Summary: The Ombudsman will not investigate Mr X’s complaint about a refund of top-up fees. This is because there is not enough evidence the actions of the care provider caused Mr X injustice.

The complaint

1. Mr X’s late mother was a resident of the care provider in 2010. Mr X paid a top-up fee of £80 per week while NHS Continuing Health Care (CHC) was being discussed. The NHS has now agreed to pay CHC for Mr X’s late mother – but only up to the time of her death. Mr X wants the care provider to refund the two weeks of top-up fees he was required to pay after his mother passed away. The care provider has refused.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
3. 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 the action has not caused injustice to the person who complained. (Local Government Act 1974, sections 34B(8) and (9))

Back to top

How I considered this complaint

4. I considered Mr X’s complaint to the Ombudsman and the information he provided. I also gave Mr X the opportunity to comment on a draft statement before reaching a final decision on his complaint.

Back to top

What I found

5. In 2010, Mr X entered into an agreement to pay a weekly top-up fee of £80 toward his mother’s care. This was because the NHS would not agree to pay CHC. The agreement Mr X signed said the top-up fee had to be paid for two weeks after a person passed away.
6. The NHS has now agreed to retrospectively pay CHC and interest. But CHC is only paid up to a person’s death. The NHS will not therefore pay the two weeks of top-up fees Mr X paid to the care provider after his mother’s death.
7. The Ombudsman has no powers to consider the NHS’s decision not to pay the two weeks of top-up fees - we can only consider the care provider’s actions. Mr X agreed to pay the top-up fees because of the NHS’s original decision not to pay CHC. The care provider entered into the agreement with Mr X to ensure it was paid in line with its terms and conditions.
8. I understand Mr X’s frustrations. But the current situation has arisen because of the original decision by the NHS not to pay CHC; it was this decision that led to him entering into an agreement with the care provider. Based on the information I have seen, there is not evidence of fault by the care provider. Any injustice to Mr X flows directly from the NHS’s decision – not the actions of the care provider itself. As I explain above, we cannot consider the NHS’s decision, and so an investigation by the Ombudsman is not appropriate.

Back to top

Final decision

9. The Ombudsman will not investigate his complaint. This is because there is not enough evidence the actions of the care provider caused Mr X injustice.

Back to top

Investigator's decision on behalf of the Ombudsman