Summary: Mrs X said the Council’s handling of Mr X’s added care costs after he left hospital was unnecessarily time consuming, caused distress and significantly affected her finances. We found there was avoidable delay by the Council and a failure to properly process Mrs X’s complaint about the costs. To put matters right, the Council agreed to apologise to Mrs X and make a symbolic payment of £1,000. The Council also agreed to remind its officers of the need to deal with complaint correspondence in a timely manner.

The complaint

1. Mrs X said the Council failed to tell her that her husband’s, Mr X, extra two hours of care following his discharge from hospital would be chargeable. Mrs X felt obliged to pay the resulting bill to ensure Mr X continued to receive care. Mrs X also said the Council delayed responding to her complaint letters about the care costs.
2. Mrs X said what happened put her to avoidable time and trouble, was frustrating and caused distress. And paying for the added care had a significant impact on her finances. Mrs X wanted the Council to reimburse the added care costs she paid.

Back to top

The Ombudsman’s role and powers

3. 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)
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (Local Government Act 1974, section 26A and 34C, as amended) Here, we found Mrs X a suitable representative to make a complaint for Mr X.
5. 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)

Back to top

How I considered this complaint

6. I have:

• considered Mrs X’s written complaint and supporting papers;
• talked to Mrs X about the complaint;
• asked for and considered the Council’s comments and supporting papers about the complaint, which included Mr X’s case records;
• shared Council information with Mrs X; and
• shared a draft of this statement with Mrs X and the Council and considered any comments received before making a final decision.

Back to top

What I found

What happened

7. Mr X had a care package funded by a direct payment and provided by company Z. The direct payment meant Mr X arranged and paid for the support covered by his care package using money provided by the Council. The Council was reviewing Mr X’s care and support needs with the possibility that it might be in his best interests to move to a residential care home. The review was not complete when Mr X went into hospital.
8. Mrs X contacted the Council while Mr X was in hospital and said she would need more help after his discharge. The Council’s records showed it considered a reassessment of Mr X’s care and support needs would be necessary once he left hospital.
9. The hospital then told Mrs X that Mr X would need extra support, which would need funding, for it to safely discharge him. Hospital staff discussed Mr X’s needs with Mrs X. A member of Z visited the hospital and agreed that Z could provide the proposed increased package of care. The next day, the hospital discharged Mr X and he returned home.
10. The Council’s records showed Mrs X made contact the day after Mr X came home asking for help and information about caring for Mr X. The Council spoke to Mrs X the next day. The Council’s records showed Mrs X was unsure about the funding for Mr X’s added care. The Council told Mrs X it would seek information about Mr X’s discharge from hospital.
11. Council emails showed its officers considered the situation. And, a few days later, the Council contacted Z, which told it the hospital had arranged for it to provide added care for Mr X, which Z thought the Council would fund. Z also explained how the added care differed from the support it provided before Mr X’s hospital admission. The Council asked Z if it was registered with the Care Quality Commission (CQC) to provide the added care services to people. The Council’s records showed Z said it was seeking the relevant CQC registration. And the Council told Z that providing the added care services without the necessary CQC registration “could be an issue”. (By law, people must register with the CQC to provide regulated health or adult care activities. It is an offence to provide regulated activities without the relevant registration.) Emails between relevant Council managers showed it then decided it could not fund the added care services provided by Z.
12. A few days later, Z told Mrs X the Council would not fund the added care services it had been providing since Mr X left hospital. Mrs X spoke to the Council. The Council’s records showed Mrs X said she had heard nothing from the hospital or Council since Mr X came home and had assumed “things were ok”. The Council’s records showed it signposted Mrs X to the hospital to address her funding concerns. The records also showed Mrs X said she had written to the Council as she was “not happy about the care situation” (‘the Letter’).
13. In the Letter, Mrs X said the hospital had telephoned saying it was discharging Mr X as an increased care package, to be provided by Z, was in place. Mrs X also said she had contacted the Council when Mr X came home to clarify matters, including about the cost of his added care. Mrs X said the Council told her it had not received the paperwork from the hospital but she should not worry. Later, Z told her the Council said it should not be providing, and it would not pay for, the added care given to Mr X. Mrs X said it was “disgraceful” that Z’s fees would not be paid when Mr X was discharged because added care was in place. Mrs X said, but for Mr X’s hospital admission, he would likely have been in a residential care home, which would cost the Council much more than Z’s added care services. Mrs X said it seemed she would have to find the money to pay Z’s fees but asked the Council to respond urgently. (Mrs X cancelled the added care services and paid Z for those it had already provided.)
14. The Council arranged a home visit to Mr and Mrs X. The Council’s records showed Mrs X could not continue with her caring role. The Council assessed Mr X’s care and support needs and decided it was in his best interests to live in a residential care home, which placement it would fund. Mr X moved into a care home about seven weeks after he left hospital.
15. About a month after Mr X moved home, the Council was in touch with Mrs X when closing Mr X’s direct payment account. The Council’s records showed Mrs X raised the lack of response to the Letter, which she had sent over two months earlier. Two days later, having followed the matter up, the Council officer dealing with the direct payment account telephoned Mrs X. The Council’s records showed its officer told Mrs X its Contracts – Adult Team would soon be in touch to deal with the Letter. The Council also gave Mrs X a telephone number for its Adult Social Care Access Team should she not hear anything.
16. After a further month, Mrs X wrote again to the Council and attached a copy of the Letter. During the next three months, Mrs X sent the Council two chaser letters, one of which advised of Mr X’s death, and then contacted her local Member of Parliament (MP). Mrs X’s MP then wrote to the Council. Nearly eight months after writing the Letter, Mrs X received a response from the Council. The Council confirmed receipt of Mrs X’s last two letters and apologised for its delayed response. The Council said it had not arranged added care for Mr X on his discharge from hospital. The Council signposted Mrs X to the hospital and Z to deal with her concerns about the costs of the added care as they had arranged it.
17. Mrs X wrote to the hospital, which replied quickly. The hospital said its staff had discussed with her the added care needed to safely discharge Mr X. The decision was Z would provide added care alongside the support it already gave to Mr X. The hospital said it had made a referral for the added support. It had then received a telephone call saying Mr X had a direct payment from the Council to pay for the added care and so discharged Mr X.
18. Mrs X sought further advice and made a complaint to us about the Council and another to the Parliamentary and Health Service Ombudsman about the hospital.

Mrs X’s views

19. Mrs X said, while Mr X was in hospital, no one said she would be responsible for paying any added care costs. If she had been told, she would have made it clear she could not afford to pay such costs. Mrs X paid Z’s fees as she did not want Z to stop providing the original support services to Mr X as good care was hard to find where they lived. But as she had not put the added care in place, the Council, and or the hospital, should repay her. Mrs X said she had a fixed income, which included rights to benefits, and needed Z’s fees repaid.
20. Mrs X was also upset at the lack of courtesy from the Council in its failure, for over seven months, to reply to the Letter and later chaser letters. Mrs X said she felt ignored and doubted the Council would have replied if her MP had not intervened. As it was, the Council’s response put her back to square one and having to raise the matter with the hospital, which also offered no refund.
21. Mrs X produced a copy of the hospital’s ‘discharge summary’. The summary showed Mr X moved to the eldercare ward for discharge planning and to await an increased care package. The summary included an entry under ‘nurse enabled discharge’ which said, “home with [increased package of care]”.

The Council’s comments to the Ombudsman

22. The Council said its records showed Mrs X contacted it while Mr X was in hospital (see paragraph 8). But it held no evidence the hospital, NHS staff or any third party contacted it about Mr X’s hospital discharge or any added care. It had no involvement in Mr X’s hospital discharge. Its records showed it found out about Mr X’s added care services when Mrs X contacted it after his hospital discharge (see paragraph 10).
23. The Council said ‘referrals’ as mentioned by the hospital (see paragraph 17) went to the Integrated Transfer of Care Hub (ITOCH). (An ITOCH brings health and care professionals together to improve working between the NHS, councils and other relevant bodies.) The hospital managed and staffed the ITOCH. However, it provided a link worker for the ITOCH from Mondays to Fridays. Referrals were sent to it electronically for action. Its link worker recorded referrals about its services on its own and the NHS casework systems. The Council said it had no record of a referral for Mr X’s hospital discharge. And it had no involvement in the telephone call mentioned by the hospital (see paragraph 17). The Council provided a copy of Mr X’s referral, which was closed within and by the ITOCH.
24. The Council said, once Mrs X told it about Mr X’s discharge, it contacted Z, which was not one of its contracted service providers. It found Z did not have the necessary CQC registration to provide the added care services. It could not therefore properly commission Z to provide such services to Mr X. It had not agreed a timescale for updating Mrs X and it could not say why it had not done so after contacting Z (see paragraph 11). But, further contact took place about two weeks after Mr X’s return home (see paragraph 12). It then focussed on reassessing Mr X’s care and support needs, which led to his moving to a residential care home about seven weeks after his hospital discharge.
25. The Council confirmed it received the Letter and Mrs X’s first chaser letter. (It had already confirmed receipt of Mrs X’s two later chaser letters (see paragraph 16).) It accepted it did not respond to the letters or refer them to its Feedback Team, which dealt with complaints. The Council said it offered its sincere apologies for any added inconvenience and stress caused by its failure to reply. The Council also offered its further apologies for the delay in replying to Mrs X’s later correspondence and for not explaining why the delay happened. The Council said it should have passed Mrs X’s letters to its Feedback Team to deal with as a complaint. The Council said it would offer Mrs X a symbolic payment of £1,000 for the stress and inconvenience caused by failure and delay in its communications and complaints handling.

Consideration

Mr X’s hospital discharge and added care costs

26. The evidence showed the Council first became aware Mr X was back home and receiving added care when Mrs X telephoned it after he left hospital. I therefore had no grounds to find the Council responsible for the added care services, or their cost, put in place to safely discharge Mr X from hospital.
27. The Council’s case records showed that, once aware, the Council took prompt and suitable action to follow up Mrs X’s queries about Mr X’s added care. Within five days it found Z did not have the necessary CQC registration to provide the added care services. And, the following day, emails between relevant senior Council managers showed it decided it could not fund the added care services. I saw no evidence of fault in how the Council looked into the matter and reached its decision. But, it did not tell Mrs X about that decision. Given the Council knew of Mrs X’s costs concerns, I found it should have contacted her on reaching its decision. I therefore found the Council fell below acceptable administrative standards and was at fault.
28. Six days after its decision, Z told Mrs X the Council would not fund the added care services. Mrs X immediately contacted the Council and then cancelled the added care services and paid Z’s invoice, which covered about two weeks of added services. I found Mrs X would likely have cancelled the added care services six days earlier if the Council had told her of its funding decision. This would have significantly reduced the costs invoiced by Z and then paid by Mrs X. I therefore found the Council’s failure promptly to tell Mrs X of its funding decision caused her injustice.
29. The evidence showed the Council, with an NHS practitioner, took prompt and suitable action to reassess Mr X’s care and support needs after he left hospital. The Council also took suitable steps to provide short term support for Mr X, although this support was not in place before he moved to a residential care home. I saw no evidence of fault in how the Council considered Mr X’s care and support needs after his hospital discharge.

Communication with Mrs X

30. The Council accepted there was fault causing injustice in its handling of Mrs X’s complaint letters (see paragraph 25). I agreed. And Mrs X described the impact of the Council’s failure to reply to her letters for over seven months (see paragraph 20). The failure to reply also put Mrs X to avoidable time and trouble in sending chaser letters and contacting her MP and others for help to get a response to her complaint.

Back to top

Agreed action

31. The Council offered to send Mrs X a further apology and make a symbolic payment of £1,000. I saw no good reason to find the offer an inappropriate or unreasonable way to address the injustice to Mrs X, which I identified at paragraphs 28 and 30. The Council sent us a copy of its further apology letter to Mrs X during this investigation. So, it formally agreed (within 20 working days of this statement) to make a symbolic payment of £1,000 to Mrs X. The payment was to recognise the distress and avoidable time and trouble caused both by its delay in telling her it would not fund Mr X’s added care costs and its poor complaint handling.
32. The Council also agreed to send a written reminder to its Adult Social Care officers about the need to handle residents’ complaints in a timely manner by either responding directly or referring them its Feedback Team. The reminder to be sent within 10 working days of this statement.
33. The Council should provide us with evidence it has complied with the actions at paragraphs 31 and 32.

Back to top

Final decision

34. I completed my investigation, finding fault causing injustice, on the Council agreeing the recommendations at paragraphs 31 and 32.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman