The Ombudsman's final decision
Summary: We will not investigate Mr X’s complaint about the Council’s refusal to reimburse his father’s care fees after his health deteriorated. That is because further investigation would not lead to a different outcome.
The complaint
Mr X complained the Council delayed reporting a deterioration in his father’s condition to the NHS. Mr X also complained that the Council delayed in completing an annual review of his father’s care needs. Mr X believes the delay caused his father to have an additional two months of care home charges totalling over £6,000, when he should have been eligible for full funding. Mr X stated that he has waited for over 18 months for the Council to investigate his complaint. He would like the Council to issue a credit note for the outstanding care fees.
The Ombudsman’s role and powers
The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
We cannot investigate complaints about actions which are not the administrative function of a council. (Local Government Act 1974, section 26(1) as amended) We investigate 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 continue an investigation if we decide: any injustice is not significant enough to justify our involvement, or further investigation would not lead to a different outcome, or (Local Government Act 1974, section 24A(6), as amended, section 34(B))
How I considered this complaint
I considered information provided by Mr X and the Council.
I considered the Ombudsman’s Assessment Code.
My assessment
Mr X’s father, Mr Y lived in a care home from 2022. In 2023, Mr Y’s condition declined following a suspected Transient Ischemic Attack (TIA), or “mini stroke”.
The care home contacted a Nurse Practitioner who carried out an NHS Continuing Healthcare funding (CHC) assessment for Mr Y in June 2023. The NHS agreed CHC funding for Mr Y in July 2023 and backdated it to late June 2023. The funding was in place until Mr Y passed away in July 2023.
Mr X made a complaint to the Council in April 2024 about the care home charges from May and June 2023. Mr X stated that CHC funding should apply from May 2023 onwards, when Mr Y’s condition deteriorated. The Council responded to Mr X’s complaint in May 2025 and said it would not reimburse the fees. The Council advised Mr X to contact the ICB regarding extending the backdated period of Mr Y’s CHC funding.
The Council should have completed an annual review of Mr Y’s care needs in February 2023. This annual review took place in July 2023. Although Mr Y’s annual review was delayed, his care needs continued to be met during this period, therefore, the delay in carrying out the annual assessment did not cause Mr Y significant injustice.
The local Integrated Care Board (ICB) is responsible for assessing Mr Y’s eligibility for CHC and providing the funding. Therefore, further investigation of the Council’s decision not to reimburse the care fees would not lead to a different outcome. Mr X would need to contact the ICB about whether the CHC funding could be backdated to an earlier date. We cannot investigate any complaint about the CHC start date because it relates to a matter which is not an administrative function of the Council.
Final decision
We will not investigate Mr X’s complaint because further investigation would not lead to a different outcome.
Investigator's decision on behalf of the Ombudsman