Summary: Mrs Y complained that services failed to provide funding for her father’s post-hospital care for long enough. We found that an Integrated Care Board funded the person’s care for an appropriate length of time. However, we found fault in the way the Council explained the process to the family. This caused avoidable stress, frustration and time and trouble for Mrs Y. In addition, we found fault in the way the Council responded to the family’s request for a meeting to discuss their complaint. We recommended that the Council apologises, makes a small financial payment to recognise the injustice and provides evidence of its learning from the complaint.

The complaint

1. Mr X left hospital and went into a nursing home (the Home) in March 2022. His daughter, Mrs Y, said a social worker from Leeds City Council (the Council) told the family that the first six to eight weeks of weeks of Mr X’s time in the Home would be fully funded.
2. Mrs Y complains, on Mr X’s behalf, that services did not honour this commitment. She said, instead, NHS West Yorkshire Integrated Care Board (the ICB) only funded the first 18 days of Mr X’s placement.
3. Mrs Y complains that Mr X lost out financially as he had to pay for his care around four weeks too soon. Mrs Y said the family paid over £4,000 to the Home which they do not consider they should have had to pay.
4. Also, Mrs Y complains about failings in the complaints process. In particular, she said that in October 2023 she asked for a meeting between the family, the Council, the ICB and the Home. Mrs Y complains the organisations met that month but did not invite the family.
5. In bringing the complaint to the Ombudsmen Mrs Y said she would like:

• the appropriate department to pay for Mr X’s care in the Home for the full period originally advised to the family by a social worker. And,
• for all parties to take responsibility for the poor communication that occurred.

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The Ombudsmen’s role and powers

6. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA). The Local Government and Social Care Ombudsman investigates complaints about adult social care providers. (Local Government Act 1974, sections 34B, and 34C, as amended). The Health Service Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’ in the delivery of health services (Health Service Commissioners Act 1993, section 3(1)).
7. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
8. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
9. If there was no fault in how an organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
10. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

11. I considered Mrs Y’s written complaint to the Ombudsmen and spoke to her and her husband on the phone. I wrote to the Council and the ICB to explain what I intended to investigate and to ask questions and for relevant evidence. I also asked for copies of relevant records from the NHS Trust responsible for Mr X’s inpatient admission. I considered all the papers I received in response. I read relevant legislation and guidance.
12. I shared a confidential version of a draft decision with Mrs Y and the organisations and invited their comments on it. I considered all the comments I received in response.

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What I found

Relevant legislation and guidance

Hospital discharge during the COVID-19 pandemic

13. In August 2020, in response to the COVID-19 pandemic and the need to keep hospital beds free, the Government introduced the Hospital Discharge Service: Policy and Operating Model.
14. The model set out that patients must be discharged from hospital as soon as it was clinically safe. It consisted of four care pathways:

• Pathway 0 applied to people with simple discharge needs and no requirement for ongoing health and social care support.
• Pathway 1 applied to people who could return home with support from health and/or social care services.
• Pathway 2 applied to patients requiring rehabilitation or short-term care in a 24‑hour bed-based setting.
• Pathway 3 applied to people who required ongoing 24-hour nursing care on a long-term basis, often in a bed-based setting.

15. In March 2022 these pathways remained in place. By this time the relevant guidance was from October 2021: Hospital discharge and community support: policy and operating model.
16. This explained that the government had provided a national discharge fund, via the NHS, up to 31 March 2022, to help cover some post-discharge care costs. The policy said the NHS would fund up to four weeks of care on discharge from hospital, up to and including 31 March 2022.
17. It also said there was an expectation that an assessment for ongoing health and care needs would take place within four weeks of discharge. It said this would include a decision about how ongoing care will be funded.

NHS Continuing Healthcare and Adult Social Care

18. NHS Continuing Healthcare (CHC) is a package of ongoing care the NHS arranges and funds where it decides the person has a ‘primary health need’. The NHS can provide CHC funding in any setting including by paying for nursing home fees. NHS-funded nursing care (FNC) is the funding provided by the NHS to residential nursing homes that also provide care by registered nurses. FNC funding is set at a weekly rate. A person’s local Integrated Care Board (ICB) is responsible for assessing their eligibility for CHC or FNC and providing the funding.
19. Where the NHS will not meet a person’s needs through CHC local authorities have a duty to arrange care and support for those with eligible needs. Section 14 of the Care Act 2014 gives local authorities discretion to charge for services they arrange and provide.
20. Where a local authority decides to charge it must carry out a financial assessment to decide what a person can afford to pay towards their care. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014. Local authorities should also have regard to the Care and Support Statutory Guidance that accompanies the Care Act 2014.

Summary of events

21. Mr X went into hospital in October 2021 after falling at home. In late December the hospital discharged him home. However, he returned to hospital several days later.
22. The hospital felt Mr X would not manage at home and the family agreed. In early January 2022 a hospital discharge coordinator spoke to Mrs Y about discharging Mr X to a Discharge to Assess placement. It referred Mr X to adult social care. In early February the Council allocated a social worker to Mr X’s case. A few days later the social worker emailed the hospital and noted that Mr X still wanted to go into 24-hour care. The social worker noted their plan to “speak to family regarding finances/etc then look into exploring placements”. The social worker spoke to Mrs Y the following day. In their notes they said they agreed to meet the family “to discuss any worries/questions they may have regarding 24 hour placements/finances etc.” They also noted they planned to give the family copies of a Care Directory and financial information when they met.
23. A social worker met members of Mr X’s family in mid-February. They agreed that Mr X would need to go into a care home when he left hospital. Other points of discussion are disputed.

• The Council said the social worker confirmed that Mr X would need to pay for his own care home placement from the outset.
• Mrs Y said it the social worker agreed that Mr X would fund his own placement after six to eight weeks of fully funded care.

24. The family chose the Home and Mr X left hospital and moved there in early March. Two days later a social worker applied for ‘Discharge to Assess: Temporary to Permanent’ funding for Mr X. The relevant team at the ICB agreed this the same day, to start from the date of Mr X’s discharge until he underwent a CHC assessment later in the month.
25. Toward the end of March professionals assessed Mr X’s eligibility for CHC. They determined that he was not eligible for CHC but was eligible for FNC. The ICB’s CHC team wrote to Mr X and said:

“This means that from 24/03/2022 we will pay the current funded nursing care contribution each week for any period in which you stay in a care home with nursing”.

26. In late October 2022 the ICB paid the Home for the first 18 days of Mr X’s time in the Home (from the date of his admission to the date of the CHC assessment). The Home did not notice and allocate this payment until late March 2023.
27. Mrs Y complained to the Council in June 2023. She said the social worker told the family that Mr X’s care would be funded for eight weeks but it had not been.
28. The Council replied toward the end of August 2023. It acknowledged there had been some miscommunication and misunderstanding about post-hospital funding. However, the Council did not give a view on who had been responsible for this, or whether it was avoidable. The Council said there were no funding arrangements that included eight weeks’ free care.

Analysis

Funding

29. The Council’s response that there are no funding arrangements which provide eight weeks' free care is correct. As detailed in paragraphs 16 and 17, at the time Mr X left hospital there was a national system in place to provide free care for up to four weeks, or until the person’s eligibility for ongoing NHS funding was assessed. Mr X received this funding and did not have to pay for his care until after the ICB determined he was not eligible for CHC. This was appropriate.
30. There is a clear dispute about what was said at the meeting between the social worker and family in February. From my independent perspective I cannot resolve this and determine what was said.
31. However, regardless of this dispute, there is evidence of shortcomings in communication during this time. The reason for Discharge to Assess funding was to allow people to move on and allow time in a non-hospital setting so a better assessment of ongoing needs could be completed. This, in turn, will affect decisions about how the person’s long-term care will be funded. Because of this, when the social worker spoke to the family in February it was still unknown whether Mr X would be found to be eligible for CHC. It should have been made clear, by the Council, during discharge planning how the Discharge to Assess funding would work, including details of how long it would last and what would happen after the CHC assessment.
32. There were further missed opportunities to provide information and advice to the family: when the social worker successfully applied for the temporary funding in the days after Mr X went into the Home; and, after the ICB decided that Mr X was not eligible for CHC. In relation to this, the only contact Mr X got after the CHC decision was a letter from the ICB.
33. Overall, Mr X did not lose out financially as his care was fully funded for an appropriate period, in line with the policies and procedures in place at the time. However, the failings in communication by the Council were fault. They meant that Mr X and his family were less well informed than they should have been. This, in turn, caused them stress and frustration along with time and trouble in pursuing a complaint. This is an injustice. In its complaint responses the Council acknowledged there was “some miscommunication and misunderstanding”. It did not give a clear view on who had been responsible, although it said it would take learning from the complaint and reiterate to staff the need for clear plans and communication. I have made a recommendation to further address the injustice below.

Complaints process

34. Mrs Y made a follow-up complaint to the Council. She then spoke to a member of the Council’s complaints team and discussed arranging a meeting involving Mrs Y, the Council, the ICB and the Home. Later in the month Council staff met staff from the ICB and the Home. No minutes were taken of the meeting. The Council said the purpose of the meeting was to discuss the Discharge to Assess payment process and how to incorporate that information into written responses from the Council and the Home. Following the meeting the Council sent Mrs Y a written response to her complaint.
35. Later, after Mrs Y asked about the meeting, the Council complaints team emailed her and noted that no one from its complaints team had attended the meeting. It said it had raised a query with the relevant head of service who attended the meeting, and asked for details of when the meeting took place and for Mrs Y to be given a copy of any notes/minutes that were made. To my knowledge Mrs Y has not received any further information since then.
36. As with the main issue of funding, there is again evidence of poor communication here. After Mrs Y asked for a meeting to discuss her outstanding concerns the Council should have given Mrs Y a clear decision and rationale if it did not consider that was appropriate or practical. It did not. This left Mrs Y feeling frustrated and aggrieved. This is a further injustice to her and I have made a recommendation to address it.

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Agreed actions

37. Within one month of the final decision the Council should write to Mrs Y and acknowledge its responsibility for failings identified in paragraphs 33 and 36. It should also apologise for the impact of these failings on Mrs Y and the family.
38. Within one month of the final decision the Council should offer to pay Mrs Y £100 to act as a tangible recognition of the injustice she was caused by the Council’s fault. This amount was suggested in line with LGSCO’s guidance on remedies. During the investigation Mrs Y told me that she and the family do not consider this to be an adequate amount. It will be for Mrs Y to decide whether to accept this payment, but the Council should offer it to her.
39. Within three months of the final decision the Council should provide the Ombudsmen with evidence of the work it has completed to learn from this complaint and to help prevent recurrences.

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Decision

40. I found there was fault in the way the Council explained the post-discharge assessment and funding process to Mrs Y, and fault in the way it handled Mrs Y’s request for a meeting. I have closed this investigation on the basis that the recommendations I have made will provide a proportionate remedy to the injustice these faults caused.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman