The Ombudsman's final decision
Summary: We will not investigate Mr B’s complaint about the Council’s failure to undertake reviews for his late aunt, Ms C. This is because further investigation could not add to the Council’s response. We are satisfied the Council has remedied the fault and there is no unremedied injustice warranting an Ombudsman investigation.
The complaint
Mr B complained his aunt’s, Ms C’s, care was not reviewed by the Council. Mr B says because of the Council’s failure to complete a Continuing Health Care (CHC) referral Ms C did not receive proper health care and suffered until he intervened and ensured she received health care. Mr B says the Council should pay for Ms C’s care because of the failures and ensure all people in its area who pay the full cost of their care are receiving reviews.
The Ombudsman’s role and powers
The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide: we could not add to any previous investigation by the organisation, or further investigation would not lead to a different outcome, or we cannot achieve the outcome someone wants, or there is another body better placed to consider this complaint, (Local Government Act 1974, section 24A(6))
How I considered this complaint
I considered information provided by the complainant.
I considered the Ombudsman’s Assessment Code.
My assessment
The Council investigated Mr B’s complaints and acknowledged it had not undertaken annual reviews of Ms C’s care since 2017. It explained it inadvertently closed Ms C’s direct payment account when she became a full cost client. The Council accepted there was delay in sending out the invoices for Ms C’s care, which it sent to him as Ms C’s attorney in May 2021 for the amount £21,621.93. The invoice covered the period 28 August 2020 until Ms C was awarded CHC funding on 19 April 2021. The Council offered to pay £660, £300 for the distress arising from the delay in sending out the invoices and £300 in recognition of uncertainty regarding alternative outcomes from not reviewing Ms C’s care needs. Mr B says the Council should agree to pay for the care as Ms C may have needed NHS care sooner.
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 Ms C was eligible for CHC funding between 2017 and 2021 when she was awarded it, there is no fault with the Council for charging Ms C for care it provided during this period.
If Mr B has evidence that Ms C would have been eligible for CHC funding he can ask the NHS to consider a retrospective application. 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 We cannot now provide a remedy to Ms C for any injustice caused to her from the Council’s failure to reassess her care needs and we are satisfied the financial payment offered by the Council remedies the injustice caused to Mr B. Although there is fault in this case, I have not seen any evidence of the systemic failure Mr B alleges warranting an Ombudsman investigation.
Final decision
We will not investigate Mr B’s complaint because we are satisfied the Council has remedied the fault and there is no unremedied injustice warranting an Ombudsman investigation.
Investigator's decision on behalf of the Ombudsman