Summary: Ms X complained the Council arranged an emergency placement for her mother, Mrs M, under the government’s ‘discharge to assess’ guidance and then wrongly charged her for that placement. Ms X also complains the care home to which the Council discharged Mrs M was unsuitable to meet her needs. The Council was at fault when it charged Mrs M for her placement. It has now said it will waive that charge. This is appropriate to remedy the injustice it caused. There was no fault in the Council’s actions when it discharged Mrs M to the care home.

The complaint

1. Ms X complains the Council:
• arranged an emergency placement at a care home (Home C) for her mother, Mrs M, so she could be quickly discharged from hospital at the start of the COVID-19 pandemic in March 2020 and then wrongly charged Mrs M for that placement;
• failed to place Mrs M in a Care Home which could meet her needs.
2. Ms X said that because she was placed in a care home which could not meet her needs, Mrs M’s health deteriorated and she was admitted as an emergency to hospital shortly afterwards. Ms X also says Mrs M has been financially disadvantaged and should not have to pay for her stay at Home C.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot question whether a council’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. (Local Government Act 1974, section 34(3), as amended)
5. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
6. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

7. I spoke to Ms X and considered her view of her complaint.
8. I made enquiries of the Council and considered the information it provided. This included
9. I wrote to Ms X and the Council with my draft decision and considered their comments before I made my final decision.

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What I found

Discharge to assess under COVID-19

10. From 19 March 2020, there was a requirement to free up hospital beds for the anticipated wave of COVID-19 admissions. Government guidance at that time directed rapid discharge of all patients who were clinically ready to leave hospital, either home or to another place of care. Transfer from the wards should have been within one hour to a designated discharge area and then discharge from hospital as soon as possible, and within two hours wherever possible.
11. Where patients were discharged under this government guidance the NHS fully funded the cost of new or extended out-of-hospital health and social care packages.
12. For patients who needed to be discharged to a rehabilitation bed or care home, the guidance stated they would not be able to remain in hospital until their first choice of care home had a vacancy. This meant some patients were discharged to an alternative care home until they were able to move to their preferred choice. The guidance stated the NHS would pay for this support.

What happened

13. At the beginning of March 2020, Mrs M was admitted to hospital after she collapsed at home. Prior to her admission Mrs M had lived on her own with no support.
14. Mrs M was reviewed by the Mental Health Team who concluded she had dementia which was impacting on her behaviour.
15. On 10 March, the hospital sent the Council a notice requesting it formally assess Mrs M’s care needs in preparation for her discharge. On 11 March the hospital sent the Council a discharge notification with a discharge date of 13 March.
16. A social worker (SW1) spoke to Ms X on 11 March. Ms X said she wanted Mrs M to be admitted to a psychiatric ward to have a full psychiatric assessment. The notes record SW1 told Ms X that the medical staff treating Mrs M would not agree to this. The notes recorded Ms X “then said she would be happy to go with the plan”. SW1 decided Mrs M would be discharged to a care home for a 12 week temporary placement to monitor her behaviour and tendency to wander and to determine her future care needs and placement.
17. SW1 started a care needs assessment with Mrs M on 11 March. This recorded Mrs M wanted some supervision with washing and dressing and her toilet needs and to be prompted to take her medication. The assessment noted Mrs M had a risk of wandering.
18. The assessment also noted a Mental Care Act assessment had been considered but not completed because Mrs M was not engaging with the process. The assessment determined the next steps were to source a temporary dementia placement which would be a 12 week chargeable placement. This would enable Mrs M’s care needs to be assessed outside the hospital setting. The Community Mental Health Team would follow up with Mrs M after discharge.
19. On 18 March, case notes record the Council identified two care homes (Home A and Home B) within reasonable distance of Mrs M’s home address. Ms X rejected Home A as it was too far away. The Council asked Home B to assess Mrs M.
20. On 19 March, the following events took place:
• the government discharge to assess procedures came into force;
• SW1 spoke to Ms X. She told Ms X that Mrs M needed a financial assessment because her care home placement would be chargeable under the Council’s charging policy; and
• Home B said it could not meet Mrs M’s needs.
21. On 20 March, Ms X said she would now consider Home A. However, Home A refused a placement because it did not think it could meet her needs.
22. On 23 March, the placement officer suggested a third care home (Home C), although noting that it required improvement by the Care Quality Commission (CQC). Home C agreed to assess Mrs M to see if it could meet her needs.
23. Between 25 and 30 March, Mrs M became medically unfit for discharge.
24. On 30 March SW1 telephoned Home C which stated it had not received a request to assess Mrs M but would arrange a telephone assessment as a matter of urgency. This took place and later that day, Home C agreed to accept Mrs M. Mrs M was discharged from hospital that evening.
25. SW1 completed a transfer form which provided the same information as the care needs assessment from 11 March.
26. On 9 April, the manager at Home C emailed the Council to say there had been over 30 incidents within the Dementia Suite involving Mrs M attacking staff and other residents. SW1 contacted the manager the same day who reported there had been no injuries requiring medical intervention. SW1 contacted the GP who reviewed Mrs M’s medication and made some changes.
27. On the same day, SW1 contacted Ms X who was unhappy she had not been consulted before Mrs M was discharged to Home C. Ms X said ward staff at the hospital had told her the placement would be funded by the NHS. SW1 informed Ms X that the placement was not funded by the NHS and because Mrs M appeared to have sufficient funds, she would have to pay for her placement.
28. Between the 9 and 15 April, there were continuing discussions around Mrs M’s medication with the GP, Home C and the Council, including the dementia crisis team.
29. On 15 April, the case was assigned to another social worker, SW2, to reassess Mrs M’s care needs. Notes from that date stated Home C was struggling to manage Mrs M.
30. SW2 spoke to Ms X. The notes record Ms X agreed it was better for Mrs M to remain in Home C until her mental wellbeing was stable and until lockdown ended. Ms X said she then planned for Mrs M to live either with her or with her son.
31. SW2’s assessment recorded the following information:
• Mrs M was discharged from hospital on 30 March 2020 to Home C and her care was chargeable from day 1;
• she required 24 hour support and was happy to stay at Home C but not indefinitely;
• Mrs M had capacity at that time to decide where she was cared for.
32. On 20 May SW2 recorded details of a telephone conversation with Ms X. These stated “I informed [Ms X] that once the placement with NHS funding (arranged by ECC but funded through NHS emergency COVID-19 process) ends on 10/6/20, her mother would be responsible to arrange and fund her own residential placement”.
33. On 2 June, Mrs M was admitted to hospital with a non-COVID-19 related infection. The notes record Home C would not take her back until she had taken a COVID-19 test and received a negative result. Therefore, Mrs M was discharged to another care home on 6 June under the emergency discharge to assess procedures. Mrs M remains at the new care home.
34. The Council sent Ms X invoices for the care Mrs M received while she was at Home C. Ms X refused to pay these because she said Mrs M had been discharged under the emergency procedures. The Council said Mrs M’s discharge had been a planned process and therefore her care was chargeable.
35. Ms X complained to the Ombudsman.
36. In response to my enquiries the Council said:
• Mrs M’s discharge was delayed because Ms X disagreed with the Council’s plan to discharge her to a residential placement;
• it acted with fault when it failed to notify Ms X of Mrs M’s discharge to Home C; and
• Home C carried out a telephone assessment prior to offering Mrs M a placement.
37. The Council reiterated Mrs M’s discharge from hospital had been planned and, therefore, did not fall under the discharge to assess guidance. It went on to state “As a gesture of goodwill, and because of the challenging time of these discharge arrangements, we propose to waive the charges for the placement at [Home C]… we believe this is a proportionate response”.

My findings

Discharge from hospital

38. On 13 March, when Mrs M originally became fit for discharge, the Council began a planned process, together with Ms X, to identify a suitable placement. At this stage there was no fault in the Council’s actions.
39. On 19 March, the government discharge to assess procedures came into force. Mrs M was medically fit for discharge but was still in hospital because the Council and Ms X could not agree a placement. At this point, the Council’s intentions for a planned discharge should have been superseded by the emergency procedures and it should have begun steps to arrange an immediate discharge for Mrs M. Its failure to do so was fault.
40. Mrs M then became unwell and was not medically fit again for discharge until 30 March. On that date, the Council contacted Home C, Home C assessed Mrs M, it offered her a placement and Mrs M was discharged that evening. All of this took place without consultation with Ms X. These actions were in line with the emergency procedures in force and not in line with the steps we would expect a Council to take when carrying out a planned discharge. The Council’s failure to acknowledge this at the time and to charge Mrs M for this period of care is fault.
41. As a result, Mrs M was charged for care that could and should have been provided under the emergency discharge to assess procedures.
42. The Council has now said it will waive the charges incurred by Mrs M for this period. This is a suitable remedy for the injustice identified.

Suitability of Home C to meet Mrs M’s needs

43. Ms X is unhappy Mrs M was discharged to a care home that she believes was unsuitable to meet her needs.
44. Home C specialises in caring for people with dementia. It carried out a telephone assessment and considered it could meet Mrs M’s needs. At this stage, the government assess to discharge regulations were in place, telephone assessments were neither unusual nor inappropriate. When Mrs M was admitted, the transfer document and care plan described Mrs M’s conditions, care requirements and how she could sometimes react negatively to other people.
45. When Home C began to struggle to manage Mrs M’s behaviour, the Council acted promptly, contacting Mrs M’s GP who arranged new medications and remaining in touch with Home C. Shortly after, the Council began a review of Mrs M’s needs in order to determine whether her care and support needs had changed. There was no fault in the Council’s actions.

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Agreed action

46. During my investigation, the Council decided to waive Mrs M’s care home fees. Within one month of the date of the final decision, it has agreed to write to Ms X to inform her of its decision.

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Final decision

47. There was fault leading to injustice. During my investigation, the Council has stated it will take appropriate action to remedy the injustice caused. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman