The Ombudsman's final decision:
Summary: Mr X and Ms Y complained the Council delayed transferring their late mother, Mrs Z, from a temporary care home to her preferred care home, pending the outcome of a Continuing Healthcare (CHC) assessment. The Council was at fault. It did await the CHC outcome, but this did not cause Mrs Z an injustice as Mrs Z was unwell and so the delay did not affect the timing of the move. The Council has agreed to apologise to Mr X and Ms Y for the lack of clarity in its communications and remind staff that CHC assessments should not delay planned care home moves.
- Mr X and Ms Y complained the Council delayed transferring their late mother, Mrs Z, from a temporary care home bed to her preferred care home, whilst awaiting the outcome of a Continuing Healthcare (CHC) assessment. They say the delay was against Council policy and their wishes and caused them distress. They want the Council to accept it was wrong to delay the move whilst awaiting the CHC assessment and take action to ensure this does not happen to others in future.
The Ombudsman’s role and powers
- 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’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
- When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
- If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
How I considered this complaint
- I read Mr X and Ms Y’s complaint and spoke with Ms Y about it on the phone.
- I made enquiries of the Council and considered information it sent me.
- Mr X, Ms Y and the Council had the opportunity to comment on the draft decision. I considered their comments before making a final decision.
What I found
- Some people with long term complex health needs qualify for free social care arranged and funded by the NHS. This is called NHS Continuing Health Care (CHC). If a person’s health is deteriorating quickly and they may be nearing the end of their life, they should be considered for the CHC fast track pathway. This ensures an appropriate care and support package can be put in place as soon as possible – usually within 48 hours.
The Council’s policies and procedures
- Council policy says officers should consider whether a person is likely to be eligible for CHC funding as part of their assessment.
- It is not Council policy to await the outcome of a CHC assessment before facilitating a move between care homes.
- Mrs Z has two adult children, Mr X and Ms Y. In September 2019, Mrs Z was discharged from hospital to a temporary bed at care home A. The Council planned to assess Mrs Z’s level of care needs in care home A, and once established, would work with Mrs Z and her family to identify a permanent care home that could meet her needs.
- The Council social worker assessed Mrs Z and spoke with her and Ms Y. They agreed she needed nursing care. Mrs Z, Mr X and Ms Y told the social worker their preferred care home was care home B.
- Care home B assessed Mrs Z and agreed it could meet her needs. It told the Council a bed would be available in about 10 days.
- The Council considered Mrs Z may be eligible for CHC funding. It asked care home A to contact the GP practice serving the home to request an assessment.
- A GP from the practice initially said Mrs Z was not for fast track, but a referral was completed and submitted to the CHC team for screening a few days later.
- On 8 October 2019, a bed at care home B became available. The Council spoke to Mr X. The record shows the Council expressed concerns to Mr X about Mrs Z’s health and whether she was well enough to travel to care home B. Mr X told the Council he thought she was well enough to move.
- The Council contacted care home B the same day to say the CHC assessment was ongoing and it would inform it of the outcome, once known. Care home B said it would hold the bed for Mrs Z until the CHC team made its decision. Care home B also raised concerns about moving Mrs Z.
- On 9 October 2019, the Council spoke to Mr X again. Mr X said he did not believe his mother met the criteria for CHC funding. The Council told him it was still awaiting the completed CHC assessment paperwork from the GP.
- The Council emailed Mr X. The email said:
“It will not be possible to move your mother until the CHC assessment has taken place, although, I understand [care home B] have a place available and that this is being held until her CHC status has been established.”
- The family contacted the Council to express concern that Mrs Z ‘s move to care home B was delayed due to disagreement over funding arrangements.
- On 14 October 2019, the Council contacted Ms Y. It said Mrs Z was too unwell to transfer to care home B and this decision had been taken by a range of professionals involved in her care. It said this decision was made in her best interests, not because of delay in the CHC assessment.
- On 15 October 2019, the CHC assessment team told the Council Mrs Z was not eligible for the CHC Fast track pathway. The Council contacted care home A and care home B and asked them to assess Mrs Z and tell the Council when they felt Mrs Z was well enough to move to care home B.
- A GP reviewed Mrs Z the following day. The GP said it was not ideal to move her. The records show the Council was aware Mrs Z’s family wanted her to move to care home B as soon as possible. It decided to arrange the move and booked hospital transport.
- Mrs Z moved to care home B on 17 October 2019.
- On 22 October 2019, Mrs Z passed away.
- Mr X and Ms Y complained to the Council. They complained the Council had blocked Mrs Z’s move to care home B because of disagreement over funding. They said it had been wrong to delay the move for financial reasons and the delay had been against the family’s wishes.
- The Council responded to the complaint. It said the delay between identifying an available bed at care home B and Mrs Z moving had been 9 days. It apologised for the impact of the delay on Mrs Z and her family. It said funding arrangements between the Council and NHS were not the reason for the delay and it had taken advice from a range of professionals who agreed it was not in Mrs Z’s best interest to transfer her at that time. It also apologised if it had not communicated the CHC assessment process well enough to the family.
- Mr X and Ms Y remained unhappy and brought their complaint to us.
- The Council acted in line with its policy by considering whether Mrs Z was eligible for CHC support and funding.
- Although the Council says funding arrangements were not the reason for the delay, the evidence shows the Council did await the outcome of CHC assessment before arranging to move Mrs Z to care home B. This is shown by:
- The manager at care home B agreeing with the Council to hold the bed until a decision has been made by the CHC team.
- The Council email sent to Mr X on 9th October which said, “it will not be possible to move your mother until the CHC assessment has taken place, although I understand [care home B] have a place available and that this is being held until such time her CHC status has been established”.
- The Council told Mr X about its concerns in the phone call on 9 October. Care home B also expressed concerns the same day.
- The Council email to Ms Y on 14 October said Mrs Z was very unwell and a move was currently not in her best interests.
- After receiving the CHC outcome, the Council asked care home A and care home B to assess if Mrs Z was fit for travel, rather than immediately arranging transport.
- The GP who reviewed Mrs Z expressed concerns about moving Mrs Z. The Council considered their advice and the family’s views. As the family had expressed a strong view for her to move, it decided to arrange for Mrs Z to move to care home B.
- Within one month of the final decision, the Council will:
- Write to Mr X and Ms Y to acknowledge that it did wait for the CHC outcome before arranging to move Mrs Z, which was against its policy. It should apologise for the lack of clarity in its communications and the uncertainty and distress caused.
- Remind relevant staff that planned moves between care homes should not be delayed whilst awaiting the outcome of CHC assessments.
- I have completed my investigation. I have found fault and the Council has agreed actions to remedy the injustice caused.
Investigator's decision on behalf of the Ombudsman