Summary: Miss X complained about the care put in place on Ms Y’s discharge from hospital. She said it was not adequate and the hospital told Ms Y it should be free for six weeks, but the Council charged her. She wants the Council to waive the charges. We found the Council was at fault in initially providing Ms Y with visits from only one care worker. We find no fault in the other matters except failing to agree a time for response to her complaint. We recommended the Council apologise to Miss X and review its processes; it agreed to do this.

The complaint

1. The complainant, whom I shall refer to as Miss X, complains about the care the Council provided to her late mother, Ms Y, on discharge from hospital. She says the Council:
• had not ensured the equipment Ms Y needed was in place
• sent only one care worker when Ms Y needed two
• had not spoken with family to ensure care was appropriate and sent male care workers although Ms Y did not want males.
• charged for the care it provided when hospital staff had advised Ms Y she would have reablement free of charge for six weeks.
• did not deal adequately with her complaint about this.
2. Miss X says the Council should cancel the charges for Ms Y’s care as she was told it would be free of charge for six weeks. She would also like to make sure that in future, communication between the hospital and social care is improved as it appeared that neither knew what the other was doing. Miss X spent a lot of time chasing for the necessary support and trying to make sure everything was sorted out while also dealing with the complaint. This caused her much stress.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

In this case, we consider Miss X to be a suitable person to complain on behalf of Ms Y.

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How I considered this complaint

6. I considered information from the Complainant and from the Council.
7. I sent both parties a copy of my revised draft decision for comment and took account of the comments I received in response.

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What I found

Background

Reablement

8. Intermediate care and reablement support services are for people after they have left hospital or when they are at risk of having to go into hospital. They are time limited and aim to help a person to preserve or regain the ability to live independently. Regulations say local authorities must not charge for the first six weeks of intermediate care or reablement services.

Council complaint procedure

9. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman.

(Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

Timescales and communication

10. Regulations do not say how long a complaint investigation should take. But they do say an expected timescale must be explained at the start, usually in discussion with the complainant. If the complainant does not want to discuss this, the responsible body must decide the timescales and confirm them to the complainant in writing. The body must keep the complainant informed of progress during the investigation ‘as far as reasonably practicable’. If the responsible body has not provided its response after six months (or after a longer period agreed with the complainant), it must write to the complainant to explain why. (Regs 13 and 14, Local Authority Social Services and National Health Service Complaints (England) Regulations 2009).

What happened

11. Ms Y was in hospital due to health conditions which included damage to her brain. The issues that Miss X complained about relate to her discharge and subsequent care.
12. The Council says responsibility for assessing and ordering equipment for discharging people who are in-patients lies with Calderdale and Huddersfield Foundation Trust (CHFT). The Council’s senior community assessment and support officer completed an assessment of Ms Y’s needs with health professionals from the hospital.
13. Prior to discharge, Council records note the case worker discussed the financial assessment and charges for the care Ms Y would receive, with Miss X’s sister. The worker consulted with the ward staff who advised they were supporting Ms Y with one person. The Council said the worker spoke to the physiotherapist who confirmed only one worker would be required if the ward were managing with one. However, records say the physiotherapist agreed with the case worker that one care worker was sufficient if a family member acted as a second carer. The case worker said there was no agreement with the family to act as a second care worker and a family worker would not be asked due to safety concerns.
14. Ms Y was discharged in September 2021, with a package of four calls a day from a single care worker. CHFT had not assessed her as needing a hospital bed, a referral to the continence service or continence aids.
15. Immediately following discharge, the care workers raised a safeguarding concern about the level of support and equipment for Ms Y. The Council arranged for the support Ms Y needed as soon as possible once it became aware. It had difficulty arranging an additional carer at such short notice and there was no record of Ms Y’s wish for only female workers. Ms Y had received care from males in the hospital. The short notice meant the Council could not accommodate the request for only female workers; this is difficult to arrange anyway.
16. The Council responded to Miss X’s complaint about these issues. It explained it was not responsible for arranging the equipment and care prior to discharge and advised Miss X this had been the responsibility of hospital staff. It said she should address these issues with the hospital.
17. The local process expects health colleagues to order suitable equipment and make referrals to the continence service and similar. However, the Council is responsible for the care that Ms Y received once discharged from hospital. This care was provided under the Care Act 2014 and the assessment which identified Ms Y’s needs was a Care Act assessment for which the Council is responsible. The Council should take advice from health colleagues but ultimately, it should make the decision on what care and support is appropriate.
18. The case worker was aware that hospital staff were moving Ms Y with only one person supporting and did discuss this possibility. However, the case worker also recorded the physiotherapist’s view that Ms Y needed two care workers to assist. Also, that the physiotherapist said one worker would be enough if a family member acted as a second worker. The case worker knew this was inappropriate and did not raise it with the family, but still arranged only one worker to assist Ms Y. This was fault and this caused stress and inconvenience to Miss X and an increased risk of harm to Ms Y.
19. Fortunately, when Ms Y clearly needed a significantly different package of support than the package she initially received, the Council worked quickly. It put suitable support and equipment in place once it became apparent that she needed more.
20. It is unclear whether Ms Y was to receive intermediate care or reablement which terms are often incorrectly used interchangeably. However, a physiotherapist was involved, and the hospital records refer to the local NHS community service resuming “rehabilitation”. It was likely therefore to be intermediate care arranged by the NHS. There is no record of a decision that Ms Y was not eligible but there are hospital records that she had declined physiotherapy. This may have indicated that rehabilitation was not suitable for her, but this was not the Council’s decision. I found no indication that the Council was responsible for providing reablement or that it offered it. I do not agree that the Council should not charge for the care and support it provided. It was not reablement, and therefore it was subject to a financial assessment.
21. The Council’s misconception that it was not responsible for the assessment and care provision, is cause for concern. This meant the Council did not take responsibility when dealing with Miss X’s complaint. Miss X complained to the hospital trust, and on 13 September 2021 she gave consent for the trust to share her complaint with the Council. The Council responded to Miss X’s complaint on 5 November 2021. The Council’s online complaints system does not provide information about how long it will take to respond, and it did not agree this with Miss X. This was fault and caused Miss X further stress.
22. The Council has advised that it did not adjust Ms Y’s charges pending the outcome of the complaint but has agreed to do this so the amount due is accurate.

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Agreed action

23. To remedy the injustice identified above, the Council has agreed to:
• Apologise to Ms X for the faults identified above, and for misrepresenting the case worker’s discussion with the physiotherapist, in its response to her complaint.
• Ensure that dates for response are agreed with complainants at the outset of the complaint process.
• Ensure staff are clear about the need to record conversations and keep an accurate record of decisions.
• Review, at senior level, the process by which the Council takes advice from health colleagues on discharge and puts this into practice.
• It should complete these actions within two months of my final decision and provide evidence to me that it has done so.

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Final decision

24. I have completed my investigation and found the Council was at fault. When the Council completes the agreed actions, it will remedy the injustice it caused.

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Investigator's decision on behalf of the Ombudsman