The Ombudsman's final decision
Summary: There is no evidence the Council was responsible for a delay in Mr X leaving hospital. Mr X consistently refused an assessment of his needs and said he would arrange his own care privately when home.
The complaint
Mrs X (as I shall call her) complains that the Council refused to let her husband go home from hospital even when he was medically fit for discharge, unless he paid an arrangement fee for a care package and purchased a new bed. She says his discharge was delayed two weeks as a result.
The Ombudsman’s role and powers
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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended) If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
How I considered this complaint
I considered the information provided by Mrs X and by the Council. Both the Council and Mrs X had the opportunity to comment on an earlier draft of this statement before I reached a final decision.
What I found
Relevant law and guidance 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 settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a 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) Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs.
When choosing to charge, a local authority must not charge more than the cost that it incurs in meeting the assessed needs of the person. It also cannot recover any administration fee relating to arranging that care and support. The only exception is in the case of a person with eligible needs and assets above the upper capital limit who has asked the local authority to arrange their care and support on their behalf. In such cases, the local authority may apply an administration fee to cover its costs.
An adult with possible care and support needs or a carer may choose to refuse an assessment. In these circumstances councils do not have to carry out an assessment.
The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment.
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. This is for all adults, whether or not they have eligible needs for ongoing care and support.
What happened Mr X, who is registered blind, was admitted to hospital in April 2021 after a stroke. The ambulance crew which attended the scene submitted a ‘care concern referral’ due to concerns about Mr X’s frailty and his sleeping arrangements (he was sleeping on a low sofa bed and was unable to stand unaided). They said Mrs X was asking for help at home.
On 4 May the hospital ward sent a referral to the Council for assistance with a suitable discharge plan for Mr X. The ward recommended discharge home with four care calls a day. A social worker was allocated to manage Mr X’s case and she discussed the recommended plan for care with Mrs X on 7 May.
Mrs X said Mr X had assets above the threshold at which he would pay the full cost of his care. The social worker explained there would be an administration fee of £435 for the care as Mr X was self-funding. Mrs X said 4 calls a day was too much and they would prefer to arrange private care and not pay an administration fee. The social worker said she would seek Mr X’s consent to have a social care assessment. The ward team also advised purchase of a single bed for Mr X to avoid him sleeping on a sofa bed and Mrs X initially agreed to pursue that.
The social worker spoke to Mr X on 14 May about a social care assessment. Mr X refused. He said he wanted to decide about his care once he was at home again. The social worker advised the ward team she considered a reablement assessment at home once Mr X was back in his own environment would be useful.
The Council’s records show that Mr X was deemed medically fit for discharge on 17 May.
Mrs X contacted the Council on 16 May. She was upset because she said no-one would tell her when Mr X could be discharged from hospital. The social worker noted ‘The hospital staff during Welland MDT on Wednesday explained they have fully been in contact with (Mrs X) to explain (Mr X)'s situation during his admission’. She added that Mr X had ‘raised concern he did not want a long term POC or a paid for service or pay the set up fee of £445 nor did he want me to set up a private homecare service.’ She said Mrs X was able and willing to set up homecare privately if Mr X wished her to do so.
The social worker also noted Mrs X now said she would not purchase another bed. The Council’s records showed the ward therapists had assessed Mr X’s ability to manage rising from a low bed and said he had done ‘surprisingly well’. She said Mr and Mrs X had agreed to a reablement assessment once they were home but there was no capacity in the reablement service ‘for AM/ PM call or any part offer’.
The social worker contacted Mrs X by telephone on 17 May and gave her a list of private care agencies to contact if she wished. Her notes conclude, “(Mrs X) had no concerns to raise with me and is aware Adult Care will close involvement.”
Mr X was discharged home on 18 May.
In June Mrs X complained to the Council. She said they had been told Mr X could not be discharged home unless they paid a set-up fee for homecare and purchased a new bed. She said they were also told he could not have transport home unless they agreed to the care package. She also said Mr X had been home for two weeks and had not had any assistance from Adult Social Care.
The Council replied to the complaint. It said the records showed Mr X had declined an assessment and did not want to pay an administration fee but at no point had been told he could not go home unless he agreed. It said concerns about transport were the responsibility of the hospital, not the Council. It also said ‘it was (Mr X’s) wish to return home with no formal support in place from Adult Care. Advice and information on Adult Care services and Private agencies was discussed and supplied to both you and your husband prior to discharge, and a care agency name and telephone contact number was exchange with you on 17th May 2021 via telephone. The Adult Care Assessor gave you directions on where to find items of important within the Care directory for future use including the Customer Service Number. A Care directory was given to (Mr X) to take home with him. During a conversation with you on 17th May 2021, the Adult Care Assessor informed you that the Adult Care involvement would be ending.’ It said there was no evidence the Council had failed to act appropriately.
Mrs X complained again. She maintained Mr X’s discharge had been delayed because they would not pay the set-up fee. She repeated they had received no help from the Council since his discharge.
The Council responded again. It said it had no record staff had said Mr X could not be discharged without agreeing to pay for care – and in fact he had been so discharged. It also reiterated that Mr X had wanted to go home without care and said he would arrange it himself once home, and that staff had given all practical help (contact telephone numbers and so on) on that basis.
Mrs X complained to the Ombudsman. She said the Council had never tried to alleviate their worries and had insisted they pay an administration fee and buy a new bed. She said she believes Mr X should have had free care for some weeks.
The Council’s records show there was no delay in discharging Mr X once he was medically fit for discharge.
The Council says ‘There was no reablement available at the point of his discharge and (Mr X) had made it clear his preference was to return home and decide once there, if he required formal support.’
The Council also says, “He denied the need for care and wanted to manage at home himself as felt he could do within his home and in his own bed. Upon his return home, the Worker phoned private care agencies, once capacity was found with an agency; the Worker contacted (Mrs X) with this information”.
The Council confirms that since his discharge from hospital Mr X has been contacted again and offered an assessment which he has declined: he agreed for the Council to make a referral on his behalf to wheelchair services, community therapy and the Blind Veterans’ Association.
Analysis There is no evidence that action by the Council delayed Mr X’s discharge from Hospital. He was medically fit for discharge on 17 May and discharged home the next day.
The Council explained to Mr and Mrs X that it could arrange care but because of his self-funding status there would be an administration fee. They decided to arrange care privately themselves instead. The Council assisted by finding which agencies had capacity and passing on that information. There is no evidence of fault there.
Ward staff had concerns following the ambulance crew report about Mr X’s ability to get in and out of the sofa bed he was using: hence the suggestion of a new bed. There is no record anyone told Mr X he could not go home until he had a new bed.
Mr X refused an assessment of his eligible needs, as was his right to do. He has since refused a further assessment.
At the time Mr X was discharged from hospital there was insufficient capacity in the reablement service to offer him that immediately. The point of the reablement service then was to assess his needs. He had declined assistance with finding care and said if he found he needed care, Mrs X would arrange it when he was home. Under those circumstances, and in view of Mr X’s continuing refusal of an assessment of his needs from the Council, I do not see he suffered injustice as a result of the lack of capacity in the reablement service on his discharge.
Final decision
I have completed this investigation on the basis there was no fault on the part of the Council.
Investigator's decision on behalf of the Ombudsman