Summary: We will not investigate this complaint about whether Ms B’s father would have been eligible for healthcare funding earlier if the Care Provider had contacted the relevant Integrated Care Board (ICB). ICBs are responsible for considering eligibility for past periods of care where an individual has not been assessed. The ICB is better placed to consider the period of care in dispute.

The complaint

1. Ms B complains the Care Provider failed to apply to the Integrated Care Board (ICB) so it could consider her late father’s eligibility for NHS continuing healthcare (CHC) funding when he moved to the nursing home. Ms B says this failure meant her father lost out on CHC funding for eight months which totals around £68,000. Ms B wants the Care Provider to pay £68,000 to her father’s estate, to apologise and pay compensation for the distress she has experienced.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. 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 further investigation will 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, sections 34B(8) and (9))

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How I considered this complaint

3. I considered information provided by the complainant including the Care Provider’s response to her complaint.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. We will not investigate this complaint about whether Ms B’s late father was eligible for CHC funding for an earlier period. The Care Provider cannot decide whether a person is eligible for healthcare funding. The relevant ICB is responsible for assessing and deciding whether a person was eligible for healthcare funding even if the individual is deceased.
6. If Ms B feels her father would have been eligible for CHC funding when he first moved into the Care Provider’s home, she can ask the ICB to complete a previously unassessed period of care (PUPoC) assessment. We cannot achieve the outcome Ms B wants. The ICB is better placed to consider this matter.

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Final decision

7. We will not investigate Ms B’s complaint because the ICB is better placed to consider whether her late father was eligible for healthcare funding for the eight months in dispute.

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Investigator's decision on behalf of the Ombudsman