Summary: We will not investigate this complaint about failures in communication for an adult’s social care and funding. The Council has completed a thorough investigation and reached sound conclusions. It is unlikely the Ombudsman could add to that or reach a different outcome. The Council has apologised to the complainant for confusion and distress caused by its failures in communication, and spoken with relevant staff to prevent future problems.

The complaint

1. Ms E says the communication from the Council about her relative, Ms F’s, care arrangements and funding has been poor. This has caused Ms E to be stressed and anxious. Ms E wants a refund of fees for a period she believes Ms F should have received Continuing Healthcare funding.

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The Ombudsman’s role and powers

2. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
3. 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:

• we could not add to any previous investigation by the organisation, 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, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

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

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My assessment

6. Ms F moved to a residential care home in May 2022. Ms E raises concerns about interactions from the Council and the care home from this time. The Ombudsman will not consider issues from 2022 as they would be late complaints in accordance with paragraph two. There is no good reason Ms E could not have raised those complaints sooner.
7. Ms E complained to the Council in April 2024 about events from November 2023. These are the issues I have considered. The Council provided Ms E with a thorough response considering the available evidence in its case records. It is unlikely the Ombudsman could add to that investigation or reach different conclusions. I do not therefore intend to repeat all the issues of complaint and findings.
8. The Council was involved as the relevant safeguarding authority to consider an incident at Ms F’s care home (care home A) which resulted in a hospital stay and a decision about where Ms F should live thereafter.
9. Ms E says the Council did not tell her which hospital Ms F went to and that she was having surgery. The Council explains it was not responsible for this. Care home A should have told Ms E about Ms F going to hospital, and the hospital should have advised the family about Ms F’s surgery. The Council correctly told Ms E she would need to make separate complaints to the relevant bodies. The Ombudsman could consider a complaint about the care provider’s actions if it is not resolved through its own complaint process. Ms E would need to exhaust that process before we can consider that matter further. The Ombudsman has no powers to consider a complaint about the hospital.
10. Ms E also complained she was not told about Ms F’s discharge from hospital to care home B. The Council accepted responsibility for this failure and apologised to Ms E for her distress. The Council also raised the issue with the relevant member of staff in their supervision meeting. That is appropriate action in response, and it is unlikely the Ombudsman would achieve anything further.
11. Ms E’s main issue of concern is about the funding of care home B and miscommunication about this. Ms F’s doctor was applying for Continuing Healthcare funding, which is funding from the NHS. Any complaints about failures in this process and the decision about eligibility is for the NHS and not in our powers to consider.
12. Ms E says the Council told her Ms F had ‘full funding’ for her care fees. I have seen no evidence to support this. The Council accepts an error in an e-mail which stated Ms F would meet the criteria for NHS funding, despite telephone conversations advising otherwise. This may have caused some confusion to Ms E, and the Council has correctly apologised for that. The Council has no power to decide Ms F’s eligibility for Continuing Healthcare funding and has spoken to its staff about avoiding involvement in funding discussions when it is not part of that staff member’s role.
13. The Council’s miscommunication does not result in Ms F wrongly paying for care. The Council has assessed Ms F is responsible to fund her own care unless the NHS decides it has responsibility to fund some or all of it. Therefore, Ms F will receive invoices from care home B. The Ombudsman cannot achieve the outcome Ms E wants, for a refund of some of Ms F’s care fees, because only the NHS can decide Ms F’s eligibility for NHS funding. If it still has not done so Ms E can complain to the NHS about its delay and can ask it to make a retrospective decision. The NHS may backdate any funding Ms F would have been eligible for.

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Final decision

14. We will not investigate Ms E’s complaint because we could not add to the Council’s investigation, reach a different outcome, or achieve the outcome Ms E wants.

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Investigator's decision on behalf of the Ombudsman