East Suffolk and North Essex NHS Foundation Trust

3. Mr U complains in June 2021 a nurse from the Trust incorrectly told him Mr E that his uncle’s care would be fully funded CHC for as long as required.

4. Mr U says based on this information, Mr E sold his bungalow and decided to go into a nursing home. They were shocked when the local integrated care board (ICB) did a review in October 2021 and found Mr E was no longer eligible for fast-track funding. He received funded nursing care (FNC), but had to contribute to the remainder of his care and paid £4,498. They say if he had known he may have to pay in future, he would not have gone into a home and would not have sold his house.

5. Mr U would like the Trust to refund the money Mr E paid because it provided incorrect information.

6. On 17 June 2021, a district matron attended Mr E’s bungalow to carry out a review of his personal needs, and decided he needed full time care in a nursing home. The nurse completed a fast track CHC funding referral. A person is eligible for fast-track funding if they are rapidly deteriorating and reaching a terminal phase. If a person is eligible, the local ICB funds all their health and social care needs. It should arrange a care package within 48 hours.

7. Mr U was at the assessment and says he asked the nurse about when a financial assessment would be done by the local authority (LA). He says she told him he did not need to worry because the care costs would be fully funded by CHC.

8. The ICB accepted the fast track CHC referral. Mr E moved into the care home, funded by the ICB, and sold his bungalow a few months later.

9. In October 2021 the ICB reviewed Mr E and decided he no longer met the criteria for fast-track funding. It assessed him to decide if he was eligible for CHC on the standard pathway, but he was not. He was eligible for FNC, which covered the nursing element of his care and the ICB paid the care home directly for this. His social care became the responsibility of the LA. A person may have to pay towards their social care depending on their financial circumstances. The LA did a means test and found Mr E should contribute to the costs of his social care. Mr E died in February 2022 and paid £4,498.04 in total towards his care.

12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We also must see this had the impact the complainant said it did, or another significant impact (effect). Having done so we cannot link the events complained about with what Mr U claims happened as a result.

13. The National Framework paragraph 217 says the fast-track pathway tool is for individuals with a rapidly deteriorating condition that may be entering a terminal phase. It says individuals may require ‘fast tracking’ for immediate provision of CHC. The intention of this pathway is that it should identify individuals who need access to CHC quickly, with minimum delay.

14. The nurse’s fast track application dated 18 June 2021 states the A&E consultant advised on 3 June 2021 that Mr E would have weeks to live due to his end stage heart failure. This was evidence of rapid deterioration. The form also states Mr E’s family felt unable to manage his increasing care needs, and due to this he ‘now wishes to be cared for in a care home as he is unable to cope at home and carers are struggling to manage his care needs in his home’.

15. Mr U says it was during the assessment on 18 June that the nurse said Mr E’s care would be fully funded for as long as he needed it. The information the nurse gave Mr E and Mr U was not fully incorrect. An individual would never contribute to their care while they received fast track funding, so it is correct that for as long as Mr E was eligible for fast track funding he would not have to pay. We recognise it was unexpected that Mr E stabilised, as doctors thought he was very close to end of life at the time of his assessment. But we appreciate the information the nurse gave could have been more detailed. There is no indication she explained that if Mr E stabilised, he may no longer be eligible for fast track funding. The Trust acknowledged this and said it will make sure this does not happen in the future.

16. Mr U says Mr E would not have agreed to go into the care home and would not have sold his home if they had known he might have to pay towards his care. We have considered if we can say Mr E would not have done these things if the nurse had given clearer information.

17. Mr E was vulnerable and we cannot conclude that he would have been safe to stay in his home. The evidence suggests Mr E wanted to go into a care home, his needs could not be met by carers at home and that both they and Mr E’s family were struggling. Based on the available evidence, we could not say Mr E would have been able to stay at home.

18. It is important to note that it was not the nurse’s or the Trust’s responsibility to give Mr E information about the funding arrangements. It is the ICB that decides on eligibility and funds the care. We can see the ICB wrote to Mr E on 24 June 2021 to say he was eligible for fast track funding. In that letter the ICB said funding is not indefinite and is subject to ongoing and periodic assessment.

19. Mr U says the family did not see this letter. This is regrettable, but it does not mean we can hold the nurse or Trust responsible for Mr E’s decision to sell his home. Regardless of what information the nurse had given him, Mr E had full details about the funding arrangements from the ICB before he decided to sell his home. It does not seem Mr E or the family checked the latest funding arrangements before he sold the bungalow.

20. We are sorry to hear that contributing to care costs was a shock for Mr E and Mr U, and that they were disappointed with the information the nurse gave. We understand why Mr U raised this complaint and we hope we have clearly explained why we cannot hold the nurse or Trust responsible for decisions Mr E made. We are sorry this is not the outcome he was hoping for.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mr U’s complaint on behalf of his uncle, Mr E, about East Suffolk and North Essex NHS Foundation Trust (the Trust). We have decided we cannot link the events he complained about to the impact he describes. Mr U says Mr E sold his house and then had to contribute towards his care costs.

2. We do not think we can hold the Trust responsible for Mr E selling his house and contributing to the costs of his care, on the basis of the conversation Mr E and Mr U had with the nurse who did Mr E’s assessment. We think the information the nurse gave was correct, but incomplete. We appreciate it was disappointing for Mr E as he had not expected to pay. But we can see that before he sold his house, he had information to say NHS continuing healthcare (CHC) funding was not indefinite and would be reviewed. We also do not think we can conclude that Mr E would have declined to move into the care home if he realised he may have to pay, as he had been assessed as unsafe to stay in his own home.