The Ombudsman's final decision
Summary: We will not investigate Mr X’s complaint about an alleged failure to apply for NHS Continuing Health Care funding for his relative, Mr Y, in April 2022. An investigation would not achieve a worthwhile outcome or what Mr X wants.
The complaint
Mr X complains the Council did not refer his relative, Mr Y, for an NHS Continuing Health Care (CHC) assessment following a review of his care needs in April 2022. He says this led to Mr Y missing out on NHS funding. He wants the Council to reimburse Mr Y’s care charges and provide training to its staff about the CHC framework.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide: we cannot achieve the outcome someone wants, or there is no worthwhile outcome achievable by our investigation.
(Local Government Act 1974, section 24A(6), as amended, section 34(B))
How I considered this complaint
I considered information provided by the complainant and the Council.
I considered the Ombudsman’s Assessment Code.
My assessment
We will not investigate this complaint. The decision about whether a person is eligible for CHC funding is made by the NHS. Even if the Council had referred Mr Y for a CHC assessment in 2022, we could not say what the outcome would have been, or whether the NHS would have awarded CHC funding for Mr Y. Any claimed injustice is therefore speculative.
An investigation could not say the Council’s actions led to Mr Y missing out on CHC funding, as the eligibility decision was not the Council’s to make. An investigation would not lead to a worthwhile outcome or achieve what Mr X wants.
Final decision
We will not investigate Mr X’s complaint because an investigation would not lead to a worthwhile outcome or achieve what Mr X wants.
Investigator's decision on behalf of the Ombudsman