The Ombudsman's final decision
Summary: We will not investigate this complaint about the Council’s failure to refer Mrs B for Continuing Health Care (CHC) funding. This is because there Is not enough evidence of fault with the actions taken by the Council to warrant an Ombudsman investigation.
The complaint
Mr B says because the Council failed to undertake a review of Mrs B’s health care needs and refer to the NHS, her estate is now left with a bill for her care which should have been covered by the NHS under Continuing Health Care (CHC) funding.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We may decide not to start an investigation if the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended)
How I considered this complaint
I considered information provided by the complainant.
I considered the Ombudsman’s Assessment Code.
My assessment
It is not an administrative function of the Council to decide whether a person is eligible for CHC funding, nor can the Council decide not to provide CHC funding. In the absence of evidence from the NHS confirming Mrs B was eligible for CHC funding, there is no fault with the Council for charging Mrs B’s estate for care it provided during this period.
It is the CCG’s decision whether to award CHC funding, so Mr B or his representative can apply for a retrospective assessment. Information about the NHS CHC funding can be found on the website below.
https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
Final decision
We will not investigate Mr B’s complaint because there is not enough evidence of fault with the actions taken by the Council to warrant an Ombudsman investigation.
Investigator's decision on behalf of the Ombudsman