Summary: We will not investigate this complaint about the Council’s involvement in an NHS continuing healthcare funding eligibility decision appeal. Any injustice is not significant enough to justify our involvement.

The complaint

1. Mx D complains the Council delayed processing their NHS continuing healthcare funding eligibility decision appeal. Mx D says the Council’s officer said they would support them with an appeal but failed to do so. Mx D also complains about the way the Council considered their complaint. Mx D says the Council’s lack of action had an impact on the quality of service they received. To put things right they want better management of officers and training for the Council’s complaints team.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organization, or
• further investigation would not 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, section 24A(6), as amended, section 34(B))

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. The Council’s officer was involved in a continuing healthcare assessment for
   Mx D as a member of a multidisciplinary team. The local Integrated Care Board (ICB) is usually responsible for the NHS continuing healthcare process.
6. When responding to Mx D’s complaint the Council accepted a delay in the assessment process occurred because of the availability of Council and NHS officers. The ICB decided Mx D was not eligible for NHS continuing healthcare. Mx D said the Council’s officer agreed to help them appeal the ICB’s decision.
7. When responding to Mx D’s complaint the Council said its officer took advice from senior management and did not challenge the ICB’s decision. The Council did not explain why it had made this decision. It apologised for the delays and any distress and anxiety caused to Mx D. It said it had allocated a new social worker who would complete a new continuing healthcare checklist.
8. Mx D confirmed when they met with the new social worker they completed the continuing healthcare checklist and submitted an appeal at the same time. We will not investigate this complaint as any injustice is not significant enough to justify our involvement. The concerns Mx D has about the way the Council considered their complaint should be directed to the Council as it is better placed to consider the issues.

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Final decision

9. We will not investigate Mx D’s complaint because any injustice is not significant enough to justify our involvement.

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Investigator's decision on behalf of the Ombudsman