Summary: Mr B complained on behalf of his mother, Ms C, that the Trust did not provide suitable rehabilitation in hospital, that the Trust and Council failed to communicate changes to Ms C’s care plan, and that the Council did not communicate with Ms C about charges for care and wrongly charged her. We found fault with how the Council communicated with Ms C about charges, and that this caused uncertainty and distress to Ms C and Mr B. The Council has agreed to apologise, make a symbolic payment, and improve services. We found no fault in the Trust’s actions.

The complaint

1. Mr B complains on behalf of his mother, Ms C, that:

• County Durham and Darlington NHS Foundation Trust (the Trust), while Ms C was at the community hospital, changed her care plan from rehabilitation funded through an intermediate care package, to long term care, even though instructions from the acute hospital said she should receive intermediate care;
• the Trust did not support Ms C to participate in rehabilitation in hospital given her recent illness and previous progress with rehabilitation, and wrongly decided she should not receive further rehabilitation;
• the Trust and Durham County Council (the Council) failed to communicate with Ms C about changes to her care plan on leaving hospital; and
• the Council failed to communicate with Ms C about charges for care, and wrongly charged Ms C for care that it had previously told her would be funded through an intermediate care package.

2. Mr B said that because of these events, Ms C did not receive the rehabilitation she needed, and was discharged from hospital without being able to stand or walk, which he said remains ongoing. Mr B said Ms C subsequently cancelled the care package. He said she has not had the care she needed, and another family member has had to step in to provide care.
3. Mr B said this caused Ms C great distress at a time when she was already vulnerable. He also said trying to resolve matters has been very stressful and time-consuming for him.
4. As an outcome to his complaint, Mr B seeks explanations for what happened, service improvements by the Trust and Council, including communication with each other and with patients and their families, and financial remedy for distress caused.

Back to top

The Ombudsmen’s role and powers

5. 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).
6. 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).
7. 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.
8. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(1), as amended)

Back to top

How I considered this complaint

9. I considered evidence provided by Ms C and Mr B, and by the Council and Trust, as well as relevant law, policy and guidance.
10. Mr B and the organisations had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Key legislation and guidance

Hospital discharge

11. The Department of Health and Social Care issued statutory guidance: Hospital discharge and community support guidance (the National Discharge Guidance) in April 2022 (updated January 2024). This provides guidance to NHS bodies and local authorities on discharging adults from hospital. It said local areas should adopt discharge processes that best meet the needs of the local population. This could include the ‘discharge to assess, home first’ approach.
12. The guidance says NHS bodies and local authorities should ensure that, where appropriate, unpaid carers and family members are involved in discharge decisions.

Intermediate care and reablement

13. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.
14. Intermediate care can include bed-based care, which is a service delivered away from home, for example in a community hospital. Reablement services are usually provided in a person’s own home by a team of mainly care and support professionals.
15. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014).

Charging for social care services: the power to charge

16. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

What happened

17. In late 2024, Ms C was admitted to hospital. After around one month in the acute hospital, Ms C was transferred to the community hospital for rehabilitation. Both hospitals are managed by the Trust. While at the community hospital, Ms C took part in therapy and rehabilitation to help her regain her mobility. Ms C later had symptoms of a respiratory infection, and she was readmitted to the acute hospital for treatment. Ms C then returned to the community hospital.
18. During Ms C’s second stay at the community hospital, the Council was also involved in planning Ms C’s discharge from hospital. The Trust considered different options for Ms C’s care after she left hospital, including an intermediate care placement in a care home. However, Ms C returned home with a package of care in place.
19. After Ms C had been at home for around four weeks, the Council carried out a financial assessment. The Council advised Ms C’s family that her care was chargeable from when she first left hospital. Ms C then cancelled her care package for financial reasons. Ms C’s family then provided her with care.
20. Mr B complained to the Council about changes to Ms C’s care plan, communication about funding, and the financial assessment. Mr B later complained to the Trust about rehabilitation and changes to Ms C’s care plan. He was dissatisfied with the organisations’ responses and complained to the Ombudsmen.

Analysis

21. As Mr B’s complaint involves several different issues, I have set these out under separate headings, below.

A) Rehabilitation in hospital

22. Mr B complained that the Trust failed to provide the rehabilitation Ms C needed to regain her mobility. He said the Trust should have given Ms C more support to enable her to participate as she was unwell.
23. The Trust’s response to Mr B’s complaint set out dates of physiotherapy entries from Ms C’s records. It said that Ms C was offered physiotherapy on 27 occasions and participated in 10 of these sessions. Mr B said it was not a case of Ms C simply declining the therapy, but she was often too unwell to take part. He said the Trust did not consider the reasons Ms C was unable to engage with physiotherapy.
24. The records support the Trust’s response that Ms C was regularly offered physiotherapy but could not always take part. This included physiotherapy at both the acute and community hospitals. Regarding Mr B’s concern that the Trust did not consider other factors that might be affecting Ms C’s participation in physiotherapy, the Trust’s complaint response acknowledges that Ms C was at times too unwell to participate.
25. The records also show that the Trust considered how to support Ms C with participation in physiotherapy. There are references to Ms C finding it difficult to engage in physiotherapy on several occasions. The notes indicate the therapy teams offered encouragement and reassurance to Ms C. They also made a referral to the mental health physiotherapy team for advice. The mental health physiotherapy team spoke to Ms C and her family, and to ward staff. They discussed factors that might be having an impact on Ms C’s mobility and provided advice.
26. The records indicate that the Trust offered Ms C regular physiotherapy, supported her to participate, and explored whether there could be underlying factors affecting her participation. Therefore, there was no fault by the Trust in how it provided rehabilitation to Ms C and supported her with participating.

B) Changes to Ms C’s care plan

27. Mr B complained that the Trust and Council changed Ms C’s care plan for after she left hospital, from temporary rehabilitation funded through an intermediate care package, to long term care. He said the Trust told them that Ms C should receive rehabilitation at an intermediate care placement, but two days later told them rehabilitation was not suitable.
28. The Trust’s response to Mr B’s complaint said it considered various discharge options for Ms C, including intermediate care, and discharge home with a long term care package. The Trust said because Ms C had not been able to fully participate in physiotherapy, the multi-disciplinary team (MDT) considered other ways to support Ms C’s rehabilitation.
29. The records for Ms C’s first stay in the community hospital initially say that if she continued to progress and engage with physiotherapy, an intermediate care bed would be suitable. It was noted that this would depend on progress with physiotherapy. The records indicate Ms C had difficulties engaging with physiotherapy on several occasions. As noted above, the records indicate the physiotherapy team continued supporting Ms C to make progress.
30. The Trust contacted the Council’s hospital social work team about plans for Ms C’s discharge from hospital, and said an intermediate care placement would be suitable.
31. However, the next day, the Trust discharge management team noted there was a query over whether an intermediate care bed would be suitable for Ms C, as it said she had not been able to engage with physiotherapy on the ward. It said that for an intermediate care bed, the person should be engaging in therapy and have rehabilitation goals. A further occupational therapy review was arranged to identify if an intermediate care bed was suitable. The records say the occupational therapy team discussed with Ms C that rehabilitation would not be appropriate as she was not able to engage with rehabilitation on the ward, and arranged a further review the next day.
32. The following day, the Council’s records show the Trust’s discharge management team told the Council Ms C was found to have long term needs. The Council said it then arranged to assess Ms C’s needs. While I could not identify a record of this discussion in the Trust’s notes, the Trust’s response to this part of the complaint reflects the records referred to above, that the discharge plan for Ms C was adapted based on assessments of her needs.
33. The records include a summary of the MDT decision that the Trust referred to in its response. This says that as Ms C was unable to progress with mobility, she was returning home with a hospital bed and package of care. The Trust also made a referral for community physiotherapy to support mobility progression.
34. I recognise Mr B’s concerns that the plan for rehabilitation following discharge from hospital was changed, as the notes indicate the initial plan was for an intermediate care bed. However, as noted above in section A), the records show the occupational therapy and physiotherapy teams completed regular assessments and reviews for Ms C while in both the acute hospital and community hospital. These included considering Ms C’s needs after leaving hospital. The Trust records indicate that based on these assessments, it considered intermediate care would no longer be suitable and Ms C would require a long term care package after leaving hospital. Therefore, I find no fault by the Trust on this point.
35. Mr B also complained about how the change in care planning was communicated to Ms C and I have considered this in section C), below.

C) Communication with Ms C about changes to her care plan

36. Mr B complained the Trust did not communicate with Ms C and her family regarding changes to her care plan, from intermediate care with rehabilitation to long term care.
37. As noted above, the records show regular physiotherapy and occupational therapy reviews and assessments for Ms C. These records refer to discussions of discharge plans, including rehabilitation and whether an intermediate care bed would be suitable as this depended on progress with mobility.
38. The physiotherapy and occupational therapy teams met with Ms C and recorded that she advised she wanted to return home. The occupational therapy team also carried out a home visit. They discussed this with Ms C and her family and confirmed the plan that she would return home with a package of care and equipment in place.
39. Therefore I found no fault by the Trust on this point, as the records indicate it discussed the different options for Ms C’s care throughout her admission with Ms C and her family. The Trust also explained the referral to community physiotherapy to support with mobility after Ms C returned home. This appears in line with the hospital discharge guidance referred to above and with the Trust’s discharge policy.

D) Council communication about the care package and charging

40. Regarding the Council’s communication with Ms C and her family about care plans, the social work team initially discussed discharge planning with Ms C. The records note Ms C was upset and could not decide, and wanted to discuss with her family. A further meeting was arranged for two days later.
41. The Council’s needs assessment form says it again discussed options with Ms C and her family, including a time to think bed and a temporary placement. However, the records say Ms C declined these and wanted to return home with a care package in place and support from her family.
42. The assessment document says the Council explained to Ms C that a long-term care package would be in place. However, the assessment document also indicates that this was an intermediate care service.
43. Mr B complained the Council did not explain that Ms C would need to contribute to the first six weeks of her care after she left hospital. Ms C said she specifically asked about charges for care because she was concerned about potential cost. Mr B and Ms C said the Council advised them that the first six weeks would be funded through intermediate care. Ms C recalled the Council said there would be a financial assessment, but that this would only apply to care provided after the initial six weeks. However, around four weeks after she had returned home, the Council advised Ms C that the care was chargeable from the start.
44. The records say that as part of the assessment while Ms C was in hospital, the Council advised her a financial assessment would take place, and that she may need to make a financial contribution. However, it does not say whether the Council said that any contributions Ms C might need to make would apply from the start of the care package. It is not clear whether the Council clarified what the change from intermediate care to a long-term care package would mean in terms of charges, so that Ms C could make an informed decision.
45. Therefore, there was fault by the Council on this point, causing uncertainty and avoidable distress to Ms C and Mr B. I have made recommendations to the Council on this point, below.

Back to top

Action

46. Within one month of the final decision on this complaint, the Council has agreed to:
47. Apologise to Ms C and Mr B; and
48. Make a payment of £150 to Ms C, to act as a symbolic recognition of the uncertainty and avoidable distress caused by the fault.
49. Within three months of the final decision on this complaint, the Council has agreed to improve its guidance on giving clear information about the need to make a financial contribution towards care.
50. The Council should provide us with evidence they have complied with the above actions.

Back to top

Decision

51. I find fault by the Council in its communication about charging, causing injustice. The Council agreed actions to remedy the injustice caused. I find no fault by the Trust.

Investigator’s decision on behalf of the Ombudsmen

Back to top

Investigator's decision on behalf of the Ombudsman