Summary: The Ombudsmen should not investigate Mr B’s complaint about poor communication and a lack of transparency when the funding arrangements for a respite placement changed. The London Borough of Redbridge and Barking, Havering and Redbridge Clinical Commissioning Groups have already explained what happened and apologised. An investigation by the Ombudsmen is unlikely to achieve more.

The complaint

1. The complainant, who I shall refer to as Mr B, complains about poor communication and transparency when the funding arrangements for a respite placement his son, Mr C, attended changed. London Borough of Redbridge
   (the Council) and Barking, Havering and Redbridge CCGs (the CCG) are the organisations complained about.
2. Mr B says the Council and the CCG knew the changes to the funding arrangements could potentially affect people who used the respite facility. However, he says the authorities did not share information or consult with service users as they should. This resulted in his son receiving an unexpected invoice from the Council and this caused the family concern. Mr B also raises issues with the way the Council assesses disability related expenditure when completing financial assessments.

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The Ombudsmen’s role and powers

3. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
4. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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).
5. The Ombudsmen provide a free service but must use public money carefully. They may decide not to start or continue with an investigation if they believe:

• it is unlikely they could add to any previous investigation by the bodies, or
• they cannot achieve the outcome someone wants.

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How I considered this complaint

6. I have considered written information provided by Mr B, the Council and the CCG. Mr B has had an opportunity to comment on a draft version of this decision.

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What I found

7. Mr and Mrs B’s son Mr C received respite at a placement I shall refer to as Placement X.
8. The CCG paid for all respite at Placement X for all service users regardless of any assessed health needs. In October 2016, the contract for respite care at Placement X ended and so did the CCG’ payment arrangement.
9. The CCG and Council then came to an agreement whereby the CCG would pay for respite care for all service users who were eligible for continuing healthcare funding as they had health needs. The Council agreed to provide funding for service users not eligible for healthcare funding in line with its charging policy.
10. The Council and the CCG did not tell service users or their representatives, at the time, about the change in funding which could potentially affect them.
11. To determine who would be eligible for healthcare funding the CCG and the Council’s social workers completed healthcare assessments for everyone who used Placement X. The Council said it anticipated most service users would be eligible for healthcare funding. It also expected people to be told about the change in funding when they were assessed for healthcare funding.
12. Once the healthcare assessments were completed the Council was aware some service users, such as Mr C, would not be eligible for healthcare funding. Mr C underwent an assessment in September 2017 and the Council, and the CCG decided to each fund 50% of his care package.
13. The Council said Mr C and others who were not eligible for 100% healthcare funding would have to contribute to the cost of their respite care subject to its financial assessment. The Council also learnt a significant number of people were not told about the change in funding for Placement X when they were assessed. This resulted in them receiving unexpected invoices for respite care.
14. The Council wrote to all people affected by its poor communication and apologised for any inconvenience and concern caused. It took the following action:
• Explained the funding position to everyone in its letter dated August 2018.
• It cancelled any invoices requiring charges to be paid for respite up until
  30 September 2018.
• It made sure everyone who used Placement X underwent a healthcare assessment and it agreed an outcome with the individual and the CCG.
• It completed financial assessments with those affected, explained why they had to contribute towards respite care and told them how much they had to pay.
15. The Council wrote to Mr B in September 2018 following previous correspondence it had sent to him about charging and its calculation of disability related expenditure. The Council said:
• it should have communicated the change in funding arrangements at Placement X better. It apologised and said it would improve future communication;
• the CCG had not told it when it stopped funding Placement X, but the Council and the CCG then put a process in place to review 32 people affected by the funding changes; and
• all the reviews were not completed by April 2018 and it had not been clear with service users about the need to undergo a financial assessment. In recognition of this issue it decided not to charge people affected until October 2018.
16. The Council also wrote to Mr C to explain the way it had allowed for disability related expenditure in the financial assessment.
17. Mr B also complained to the CCG and received a response in October 2018. As well as other matters the letter responded to an issue he had raised about the CCG’s decision to fund 50% of Mr C’s respite. The CCG said the decision was based on information provided by a nurse assessor and a social worker after being reviewed by two nurses.
18. The CCG sent another letter to Mr B in March 2019. The CCG said Mr B had already received a response to four parts of his complaint so it would not provide a further response. This letter confirmed it had completed a second healthcare funding assessment with Mr C in November 2018 which concluded he was eligible for 100% healthcare funding. The CCG also apologised for the delay in responding to Mr B’s complaint.

Findings

19. The responses from the Council and the CCG have provided adequate information to explain what happened with the funding arrangements for Placement X. The Council and the CCG apologised to Mr C.
20. The Council recognised its poor communication had impacted adversely on Mr C and other services users. It acted to remedy any injustice caused and said it would improve its future communication. An investigation by the Ombudsmen is unlikely, on balance, to achieve much more detailed explanations, more extensive apologies or more significant improvements.
21. An investigation by the Ombudsmen is unlikely to find fault in the way the Council considers disability related expenditure. Its charging policy allows it to consider costs higher than the amount it automatically allows disability related costs.
22. Mr B could have asked the CCG to reconsider its decision to fund 50% of
    Mr C’s care package by following the CHC appeals process. The CCG has confirmed that Mr C now receives 100% healthcare funding following a second assessment.

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Final decision

23. I should not investigate this complaint about the Council’s and the CCG’s poor communication regarding funding, charging and a request for payment for a respite placement. The Council and the CCG have already provided adequate explanations and apologies for what happened. The Council also acted to remedy any injustice caused by its faults.

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Investigator's decision on behalf of the Ombudsman