Summary: We uphold Mrs X’s complaint about respite care provided to her late father, Mr Y. The Council accepted fault for not following Mr Y’s care plan, causing injustice to Mrs X and Mr Y, and has agreed to provide a financial remedy to Mrs X in view of the injustice it has already acknowledged. We will not investigate Mrs X’s complaint about the Trust, ICB and Council in relation to an assessment for NHS Continuing Healthcare. This is because it is unlikely we could add to the response already provided by the organisations.

The complaint

1. Mrs X complains her father, Mr Y, received poor care when he took up a respite placement in June 2022, arranged by Cumbria County Council (the Council). Mrs X said the nursing home did not follow Mr Y’s care plan, meaning he did not get the care he needed. Mrs X also said this caused her distress.
2. Mrs X also complains about how she was treated when Mr Y had an assessment for NHS Continuing Healthcare (CHC). The CHC decision was made by NHS Lancashire and South Cumbria Integrated Care Board (the ICB), and the assessment involved assessors from the Council and University Hospitals of Morecambe Bay NHS Foundation Trust (the Trust). Mrs X says the assessors did not believe her or take account of her views about Mr Y’s needs, and that they wrongly raised a safeguarding alert. Mrs X said she felt undermined by how the assessment was conducted.
3. Mrs X’s desired outcomes are:

• Improvements to the CHC assessment process, so that families and carers are listened to and treated fairly; and
• Financial remedy of half the fees paid for the month’s respite care.

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The Ombudsmen’s role and powers

4. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe it is unlikely they could add to any previous investigation by the bodies.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I considered information provided by Mrs X, including the complaint response from the Trust, the Council, and the ICB.
6. I considered the Ombudsman’s Assessment Code.
7. Mrs X had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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My assessment

8. Mr Y lived at home and his daughter, Mrs X, cared for him. In June 2022, Mr Y went to a respite placement at a nursing home. The respite stay was initially arranged for two weeks, but Mr Y stayed for four weeks, so that some electrical work could take place on his home.
9. After he returned home from the respite placement, Mr Y had an assessment for NHS Continuing Healthcare funding (CHC). CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist. The threshold for meeting the CHC Checklist is set low.
10. If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. This assessment is completed using a decision support tool (DST). The DST is a record of the relevant evidence and decision-making.
11. The DST makes a recommendation about whether a person is eligible for CHC or for NHS-funded nursing care, which is set at a weekly rate. The relevant ICB will then make a final decision which must uphold the recommendation of the DST in all but exceptional circumstances.
12. The CHC assessment was carried out at Mr Y’s home. Mrs X was also present. Mr Y was not found eligible for CHC funding.
13. Mrs X complained to the Council about its role in the CHC assessment, and about the respite care placement. She said the nursing home had not followed the care plan she had provided, even though it had agreed to do so. She said Mr Y could not have dairy products, but the nursing home gave them to him. She also said a bed extension was requested but not provided, the nursing home did not use Mr Y’s clothes which were adapted for him, and when he left the placement, he had a pressure sore on his foot.
14. Regarding the CHC assessment, Mrs X complained the assessor did not familiarise themselves with Mr Y's situation, as they only contacted her shortly before the assessment. Mrs X said the assessor did not listen to her, and that they agreed with her initially about Mr Y’s needs and then changed their opinion. Mrs X also said during the assessment, the Council and Trust said there had been no concerns over meeting Mr Y’s needs at the respite placement, when this was not the case.
15. The Council acknowledged it would have been best practice if the social worker had met Mrs X before the assessment. However, the Council said the social worker had spoken to Mrs X by telephone and had the information they needed to take part in the CHC assessment.
16. The Council said it would improve services by looking at which future CHC assessments would benefit from an in-person meeting before the assessment took place. The Council also said during the discussion, the social worker had supported a higher score for Mr Y because of evidence provided by Mrs X, Mr Y’s GP Practice, and the district nursing team. However, the Council went on to say that in the professional discussion with the nurse, the social worker considered Mr Y’s needs were not sufficiently complex to disagree with the nurse assessor’s conclusion that he did not meet the threshold for CHC funding. The Council said it would put in place further training for staff on partnership working when completing CHC assessments.
17. Regarding the respite placement, the Council accepted the care plan was not followed, meaning Mr Y received an “unsatisfactory service”. The Council apologised for any distress caused by this, but declined to waive the fees.
18. Mrs X also complained to the Trust about the CHC assessment. Mrs X explained she complained first to the ICB but she did not want to complain about the funding decision itself, but about how the assessment was done. Therefore, the Trust responded to this part of her complaint.
19. The Trust’s response said it should have been made clear to Mrs X how carers’ and families’ views are considered during CHC assessments, and apologised if this did not happen. I recognise that Mrs X explained that what happened at the meeting caused her great distress and that she felt her views were not being heard. The Trust acknowledged there was disagreement about the “scorings” during the assessment. It said this had been fed back to the assessor, who felt they had been clear about their rationale, but would receive continued support for future practice. The Trust said it had also offered a further assessment with different team members, but Mrs X had not taken that up. Mrs X also said the Trust had offered her a meeting to discuss her complaint, but after Mr Y passed away, she had not felt able to pursue this.
20. Mrs X was dissatisfied with these responses and complained to the Ombudsmen. Mrs X said that making the complaint has caused her distress and had a considerable impact on her.
21. The Trust and Council have offered appropriate apologies to Mrs X about the shortcomings already acknowledged in the CHC assessment meeting. The Trust and Council have also taken steps to address this through service improvements set out above, and by offering Mrs X a further assessment at the time in order to resolve her concerns about this.
22. Regarding the complaint about respite care, if we investigated this issue it is likely we would find the Council at fault, because it has already accepted that Mr Y received an unsatisfactory service. We therefore asked the Council to consider remedying the injustice caused, by providing a financial remedy of £200 to Mrs X to resolve the complaint early.

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Agreed Actions

23. The Council has agreed to pay Mrs X £200 within one month of this decision, in view of the injustice caused to her as a result of unsatisfactory care provided to Mr Y.
24. The Council should provide us with evidence it has complied with the above actions.

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Final decision

25. We uphold Mrs X’s complaint about respite care provided to Mr Y, because the Council has agreed to an appropriate remedy for the injustice it has acknowledged. We will not investigate Mrs X’s complaint about the Council, Trust and ICB in relation to the CHC assessment meeting, because an investigation by the Ombudsmen would be unlikely to add to the responses already provided by the Trust and the Council.

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Investigator's decision on behalf of the Ombudsman