Summary: Mr X complains the Council and an NHS Integrated Care Board (ICB) failed to meet his late wife’s need for nighttime care, after the NHS decided she was not eligible for NHS Continuing Healthcare. We have discontinued the investigation into his complaint about the Council, so the ICB can have an opportunity to investigate and respond to his complaint. If Mr X remains dissatisfied, we will then be able to consider a joint investigation into his complaints with the Health Service Ombudsman.

The complaint

1. The complainant, Mr X, complains the Council and an NHS Integrated Care Board failed to meet his late wife’s need for nighttime care after the NHS decided she was not eligible for NHS Continuing Healthcare.

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The Ombudsman’s role and powers

2. It is our decision whether to start, and when to end an investigation into something the law allows us to investigate. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)
3. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).

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How I considered this complaint

4. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• consulted our Joint Working Team about the complaint; and
• invited comments on a draft of this statement from Mr X and the Council, for me to consider before making my final decision.

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What I found

What happened

5. When Mrs X left hospital in December 2023, the Council funded daytime care and the NHS funded nighttime care. Following a multidisciplinary team meeting in March 2024, the NHS decided Mrs Y did not qualify for NHS Continuing Healthcare. The NHS ended funding for nighttime care on 18 April.
6. Mr X complained to the Council about the failure to fund Mrs Y’s nighttime care. He also appealed the NHS decision that his wife did not qualify for NHS Continuing Healthcare. But he did not complain to the NHS about its failure to work with the Council over who should be funding his wife’s nighttime care.
7. As a result of Mr X’s complaint, the Council agreed to fund nighttime support from August 2024, on a “without prejudice” basis. It did this while it continued to question whether the need for nighttime care was a healthcare need, which the NHS should fund.
8. Between April and August Mr & Mrs X paid over £13,000 for nighttime care, which he wants to have refunded.
9. Mrs X died in December 2024.

Are there grounds to continue the investigation into this complaint?

10. While the Ombudsman has the power to do joint investigations with the Health Service Ombudsman, both bodies (NHS and local government) need to have had the opportunity to investigate and respond to a complaint before we carry out a joint investigation. Our Joint Working Team has advised that, as Mr X has not yet complained to the NHS Integrated Care Board, he first needs to do this before we can investigate his complaint about the Council and the NHS. Once he has completed the NHS complaints process, if he remains dissatisfied, Mr X will be able to contact us (or the Health Service Ombudsman) to pursue his complaint about both bodies.

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Final decision

11. I have discontinued my investigation on the basis Mr X needs to complain to the NHS Integrated Care Board before we can investigate his complaint jointly with the Health Service Ombudsman.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman