

1. Mrs X complains about the lack of support from Leicester City Council (the Council), Leicestershire Partnership NHS Trust (the Trust) and S6 Care Ltd, who run The New Wycliffe Home (the Care Home). She complains about the lack of assessment for Continuing Healthcare (CHC) for her late sister, Ms Y. Mrs X says no one she spoke to took responsibility for completing a CHC Checklist and kept passing her on to someone else.
2. Mrs X says the faults meant she spent a lot of her time trying to get the right support for Ms Y. This caused Mrs X more distress at a time she was dealing with her own health problems.

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The Ombudsmen’s role and powers

3. 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).
4. The Local Government and Social Care Ombudsman investigates complaints about adult social care providers. (Local Government Act 1974, sections 34B, and 34C, as amended)
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
• the injustice is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the bodies.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

6. I considered evidence provided by Mrs X and the organisations complained about, as well as relevant law, policy and guidance.

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My assessment

Relevant guidance and legislation

CHC Assessment

7. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist.
8. If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. This assessment is completed using a decision support tool (DST).

Brief background

9. Ms Y had a hospital admission in May 2024 following a stroke. When she left hospital she moved into a Care Home. Mrs X considered Ms Y could be eligible for CHC funding and understood a Checklist would be completed after she left hospital. This did not happen. Mrs X contacted several organisations, including the hospital, the Care Home, Ms Y’s GP, district nurses and the social care team at the Council. Mrs X says she found this distressing, particularly as she was dealing with her own health problems too.
10. Unfortunately Ms Y did not get a checklist completed by anyone before she died in November 2024. Mrs X complained to the organisations about the lack of support and failure to complete a Checklist. The Trust coordinated the response. Since Mrs X made her complaint, the Integrated Care Board has started a retrospective review of Ms Y’s CHC needs.
11. The Trust explained that professionals in the community often complete checklists to avoid unnecessary hospital stays. It apologised for not explaining this properly at the time. It also accepted it should have included instructions on the discharge documentation about Ms Y needing a checklist completed after she left hospital. The Trust apologised to Mrs X for the impact this had on her. I consider this to be a proportionate response and remedy to this part of the complaint.
12. The Council were not involved in Ms Y’s day-to-day care, but it did make referrals to the district nurses and to the GP surgery to ask them to complete a checklist. It appears the district nurses rejected the referral because Ms Y was not under the care of their team, but they communicated this to the Council. It then contacted Ms Y’s GP.
13. The Care Home or the GP surgery could arrange or complete a checklist for CHC. The Council agreed to help when Mrs X asked for help by contacting appropriate health professionals. This does not indicate fault. I have seen Mrs X had problems contacting the Council by telephone and not having her calls returned. The Council explained was due to a technical problem with telephone lines. It said this has now been fixed and the Council apologised to Mrs X. This appears to be a proportionate response.
14. The Care Home accepted its record keeping was poor. As there had also been staff changes, this meant it could not answer all of the complaints Mrs X made. This also means it would be difficult for us to clarify what actions the Care Home staff took to make or follow up requests for a CHC checklist. This does indicate fault with record keeping, which the Care Home has already accepted. It gave apologies to Mrs X for her family’s experience and the inability to provide more information. Since the events complained about the Care Home has had a change of management. It explained the issues in this complaint have been used to educate staff about record keeping, escalating and requesting CHC assessments in future. In view of the lack of documentation and the actions already taken to make improvements, I consider we are unlikely to achieve more by investigating.
15. I can see it was frustrating for Mrs X to have to ask different organisations for help and not make much progress until after Ms Y died. This must have been exacerbated with Mrs X having her own health problems to deal with too. However, the Trust, the Council and the Care Home, have accepted there was fault and taken action to make improvements. A complaint about the GP surgery is being dealt with separately. The retrospective review for CHC will remedy any financial injustice should this show Ms Y’s needs qualified for CHC funding.

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Final decision

16. We will not investigate this complaint because we are unlikely to achieve more. Fault has been accepted by the Trust and the Council and the apologies and further actions already taken appear proportionate.

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Investigator's decision on behalf of the Ombudsman