Summary: We uphold Mrs X’s complaint that Gainsborough House and Liverpool City Council provided inaccurate information about a change to her sister, Ms Y’s, care funding. However, we did not find this caused a financial injustice to Ms Y. The Care Home and the Council will apologise to Mrs X for the confusion caused. We did not find fault with the actions of NHS Cheshire and Merseyside ICB.

The complaint

1. Mrs X complains on behalf of her sister, Ms Y, about the way a change in her care funding was handled in February 2022. She complains Gainsborough House (the Care Home) is asking the family to pay a month’s fees arising from an error which was not her fault. The Care Home is run by London and Manchester Healthcare Ltd.
2. NHS Cheshire and Merseyside Integrated Care Board (the ICB), who previously provided Ms Y with NHS Continuing Healthcare (CHC) funding, has declined to pay the disputed month’s fees. Mrs X also says she did not receive notification from the ICB of the date the CHC funding would finish.
3. Mrs X does not accept the Care Home’s explanation that a social worker from Liverpool City Council (the Council) gave the Care Home incorrect information about the CHC funding end date, which the Care Home says led it to issue an incorrectly dated contract.
4. Mrs X says she has found trying to resolve the situation extremely stressful. She would like for the £5,128.32 debt wiped from Ms Y’s account.

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The Ombudsmen’s role and powers

5. 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).
6. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
7. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused. We might also recommend the organisation takes action to stop the same mistakes happening again.
8. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)
9. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)

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How I considered this complaint

10. I have considered the information Mrs X provided in support of her complaint. I have also received information from the ICB, the Council and the Care Home including a range of correspondence between the organisations and Ms Y’s family. I have carefully considered all the written and oral evidence submitted, even if it is not all mentioned within this decision statement.
11. I shared this draft decision with Mrs X, the ICB, the Council and the Care Home and they had an opportunity to comment. I have considered the comments I received.

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What I found

12. Ms Y lived at Gainsborough House (the Care Home) from 2019 to December 2024.
13. Ms Y does not have mental capacity to manage her financial affairs. Mental capacity is the ability to make an informed decision based on understanding a situation, the options available, and the consequences of the decision. Her sister, Mrs X, is Ms Y’s court appointed deputy and manages Ms Y’s financial affairs on her behalf. Mrs X’s son, Mr X, supports her in her role.
14. Ms Y was in receipt of CHC funding. The ICB used this funding to pay Ms Y’s care home fees. CHC funding is a package of ongoing care that is arranged and fully funded by the NHS where a person has been assessed as having a ‘primary health need’.
15. In late 2021, the ICB reviewed Ms Y’s CHC funding. Following this, the ICB decided Ms Y was no longer eligible for CHC funding. As a result, Ms Y’s CHC funding ended on 3 February 2022. Ms Y was granted Funded Nursing Care (FNC) which is a contribution from the NHS to pay towards the nursing part of her care fees. Ms Y was then responsible for paying the remaining care fees.
16. On 7 January 2022, the ICB sent an email directly to the Care Home manager with a formal letter attached confirming Ms Y’s CHC funding would end on 3 February 2022. The ICB asked the Care Home to give a copy directly to Ms Y. The Care Home says it has no record of this letter and cannot confirm if it was received. Mrs X says the Care Home did not pass a copy of this letter to her.
17. On 11 January 2022, the ICB informed the Council’s social worker that Ms Y’s CHC funding would end on 3 February 2022. The next day, the social worker incorrectly told Mr X by telephone Ms Y’s CHC funding would end on 3 March 2022.
18. On 24 January 2022, the social worker incorrectly advised the Care Home’s accounts staff by email that Ms Y’s CHC funding would end on 3 March 2022.
19. On 27 January 2022, the social worker replied to an email from Mr X, correctly stating that Ms Y’s CHC funding would end on 3 February 2022.
20. The Care Home took the incorrect date from information provided by the social worker and drew up a new contract for Ms Y. This new contract incorrectly stated Ms Y would become a self-funder on 3 March 2022. On 31 January 2022, the Care Home sent this new contract to Mrs X.
21. On 1 February 2022, the Care Home accounts team replied to an email from Mr X, advising him funding would end on the incorrect date of 3 March 2022.
22. On 24 February 2022, the ICB sent a copy of its letter dated 7 January 2022 to Mrs X. This letter correctly confirmed Ms Y’s CHC funding ended on 3 February 2022. The ICB has explained there was a short delay sending this directly to Mrs X as it first needed to confirm she had authority to act for Ms Y. The ICB sent this letter to Mrs X’s home address by recorded delivery.
23. On 11 March 2022, Mrs X signed the Care Home’s new contract which incorrectly stated Ms Y would be self-funding from 3 March 2022.
24. The Care Home invoiced the ICB for Ms Y’s care fees for February 2022. The ICB did not pay as Ms Y’s funding had ended on 3 February 2022.
25. In September 2022, Mr X emailed the social worker, explaining Ms Y’s CHC funding had ended in February 2022 and the family were currently appealing this. The appeal was unsuccessful.
26. On 13 January 2023, the Care Home contacted the ICB with a query about Ms Y’s FNC status as there was a debt on the account. The Care Home said Ms Y’s CHC funding had ended in March 2022. The ICB’s reply confirmed Ms Y’s CHC funding had ended on 3 February 2022, not 3 March 2022.
27. In January and February 2023, the Care Home invoiced Mrs X for the outstanding bill for February 2022. Mrs X paid the invoice.
28. In January 2024, Mr X reviewed Ms Y’s contract which stated she would become a self-funder from March 2022. Mrs X and Mr X raised a complaint about the payment from February 2022, which they said was outside the terms of the signed contract and therefore Ms Y should not be responsible for that month’s fees. Mrs X and Mr X withheld the disputed amount from the next care fee payment, creating a £5,000+ debt on Ms Y’s account.
29. In December 2024, Ms Y moved from the Care Home. The dispute about the outstanding debt on the account remains unresolved.

Analysis

The ICB’s actions

30. The ICB wrote to the Care Home, formally notifying it of the correct date Ms Y’s CHC funding would end and asking for the information to be passed to Ms Y. The ICB has provided evidence of the email sent directly to the Care Home manager.
31. The ICB also sent a copy of this letter directly to Mrs X’s home address, shortly afterwards. The ICB has provided evidence the letter was sent by recorded delivery.
32. The ICB notified both the Care Home and Mrs X of the correct date Ms Y’s CHC funding would end. The ICB has not contributed to the confusion over the end date. Further, the ICB is not responsible for the disputed care bill for February 2022, which is for a period of care after Ms Y’s CHC funded had ceased. I have not found any evidence of fault by the ICB.

The Council’s actions

33. The social worker provided the incorrect date Ms Y’s CHC funding would end to both the Care Home and Mr X on more than one occasion. This was fault and contributed to the confusion over when Ms Y’s funding would end. This confusion caused Mrs X and Mr X frustration.

The Care Home’s actions

34. As above, I have seen evidence from the ICB that its letter of 7 January 2022 was sent by email directly to the Care Home manager.
35. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened. While the Care Home has no record of this letter, I am satisfied that, on the balance of probabilities, the Care Home manager received it.
36. I acknowledge the Council’s social worker confused matters by giving an incorrect date to the Care Home. However, the Care Home had the correct date for Ms Y’s CHC funding to end directly from the ICB, over a week before the social worker gave the wrong date. The Care Home should have relied upon the formal information from the ICB. It seems the Care Home manager did not act on the ICB’s letter by ensuring it was passed to the relevant people, including Ms Y and the Care Home’s accounts team. This was fault and added to the confusion over the date for Ms Y’s new contract.

Injustice

37. Mrs X and Mr X say it is not Ms Y’s fault that the date on the Care Home’s new contract was incorrect and therefore she should not be responsible for the care fees for February 2022 when the contract states she would begin paying her fees in March 2022. Mrs X and Mr X wish to have the debt wiped from Ms Y’s account.
38. When we find fault in an organisation’s actions, we then look at what injustice this has caused. Our approach to injustice is to, where possible, put a person back in the situation they would have been in had the fault not occurred.
39. I have found fault with the Council and the Care Home’s actions, which contributed to confusion over the date Ms Y’s CHC funding ended.
40. Ms Y’s CHC funding ended on 3 February 2022. From this date, Ms Y would have been responsible for her care fees. Had the fault not occurred, Ms Y would have paid the fees from February 2022 at the time. Ms Y has not suffered a financial loss due to the fault. Therefore, we would not recommend that the Care Home wipe the debt from Ms Y’s account.
41. I recognise Mrs X and Mr X received conflicting information about the end date for Ms Y’s funding. This was unhelpful.
42. I also acknowledge it was the Care Home’s responsibility to draw up the contract correctly. The subsequent confusion has been worrying and time consuming for Mrs X and Mr X. However, this injustice does not override the fact Ms Y was responsible for the disputed fee once her CHC funding ended on 3 February 2022.
43. In 2023, Mrs X paid the February 2022 invoice. Therefore, this amount has been settled.
44. In 2024, Mr X withheld payment from a subsequent care bill while he challenged the historic matter. There is no automatic right to offset this with a bill for care provided at a later date because a previous bill is now in dispute. Refusing to pay for a 2024 care bill is refusing to pay for care which was provided to Ms Y in 2024. This unpaid care is separate to the matter complained about and cannot be conflated with an already paid and later disputed bill from February 2022. The Care Home is currently considering whether to take legal action to recover this amount.

Breach of contract

45. Mr X says the Care Home is in breach of contract by asking Ms Y to pay for care provided prior to March 2022, per the date on the contract.
46. We cannot say whether an action was lawful, and we cannot determine a breach of contract. Only a court could do that. If Mr X wishes to challenge a breach of contract, it is open to him to seek legal advice on the matter.

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Actions

47. Within one month, the Council and the Care Home will apologise to Mrs X and Mr X for confusion and inconvenience caused by inaccurate information in relation to the end date for Ms Y’s CHC funding.

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Final decision

48. I have not found fault with the ICB’s actions.
49. I have found fault with the Council and the Care Home’s communication surrounding the date Ms Y's CHC funding would end. This caused Mrs X and Mr X confusion and inconvenience.
50. However, I found this fault did not cause Ms Y a financial loss.
51. I have now completed my investigation.

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Investigator's decision on behalf of the Ombudsman