Summary: We cannot investigate this complaint about the care provided by the care home. This is because the care was funded by the NHS and therefore outside the Ombudsman’s jurisdiction.

The complaint

1. Mrs X has complained on behalf of her late sister, Mrs Y, about the care she received while she was a resident in the care home. Mrs X says her sister’s physical needs were met, but the care home did not provide support to improve her mental wellbeing. Mrs X has also complained the care provider prevented her from visiting Mrs Y and did not comply with her request to read the bible to her when she died.

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The Ombudsman’s role and powers

2. 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 there is another body better placed to consider the complaint.

(Local Government Act 1974, section 24A(6), as amended)

3. We investigate complaints about councils and certain other bodies. We cannot investigate complaints that are wholly the responsibility of bodies such as the NHS. (Local Government Act 1974, sections 25 and 34A, as amended)

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How I considered this complaint

4. I have considered Mrs X’s complaint and the care provider’s responses. I invited Mrs X to comment on a draft of this decision.

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What I found

5. NHS Continuing Healthcare is a package of care arranged and funded by the health service to meet physical or mental health needs that have arisen because of a disability, accident, or illness.
6. The NHS can provide continuing healthcare at home or in a residential care home. The NHS is responsible for meeting the full cost of care in a care home for residents whose primary need for being in care is health-based. Complaints about NHS Continuing Healthcare are dealt with by the Parliamentary and Health Service Ombudsman (PHSO).

What happened

7. Mrs Y was a resident in the care home from 2015. Mrs X has complained about the care her sister received while she lived in the home. Mrs X says she tried to introduce measures to improve her sister’s quality of life, such as putting a whiteboard in Mrs Y’s room for her to read. However, Mrs X says the care provider failed to properly use the equipment.
8. Mrs X has also complained about the actions of the care provider shortly before Mrs Y died. She says it prevented her from visiting her sister and did not comply with Mrs Y’s request to read the bible to her.

Assessment

9. I will not investigate this complaint about the care Mrs Y received from the care provider. This is because the complaint is outside the Ombudsman’s jurisdiction.
10. The care provider has confirmed that Mrs Y’s care was fully funded by the NHS via Continuing Healthcare. We cannot investigate complaints about NHS funded care. Therefore, the complaint is outside our jurisdiction. The funding arrangements also mean this is a matter for the PHSO.

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Final decision

11. We cannot investigate this complaint. This is because the complaint is outside our jurisdiction.

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Investigator's decision on behalf of the Ombudsman