Summary: We will not investigate Mrs X complaint about delay in the Council completing a continuing health care (CHC) checklist for her mother. This is because the Council has agreed to resolve the complaint early by providing a proportionate remedy for the injustice caused by the fault accepted.

The complaint

1. Mrs X complains about delay in the Council completing a continuing health care (CHC) checklist for her mother. Mrs X said she requested the Council complete one in May 2021.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. Mrs X asked the Council to complete a CHC checklist for her mother, Mrs A, in May 2021. Depending on the outcome of the checklist, an individual will either be told they don’t meet the criteria for a full assessment and therefore, are not eligible, or they will be referred for a full assessment of eligibility. Being referred for a full assessment does not mean the individual will be eligible for NHS continuing healthcare.
6. During its complaint investigation, the Council accepted it delayed in completing the CHC checklist. As a remedy, the Council offered to pay for Mrs A’s care charges from November 2021 until March 2022. The Council said it agreed to pay from November 2021 as this was when there was evidence of a change in Mrs A’s mental health and so would have been eligible for a full CHC assessment.
7. I do not consider it is possible to say what the outcome of the CHC checklist would have been if the Council had completed it without delay. The Council did not outline any rationale for why it did not consider Mrs A would have been eligible for a full CHC assessment prior to November 2021.
8. Therefore, we invited the Council to complete a CHC checklist for Mrs A based on the information that would have been available to it in May and June 2021.
9. If the outcome of the checklist is that a referral would have been made for a full assessment, then it would be appropriate for Mrs X to pursue the matter of backdating the funding with the relevant Integrated Care Board (ICB). This is because the Council has no power to decide whether someone is eligible for CHC funding. Instead, the ICB is the relevant body to decide what date Mrs A would have been eligible for CHC funding.
10. I note the Council offered to pay for Mrs A’s care charges from November 2021 until March 2022. This offer goes beyond what the Ombudsman would have been able to recommend. Further, the Council has offered Mrs X a symbolic financial payment of £450 to recognise the distress and time and trouble caused. This offer is in line with our guidance on remedies.

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Agreed action

11. To its credit, the Council agreed to resolve the complaint and will complete the above within four weeks of the final decision.

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Final decision

12. We have upheld this complaint because the Council has agreed to resolve the complaint early by providing a proportionate remedy for the injustice caused.

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Investigator's decision on behalf of the Ombudsman