Summary: We will not investigate a complaint about a Council’s delay in completing a needs assessment or continuing healthcare checklist following a hospital discharge. This is because there is insufficient evidence of significant injustice linked to any faults with the process.

The complaint

1. Dr B complains on behalf of her mother, Mrs C, about Sunderland City Council (the Council). She complains the Council failed to consider the impact of delays in assessing her mother’s care needs following her discharge from hospital in October 2021. Dr B says the delays and lack of care plan resulted in Mrs C needing to return to hospital a few weeks later.
2. Dr B also complains that a social worker completed a Continuing Healthcare (CHC) checklist for her mother without considering evidence from her as an essential care giver.
3. Dr B complains the Council implied she obstructed Mrs C’s hospital discharge in early October 2021 because of her unresolved concerns about safeguarding issues at her previous care home.
4. Dr B considers the failings led to her mother’s health rapidly deteriorating to the point where she had no mobility and needed nursing care with full CHC support. She says the events have also impacted on her with additional stress caused by her struggle to ensure her mother’s needs were met.
5. Dr B wants the Council to accept the failings and refund care home fees between 25 October and 13 November 2021.

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The Ombudsman’s role and powers

6. The Ombudsman investigates 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 may decide not to continue with an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• further investigation would not lead to a different outcome.

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

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How I considered this complaint

7. I considered information provided by Dr B and the Council.
8. I considered the Ombudsman’s Assessment Code.
9. The complainant had an opportunity to comment on my draft decision.

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My assessment

Background information

10. Mrs C was resident at care home (Home 1). She was admitted to hospital in August 2021. At the same time the Council was considering some safeguarding concerns about Home 1. The Council discussed these issues with Dr B while Mrs C was in hospital.
11. The hospital considered Mrs C was medically fit for discharge in early October 2021. Mrs C planned to return to Home 1. However, she had a set-back and had to remain in hospital until the end of October.
12. During this time Dr B found a different care home (Home 2) for her mother to move to when she left hospital. Due to national COVID-19 hospital discharge arrangements that were in place at the time, the Council planned to assess Mrs C’s care needs after she had moved to Home 2 (discharge to assess).
13. A social worker completed a welfare check and a CHC Checklist when Mrs C had been at Home 2 for a week. The checklist did not indicate a need for a full CHC assessment (a decision support tool (DST)).
14. After around three weeks, Mrs C needed to go back to hospital. At this point the Council had not completed a care needs assessment.

Analysis

Assessment delays

15. The Council accepted fault with not sharing information with the care home about Mrs C when she left hospital. However, as the placement was under the discharge to assess process, the Council’s failure to provide the screening report to Home 2 would not have affected the decision to discharge her there.
16. Under the discharge to assess arrangement, the Council should complete a care needs assessment in 28 days. However, Mrs C returned to hospital before then.
17. We are therefore unlikely to find fault in the timing of a care needs assessment by the Council or link any potential injustice to the lack of assessment. The Council completed a welfare check after a week. Home 2 reported no concerns and Mrs C said she was settling in well.
18. Although Mrs C’s health declined and she needed to return to hospital, it appears her health was poor and had fluctuated in recent months. Notably, Mrs C’s hospital discharge planned for 5 October 2021 was cancelled because she became medically unfit. I therefore consider it unlikely we could link a decline in Mrs C’s health to any potential fault with assessments or her placement.

CHC Checklist

19. Dr B complained the social worker completed a CHC checklist without considering evidence from her as an essential care giver. She says this goes against the National framework for NHS continuing healthcare and NHS-funded nursing care. In Dr B’s complaint to the Ombudsman, she quoted sections of the National Framework that she felt were relevant. However, these sections relate to people who lack mental capacity (as defined under the Mental Capacity Act) and/or need a best interests decision making about the continuing healthcare process. These did not apply to Mrs C. The National Framework does however set out the importance of carers and that NHS bodies and local authorities have a responsibility to work in partnership with carers.
20. The Council’s complaint response explained the social worker based their completion of the checklist on relevant health and care records. They also discussed Mrs C with the manager of Home 2. It seems there was some discussion between Dr B and the social worker, although it is not clear this was specifically about the CHC checklist.
21. It would be difficult to say whether further discussion with Dr B about Mrs C’s needs would have changed the outcome of the CHC checklist. This would have been the social worker’s view of Mrs C’s presentation and needs. If the decision had been different and the checklist indicated a full continuing healthcare decision support tool (DST) was needed, it is unlikely this would have happened before Mrs C’s hospital readmission. The National Framework sets out that CHC decisions should be completed within 28 days. I therefore consider it is unlikely to have affected the care Mrs C received prior to her hospital readmission.

Safeguarding issues

22. The Council’s response recognised Dr B had concerns about Mrs C’s previous care home but said there was no reason to delay the discharge process. It said the social worker agreed a plan with Dr B to resolve the issues with Home 1. However, before Mrs C returned to Home 1, she became medically unfit for discharge and needed to remain in hospital.
23. I can appreciate Dr B was frustrated with the safeguarding process and the decisions around her mother’s hospital discharge. However, I do not consider the Council’s response implies Dr B was obstructing her mother’s hospital discharge, but rather explaining the events in a factual way. It noted Mrs C had capacity to make decisions about her discharge and that she had wanted to return to the care home. Unfortunately Mrs C had a set-back and the discharge did not go ahead. There was therefore no injustice relating to the safeguarding concerns not being resolved before Mrs C’s return to Home 1.

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Final decision

24. We should not investigate this complaint. This is because there is insufficient evidence of fault with the delays in assessment. Additionally it is unlikely we would find an injustice linked to any fault we might find with other aspects of the discharge process.

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Investigator's decision on behalf of the Ombudsman