Summary: Mr A complains his mother’s estate has been invoiced for a care home stay which should have been covered by discharge to assess funding. He also complains his mother was not referred to the Integrated Care Board for continuing healthcare funding. We will not investigate this complaint because an investigation is unlikely to find fault with the Council. The NHS Trust has not yet had an opportunity to respond to Mr A’s complaint.

The complaint

1. Mr A complains about North Yorkshire Council (the Council) and York & Scarborough Teaching Hospitals NHS Foundation Trust (the Trust). Specifically, Mr A complains:
• the Council invoiced his mother’s estate (Mrs B) for a six day stay at a Care Home which should have been covered by NHS discharge to assess (D2A) funding after she left hospital;
• he did not agree to the charges and has challenged them with the Council, but it has closed the complaint without resolution;
• she was not referred to the Integrated Care Board (ICB) for continuing healthcare (CHC) assessment and funding;
• he was misinformed by a doctor at the Trust that the bed would be D2A and therefore nonchargeable; and
• his mother had delirium meaning her capacity was impaired, but no Mental Capacity Act assessment was completed on her when she was in hospital.
2. Mr A explains receiving the invoice and having to make a complaint while grieving has added extra and unnecessary distress. He feels unfairly treated by lack of transparency and accountability for misinformation.
3. Mr A wants the Council to withdraw the charge from his mother’s estate and to admit it should have assessed her capacity. He wants service improvements to the discharge process, so all information is given in writing not just verbally and an apology.

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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. The complaints procedure for councils and NHS organisations is set out in the Local Authority Social Services and NHS Complaints (England) Regulations 2009. The provisions of the regulations mean that anyone who is dissatisfied with a decision made by the council or NHS is able to make a complaint about that decision and have the complaint handled by the council or NHS.
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. 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 could add to any previous investigation by the bodies or find fault.

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What I have not considered

8. The Trust has confirmed Mr A has not made a formal complaint. The law says organisations should be given the opportunity to investigate a complaint before the Ombudsmen consider it. Mr A should make a complaint to the Trust direct if he wishes to pursue these issues.

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How I considered this complaint

9. I have considered the information Mr A has provided and the complaint responses from the Council.
10. Mr A commented on my draft decision, and I considered these before making a final decision.

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What I found

Chargeable bed

11. Mr A complains the Council has invoiced his mother’s estate for a six day stay at a Care Home which he believed would have been covered by NHS discharge to assess (D2A) funding. He explains he did not agree to the charge and even though he challenged the Council, it has closed the complaint without resolving the issue.
12. The Council responded to Mr A’s complaint on 16 June 2025. It explained to Mr A the social worker who discussed with Mrs B where she would go after hospital knew she had delirium, but she knew where and when she was, and could clearly explain her wishes.
13. A diagnosis of delirium does not mean a person is not able to make their own decisions. The social worker ensured Mrs B was able to understand the information she was being given before discussing her options.
14. The Council explained Mrs B was offered an ICB funded bed, which would have been the one through D2A. She explained to the social worker her husband had had a previous bad experience at the home where the bed was offered, so she refused this funded bed. The social worker told Mrs B if she wanted to take another bed, she would need to pay for it. Mrs B said she understood this but did not know her financial situation, so it was noted a financial assessment would need to take place.
15. Mr A was not happy with this response, so he raised further concerns with the Council, which it replied to on 9 July 2025. It said it knew Mr A had been given the wrong information by a doctor from the Trust, but the same social worker who spoke to Mrs B also spoke to Mr A before his mother left hospital and gave him the correct information. Mr A therefore knew before Mrs B left hospital she would need to pay for the bed she was moving to.
16. The Council agreed with Mr A communication between the Trust, Council, Mr A and Mrs B could have been better at this time and has put a new policy in place to make this process easier for people to understand.
17. An Ombudsmen investigation is unlikely to fault with the actions of the Council. It considered Mrs B’s diagnosis of delirium and took steps to ensure she was able to make informed decisions about her future care. In its complaint process it has accepted things could have been done better and taken steps to improve this for future users, which is what the Ombudsmen would accept.

Referral to ICB for CHC funding

18. Mr A also complains Mrs B was not referred to the ICB for a CHC assessment and funding.
19. In both of its complaint response letters, the Council explains a referral for a CHC assessment does not take place while an individual is in hospital. Guidance explains an assessment for CHC can only take place when the individual is in a stable environment and their longer term needs can be assessed.
20. NHS England hospital discharge and community support guidance says “it is best practice that any assessment of longer-term (ongoing) needs should be anticipated and initiated during a person’s recovery journey but not fully completed until the person has reached a point of recovery and stability where it is possible to make an accurate assessment.” This includes the assessment for CHC.
21. Further investigation by the Ombudsmen is unlikely to find fault in the Council not referring Mrs B for a CHC assessment while she was in hospital.

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Decision

22. The Ombudsmen will not investigate this complaint because an investigation is unlikely to find fault with the actions of the Council. Mr A can complain to the Trust directly.

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Investigator's decision on behalf of the Ombudsman