Summary: Miss G is complaining about the care provided to her mother, Mrs H, by North Lincolnshire Council and Northern Lincolnshire and Goole NHS Foundation Trust in 2024. We will not investigate Miss G’s complaint. This is because an investigation by the Ombudsmen would be unlikely to add to the work the Trust has already undertaken to investigate Miss G’s concerns.

The complaint

1. Miss G, is complaining about the care provided to her mother, Mrs H, by Northern Lincolnshire and Goole NHS Foundation Trust (the Trust) and North Lincolnshire Council (the Council) when Mrs H was an inpatient in Scunthorpe General Hospital in March 2024. Miss G complains that:

• the professionals supporting Mrs H failed to complete Continuing Healthcare Checklist for her during her admission;
• the Trust failed to complete an adequate Speech and Language Therapy (SALT) assessment for Mrs H;
• a multidisciplinary meeting held by the Trust and Council failed to adequately consider Mrs H’s care needs;
• the Trust discharged Mrs H to a residential placement when her level of need was such that she required a nursing home; and
• the Trust and Council failed to handle her complaints appropriately.

2. Miss G says Mrs H’s condition deteriorated following her discharge to an inappropriate placement, leading to her death in July 2024. Miss G says she found these events extremely distressing.
3. Miss G would like to see these organisations to take action to improve their services to prevent similar problems occurring for other people. Miss G would also like to receive a significant financial payment in recognition of the distress caused to her by these events.

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The Ombudsmen’s role and powers

4. 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).
5. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault, or that we would be unlikely to add to any previous investigation undertaken by the organisations involved in a person’s care.

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How I considered this complaint

6. I considered evidence provided by Miss G and the Trust, as well as relevant law, policy and guidance.
7. Miss G had an opportunity to comment on my draft decision. I considered her comments before making a final decision.

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What I found

Relevant guidance

Continuing Healthcare (CHC) funding

8. 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’. 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.
9. The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care (the CHC Framework) is the key guidance around Continuing Healthcare.

Background

10. Mrs H had a diagnosis of advanced dementia, along with some other long-term health conditions. She was admitted to Scunthorpe General Hospital in early March 2024 having suffered a fall in the care home where she lived.
11. After a period of inpatient treatment, the professionals supporting Mrs H held a multidisciplinary team meeting on 21 March to discuss her discharge from hospital.
12. The meeting agreed Mrs H would be discharged to a residential care home placement pending further assessment.
13. The discharge took place on 25 March.
14. Mrs H’s condition deteriorated, and she subsequently died in July 2024.

My conclusions

CHC Checklist

15. Miss G complained that the professionals supporting Mrs H failed to complete a CHC Checklist for her during her admission. She says a subsequent checklist completed for Mrs H following her discharge showed she had health needs.
16. The Trust said it would ordinarily only carry out a CHC Checklist in hospital in exceptional circumstances. The Trust said that, as Mrs H was not considered to require nursing care at that time, she would not have met the criteria for assessment in hospital. It said that, in most cases, screening or assessment is completed in the community following discharge. The Trust said this allows for a period of recovery so that the person’s needs can be more accurately captured.
17. The Ombudsmen cannot decide whether a person is eligible for CHC funding. This is a decision for the professionals involved in the person’s care. The CHC Framework makes clear that the threshold for a checklist is deliberately low. However, at the point of discharge, the professionals supporting Mrs H considered she did not have any nursing needs. As a result, they concluded a checklist was not indicated.
18. Miss G explained that she disagreed with this decision. She also explained that a subsequent CHC Checklist completed for Mrs H in the community following her discharge was positive. I note Miss G’s comments.
19. Nevertheless, it is not our role to substitute our judgement for that of the professionals involved in a person’s care. The Trust has provided a rationale for its decision not to complete a CHC Checklist for Mrs H. While I accept Miss G does not agree with this decision, I consider it unlikely that an investigation by the Ombudsmen would identify fault in the way the Trust made it. For this reason, we will not investigate this point.

Speech and Language Therapy

20. Miss G complained that the Trust failed to arrange for Mrs H to have a proper Speech and Language Therapy (SALT) assessment.
21. The Trust said a SALT assessed Mrs H on 11 March 2024. The Trust said the SALT found Mrs H could manage food and drink orally and had no concerns about her ability to swallow. The Trust went on to say that staff maintained a food chart for Mrs H. The Trust said this showed Mrs H could eat most of her meals with assistance.
22. The care records show a SALT visited Mrs H on the ward on 11 March to complete an assessment. The SALT discussed Mrs H’s care with ward staff and noted that she was managing oral feeding without concern. The SALT concluded that Mrs H could continue with oral feeding but noted she may choose softer food options due to problems with her teeth.
23. The evidence I have seen shows a SALT did assess Mrs H and concluded she was able to maintain oral feeding. This conclusion appears to be supported by the food charts, which show Mrs H was generally eating well. On this basis, I consider an investigation would be unlikely to add anything to the investigation the Trust has already undertaken.

Discharge meeting and placement

24. Miss G complained that a multidisciplinary meeting held by the Trust and Council failed to adequately consider Mrs H’s care needs. She said this led to Mrs H being discharged to a residential placement that could not meet her needs and that her condition deteriorated consequently.
25. The Trust said it convened a multidisciplinary team meeting on 21 March 2024 to discuss Mrs H’s discharge. The Trust said a social worker explained that Mrs H did not require nursing care at that stage. However, the Trust said Mrs H was to be discharged to a care home with a nursing unit that would allow her to be transferred if her condition deteriorated in future.
26. I have reviewed the note of the discharge meeting. This shows there were discussions regarding Mrs H’s long-term care. However, the multidisciplinary team agreed Mrs H did not have any nursing needs at that time. The discharge summary for Mrs H records that she was to be discharged with oral medications, but no further health interventions.
27. I consider the Trust and Council properly considered Mrs H’s needs at the point of discharge, albeit I recognise Miss G does not agree. In my view, an investigation by the Ombudsmen would be unlikely to identify significant fault here.

Complaint handling

28. Miss G said the Council and Trust failed to handle her complaint appropriately and kept directing her to other organisations without taking responsibility. Miss G said she first approach the Trust with her complaint in March 2024. She said the Trust advised the complaint was not in its remit. Miss G said she then approached the local Integrated Care Board (ICB), which advised her to contact the Council. Miss G said the Council then advised her to contact the Trust again. However, when she did so, Miss G said the Trust again refused to look at the complaint. Miss G said it was only when she wrote to the Trust’s Chief Executive that she made any progress.
29. The Trust acknowledged having received a complaint from Miss G related to medication on 22 March. The Trust said it responded on the same day. As Miss G was unhappy with the response, the Trust said it proposed to resolve Miss G’s concerns via a meeting with a pharmacist rather than through the formal complaints process. However, the Trust said Miss G advised on 23 March that she had approached the ICB instead as she felt the Trust had not fully understood her complaint. The Trust acknowledged it failed to respond to Miss G’s email of 23 March and apologised for this.
30. The Trust said its Patient Advice and Liaison Service (PALS) received further correspondence from Miss G via the Chief Executive’s office on 4 April. The Trust said this included additional concerns that Miss G had not previously raised. The Trust said it also received contact from the ICB about the complaint the following day. This led the Trust to begin its investigation on 25 April. The Trust acknowledged it should have communicated with Miss G more clearly and apologised for this omission.
31. The complaint correspondence shows there was confusion regarding the handling of Miss G’s complaint. The Trust’s response acknowledges and apologises for this. I consider this to be an appropriate response to the complaint. An investigation by the Ombudsmen would be unlikely to add to this.

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Final Decision

32. We will not investigate Miss G’s complaint. This is because an investigation by the Ombudsmen is unlikely to add to the work that has already been undertaken by the Trust to look at Miss G’s concerns.

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Investigator's decision on behalf of the Ombudsman