Midlands and Lancashire CSU HQ (23 014 962a)
Category : Health > Assessment and funding
Decision : Closed after initial enquiries
Decision date : 06 Aug 2024
The Ombudsman's final decision:
Summary: Ms A has complained on behalf of a residential care home about a lack of funding by a council and an integrated care board for the increased support the care home provided to a resident. Ms A has also complained about a lack of safeguarding by the Council. We do not find fault with the Integrated Care Board. We find fault with the Council in relation to funding and safeguarding leading to a financial shortfall and increased risk for the Home. The Council has agreed to a financial remedy, apology and a reminder to staff as a satisfactory remedy.
The complaint
- Ms A, on behalf of Leicestershire County Care, is unhappy with Leicester City Council (the Council) and Midlands and Lancashire Commissioning Support Unit (the CSU) on behalf of NHS Leicester, Leicestershire and Rutland Integrated Care Board (the ICB) in relation to a lack of funding support for a resident, Mr B, under their care.
- Mr B’s needs increased leading to assaults on staff and residents which meant he needed more support.
- Ms A has criticised the delay in agreeing to fund Mr B and that the funding was not backdated to when she first raised concerns in June 2023.
- In addition, Ms A is unhappy with a lack of safeguarding by the Council which she said put staff, residents, and visitors at risk.
- Ms A said the circumstances of the complaint led to residents, staff and visitors being assaulted and having to provide more support to prevent this. This support has not been paid for by either the Council or the ICB.
- Ms A would like the extra support to be reimbursed jointly by the Council and the ICB for the period June 2023 to September 2023.
The Ombudsmen’s role and powers
- 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).
- We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we 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).
- If it has, we 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.
- 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)
How I considered this complaint
- I have considered evidence from Ms A in written form and over the telephone. I have also considered evidence from the Council, CSU and ICB including complaint responses and correspondence.
- I have also taken account of the relevant guidelines and legislation.
- I gave Ms A and the organisations an opportunity to comment on my draft decision. I received comments from the Council which I considered before making this final decision.
What I found
Continuing Healthcare
- Continuing Healthcare (CHC) is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. CHC funding can be provided in any setting and can be used to pay for a person’s residential nursing home fees in some circumstances.
- A person’s local Integrated Care Board (ICB) is responsible for assessing their eligibility for CHC or FNC and providing the funding. ICBs sometimes commission other NHS organisations to carry out the assessments on their behalf.
- For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist. The threshold for meeting the CHC Checklist is set low.
- If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. This assessment is completed using a decision support tool (DST). The DST is a record of the relevant evidence and decision-making. The DST’s recommendation is the usually agreed by the ICB. Funding is then provided from the date the person is found eligible for CHC.
Background
- Mr B stayed at a care home (the Home) ran by Ms A for Leicestershire County Care. His care was funded by the Council and in 2023 his behaviour began to deteriorate.
- Mr B became aggressive to staff and residents.
- The Home involved various agencies including the Council, Mr B’s GP, the police and the In Reach Team, which is a local Older People’s Mental Health Team.
- In late July 2023 the Home served notice to remove Mr B as a resident.
- Mr B had a CHC checklist carried out in August 2023 and CHC funding was agreed in September 2023. The ICB agreed to fund his care from September 2023 onwards.
- Mr B then moved to nursing home which was better equipped to meet his needs.
Funding
- Ms A said she placed extra staff on at the Home to accommodate Mr B’s shift in behaviour and to meet his increased needs.
- Ms A said she raised this with the Council in June 2023 regarding the level of support Mr B now required.
- Ms A said she raised the matter with the Council asking if it would fund Mr B’s increased level of support until he was found eligible for CHC, the period June to September 2023.
- Ms A said the Council told her it would not fund the increased support for this period as this was a health need and so any support would not be funded by the Council but would need to be funded by the NHS.
- The ICB said it was not aware of Mr B before August 2023 and so had no way of agreeing funding prior to this.
- Ms A feels there is a shortfall of four months from her raising her concerns about Mr B’s behaviour and required extra support being funded by the ICB. This has left the Home at a financial disadvantage. She feels the Council, the ICB, or both are responsible and so should each pay half of the cost of this extra support for this period.
- The Council has said it was first contacted in May 2023 by the Home about Mr B’s behaviour and the In Reach Team got involved. The Council said the Home told the Council it could now manage Mr B’s needs following the input from the In Reach Team and the Home did not contact the Council again until July 2023.
- In July 2023 the Home contacted the Council again to say Mr B had attacked staff and residents and it could no longer manage his needs. The Council informed the Home to contact Mental Health Services to carry out a Mental Health Act assessment.
- The assessment recommended medication and more involvement of the In Reach Team.
- The Council said that the Home contacted it in July 2023 to state it was serving notice on Mr B to remove him from the Home.
- The Council discussed with the matter with In Reach Team about completing a CHC checklist at this time but the Team advised that due to the medication change it was not appropriate as Mr B’s needs could not yet be assessed as a baseline. The Team arranged an assessment for the end of August.
- The Council said it was the responsibility of the In Reach Team to carry out the checklist.
Analysis
- There is no record in the Council’s records of the Home contacting the Council in June 2023 about Mr B’s behaviour. There is a record in July 2023 and with the Mental Health Act assessment and the medication being changed, it was right to wait until the end of August until a checklist was carried out.
- The National Framework also states that funding comes from when the person is found eligible, not from the date of the checklist.
- In view of this I do not find fault with the Council in relation to not ordering a checklist earlier. In addition I do not find fault with the ICB in not paying for the earlier period of support as it only became aware of Mr B in August 2023.
- However, the Council was responsible for Mr B’s care up until he became eligible for CHC and when he required extra support it declined to provide this support to the Home.
- The social care records illustrate that from the start of August onwards the Home was providing 1:1 care to Mr B and asking the Council to provide funding for this.
- The Council discussed the matter and there was mention of a Shared Care fund with the NHS which could be used.
- However, the Council decided against using this fund as the CHC assessment process had already started.
- The Care Act 2014 Section 19 states where an individual with urgent needs is referred to the local authority, the local authority should provide an immediate response and meet the individual’s care and support needs. For example, where an individual’s condition deteriorates rapidly, they will need a swift response to ensure their needs are met.
- Even though the In Reach Team was involved and a CHC assessment process was ongoing, the Home were still needing extra support to deal with Mr B’s behaviours. The Council was responsible for meeting this urgent need for the period the Home was providing extra support until Mr B was found eligible for CHC. The Council did not provide this support or provide funding for it. This was fault on its part which led to a financial shortfall for the Home.
Safeguarding
- Section 42 of the Care Act 2014 says that a council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.
- Where the actions required to protect the adult can be met by local authorities, they should take appropriate action. In some cases, safeguarding enquiries may result in the provision of care and support (under either section 18 or 19 of the Care Act).
- In this case the Home raised concerns about Mr B, staff and residents’ safety.
- The Council did not carry out a safeguarding enquiry to see what preventative action could be taken. This was fault on its part. It may have been the result would have been the same as the Council was not willing to provide support, however it was a missed opportunity to explore who was at risk and mitigate any risk of harm done to residents.
Recommendations
- I find faults in funding and safeguarding led to a financial shortfall and a missed opportunity to reduce the risk of harm to the Home residents. Therefore, I recommend that by 6 September 2024 the Council:
- Writes to the Home to apologise for the financial shortfall and missed opportunity to reduce the risk of harm caused by its failings in funding and safeguarding
- Pays the Home the amount it spent on providing extra care to Mr B from August 2023 to when he was found eligible for CHC in September 2023
- Reminds its staff of the importance of carrying out safeguarding enquiries when care home residents are at risk of harm
- The Council should provide us with evidence it has complied with the above actions.
Final decision
- I find fault with the Council in relation to funding and safeguarding. I do not find fault with the ICB.
Investigator’s decision on behalf of the Ombudsmen
Investigator's decision on behalf of the Ombudsman