Summary: We will not investigate this complaint about the Care Provider incorrectly completing a funding checklist for Mr Y’s father. This is because we cannot achieve the outcome Mr Y is seeking.

The complaint

1. Mr Y complains the Care Provider incorrectly completed an NHS Continuing Health Care (CHC) funding checklist for his father. He says consequently his father was not fully assessed for CHC funding and he has had to pay for his father’s care himself.

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The Ombudsman’s role and powers

2. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
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’. 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 we cannot achieve the outcome someone wants. (Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

4. We spoke to Mr Y to confirm our understanding of his complaint. We considered information from him and the Care Provider. Mr Y had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

5. Mr Y’s father receives residential care from the Care Provider. The Care Provider completed an NHS CHC funding checklist in October 2019. Based on the checklist it did not make a referral to the NHS to complete a full assessment for funding. Mr Y disagreed with the outcome as he felt the checklist had been completed incorrectly.
6. The Care Provider agreed at Mr Y’s request to complete a second checklist to consider whether to make a referral to the NHS to assess his father for CHC funding in July 2020. It again found that Mr Y’s father was not eligible to be referred for a full assessment by the NHS. Mr Y then raised a complaint with the Care Provider about its completion of the checklist.
7. The Care Provider responded to the complaint in August. It said it had completed the checklist correctly and the information was accurate.
8. Mr Y approached the Ombudsman in August after receiving the response. Mr Y told the Ombudsman he is seeking CHC funding, so his father’s care would be paid for by the NHS.

Analysis

9. The Ombudsman cannot achieve the outcome Mr Y is seeking as we do not have the power to award NHS CHC funding. If the Ombudsman investigated this complaint, we could only recommend the Care Provider carry out a further CHC funding checklist. Mr Y said in response to a draft of this decision that he wanted the Ombudsman to recommend this so the Ombudsman could ensure compliance from the Care Provider. However, the Ombudsman does not have the power to enforce decisions in this way. Further, Mr Y can ask the NHS directly to complete a retrospective CHC funding assessment and provide any information which he feels should have been considered in the original checklist. Consequently, we will not investigate this complaint.

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Final decision

10. We will not investigate this complaint. This is because we cannot achieve the outcome Mr Y is seeking.

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Investigator's decision on behalf of the Ombudsman