Summary: Ms X complained the Council social care team has not supported her since the health service discharged her from hospital. Ms X said she has not had her needs met. The Council was not at fault.

The complaint

1. Ms X complained the Council social care team has not supported her since the health service discharged her from hospital. Ms X said she has not had her needs met.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a Council’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)

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How I considered this complaint

4. I read Ms X’s complaint and spoke to her about it on the phone.
5. I considered information provided by Ms X and the Council.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Background information

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
9. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
10. Individuals may need care and support provided by their local council and/or services arranged by ICSs. Councils and ICSs therefore have a responsibility to ensure the assessment of eligibility for care and support and for CHC respectively take place in a timely and consistent manner. If, following an assessment, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person’s health needs, either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both a council and an ICS, this is known as a ‘joint package of care’. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a council to meet.
11. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman.
12. Intermediate care and reablement support services are for people usually 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. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

13. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

What happened

14. This is a summary of events, outlining key facts and does not cover everything that has occurred in this case.
15. Ms X has complex additional needs. She was admitted to hospital in July 2022.
16. The NHS confirmed Ms X was well enough for discharge in January 2023. The NHS raised concerns about the suitability of Ms X’s home. The Council completed an assessment. The assessment noted Ms X’s medical needs and confirmed the assessment was not appropriate as she remained in hospital.
17. The NHS arranged a short-term reablement placement at a nursing home for six weeks. Ms X moved into the placement in March 2023. The placement was fully CHC funded.
18. Ms X complained to the Council in March 2023. She was unhappy with the placement.
19. The Council responded to Ms X’s complaint in May 2023. The response confirmed the Council would complete an assessment and a CHC meeting.
20. The Council completed an assessment in May 2023. The assessment confirmed Ms X’s needs related to her health. The Council stated the placement and support remained fully CHC funded. The Council confirmed it was not providing services and would close the case.
21. Ms X was not satisfied with the Council’s response and has asked the Ombudsman to investigate. Ms X would like the Council to provide appropriate support.
22. In response to my enquiries the Council stated it completed an assessment and Ms X’s care is fully CHC funded.

My findings

23. Ms X’s circumstances are complicated by concerns around her housing situation. This investigation has only considered matters relating to Ms X’s social care assessment.
24. The Council has a duty to complete an assessment to consider an individual’s needs. The Council must consider if any requirements arise from an individual’s health needs. If this is the case, the Council should engage with the NHS to confirm who would meet the identified needs.
25. The NHS funded the placement from Ms X’s discharge. The Council completed an assessment. The assessment confirmed Ms X’s needs were due to her health needs and the Council would take no further action. The NHS is therefore responsible for the package of care for Ms X. The Council was not at fault.

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Final decision

26. I have completed my investigation. The Council was not at fault.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman