Mrs A complains about the care provided to her father by a Council, a Trust and a ICB before his death. She also complains the Council failed to complete a continuing healthcare assessment. We will not investigate these complaints because there are no indications of fault which has not already been accepted by the organisations. Where fault has been accepted, it is unlikely we could add anything more. The Council did not investigate parts of Mrs A’s complaint through the formal complaints process. We uphold this part of her complaint because the Council should have investigated, it has now agreed to do so.

The complaint

1. Mrs A complains about the care provided to her father, Mr B, before his death in November 2023, by Leicester City Council (the Council), University Hospitals of Leicester NHS Trust (the Trust) and Leicestershire and Rutland Integrated CARE Board (the ICB). Specifically, Mrs A complains;

• Mr B’s discharge from hospital in October 2023 was rushed and unsafe. Discharge planning did not include the family. The Council did call a family member, but this was after the meeting and once all decisions had been made by the Council and the Trust.
• Mr B developed a category three pressure ulcer while in hospital.
• The Council did not complete a continuing healthcare (CHC) assessment for Mr B before he left hospital and this led to delays.
• When at home, there was no review of Mr B’s care and the family struggled to manage with four care visits especially as his health was deteriorating. Infected bed sores were missed by the nurses and had to be pointed out by a family member for care.
• The care package provided to Mr B was insufficient and nothing was done to improve his quality of life.

2. Mrs A says her father suffered in his final days and this could and should have been avoided. Mrs A still suffers with immeasurable distress years after the events and has been unable to move on.

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The Ombudsmen’s role and powers

3. 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).
4. Part 3 of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. (Part 3 Local Government Act 1974; section 25(6) & (7) of the Act)
5. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in future we may recommend a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended, and Health Service Commissioners Act 1993, section 9(4))
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. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

8. I considered evidence provided by Mrs A, the responses from the organisations, as well as relevant law, policy and guidance.

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What I found

Hospital discharge

9. Mrs A complains Mr B’s discharge from hospital in October 2023 was rushed and unsafe. She says the discharge planning did not include the family. She acknowledges the Council did call a family member, but this was after the meeting and once all decisions had been made by the Council and the Trust.
10. When Mr B was well enough to leave hospital, he was able to make decisions about his own care. The Council’s and Trust’s notes both show there were several members of his family involved in the decision-making process, one of which was Mrs A. We expect Council’s and Trust’s to take a proportionate approach to speaking with family members, but we would not expect them to speak to every interested person about every decision. The Council did apologise to Mrs A in its complaint response letter 22 February 2024 if she wanted to be more involved.
11. Mr B was able to make his own choices and wanted to go home, ultimately there would be no expectation on the Council to consult Mrs A, families would be expected to discuss issues between themselves as they arise. There is no indication of fault.

Development of pressure ulcer

12. Mr B developed a category three pressure ulcer while in hospital. Mrs A complains this should not have happened if Mr B had been receiving good care while in hospital.
13. In its complaint response letter 4 December 2023, the Trust apologised to Mrs A for the distress caused at knowing her father had developed a pressure ulcer. It explained Mr B’s skin was very fragile because he had cancer and was on full bed rest. He was therefore known to be at high risk of skin break down. To try and prevent this, he was moved to a specialist pressure relieving mattress and given specialist boots to protect the skin on his heels.
14. Mr B moved to a community hospital in July 2023; the Trust gave the hospital recommendations to help maintain his skin and prevent further breakdown. We are not considering the actions of the community hospital as part of this assessment.
15. Unfortunately, when Mr B went back into the Trust’s care in the middle of August 2023, his skin was much worse then when he moved. Two days after he was back in the Trust’s care, it made a referral to a tissue viability nurse who gave advice on how to heal the pressure ulcers.
16. His skin was reviewed again every seven days, and when he was discharged at the beginning of September, his skin had improved and the pressure ulcers were healing. This indicates the care being given on the ward for his skin was good.
17. The Trust said it had taken learning from Mr B’s care. I asked the Trust for evidence it had completed what it said it would. The Trust completed a root cause analysis for Mr B, which shows a step-by-step approach to understanding what happened and why. As a result of this, the Trust provided further training to its staff in July 2023, one week after Mr B first left its care.
18. In summary, the Trust has accepted Mr B did develop pressure ulcers while in its care. It took steps to help heal these and used specialist equipment to prevent further skin breakdown. The ulcers got worse when Mr B moved to a community hospital, whose care is not part of this assessment. The Trust worked to heal the ulcers when he returned to their care, and they were improved by the time he went home. The Trust has taken learning from the events and apologised for the distress to Mrs A, which is what we would expect. It is unlikely Ombudsmen investigation could add anything more.

CHC assessment

19. Mrs A complains the Council did not complete a CHC assessment for Mr B before he left hospital.
20. 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’. The ICB is responsible for assessing their eligibility for CHC or funded nursing care (FNC) and providing the funding. ICBs sometimes commission other NHS organisations to carry out the assessments on their behalf.
21. 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. 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).
22. The Council explained in its complaint response letter 22 February 2024, a checklist was completed for Mr B and the DST was booked for 29 November 2023, sadly Mr B died before this could take place.
23. Mrs A believes Mr B should have been assessed for CHC while he was in hospital, so the funding could have been secured before he went home. The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care July 2022 says “Screening and assessment of eligibility for NHS Continuing Healthcare should be at the right time and location for the individual and when the individual’s ongoing needs are clearer. The full assessment of eligibility should normally take place when the individual is in a community setting.”
24. I can find no indication of fault by the Council, it could not have completed the checklist sooner as Mr B was not settled in his own home before this time and his longer-term needs could not be established. I also find no fault with the ICB as it would be reasonable for it to wait for the referral before it could know Mr B might need funding.

Part of the complaint not responded to by the Council

25. While considering Mrs A’s complaint, I noted the Council did not respond to several issues raised in her original complaint made 8 February 2024, namely about the care Mr B received once he went home and the suitability of the care package he was receiving.
26. The Council has not investigated part of Mrs A’s complaint under the statutory adult social care complaints procedures as set out in The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. This is fault.
27. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. The council should include in its complaint response:
• how it considered the complaint;

• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman.
  (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

28. If we investigated this part of the complaint now, we may find issues could have been addressed by the Council in the first instance.
29. We provide a free service but must use public money carefully. I therefore asked the Council to consider investigating the parts of Mrs A’s complaint which were not addressed originally. The Council has agreed to do this.
30. If Mrs A is unhappy with the decision reached by the Council, she can raise a new complaint with us.

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Decision

31. We partly uphold this complaint because the Council did not investigate part of Mrs A’s complaint. The Council has agreed to investigate and provide a response to Mrs A.
32. We will not investigate the other parts of Mrs A’s complaint because it is unlikely Ombudsmen investigation could achieve anything more and there are no indications of further fault.

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Investigator's decision on behalf of the Ombudsman