Decision date: 24 June 2024
Summary
This was a charging complaint related to reablement – the free care that comes after hospital discharge if one is considered suited to that sort of service, the purpose being to help a person to preserve or regain the ability to live independently.
Mrs Y was charged, by dint of fault, and the charge had to be repaid.
What happened
In August 2022, Mrs Y’s doctor referred her to the Rapid Response Team (RRT) regarding acute back pain. The RRT found Mrs Y needed a twice-daily care package to help with daily tasks and personal care. The Community Reablement Service (CRS) provided the package for two days in August before Mrs Y went to stay with her son, Mr X.
When she returned home, in September, the RRT assessed her again and reinstated Mrs Y’s care package between 1 September to 22 September 2022.
This became an ordinary domiciliary care package on 23 September which an outside Care Provider delivered.
In December 2022 the Council completed what it called a Strength Based Assessment and found that she needed ongoing care; it began care planning. [the report does not say what happened about that!]
Three months later Mrs Y had a stroke and was admitted to hospital. Her care package stopped and the Council’s reablement team closed her case.
In mid-April 2023 before she was discharged from hospital, an OT told Mr X, Mrs Y’s son, that she required long-term care and would be financially assessed for her financial contribution towards the cost.
The hospital discharge took place and the Council commissioned one 45-minute morning visit and 2 x 30-minute visits at lunch and teatime. Documents for the care package stated it was not a reablement service.
The day after the hospital discharge an email was sent to Mr X stating that Mrs Y would receive a reablement package.
The Council charged Mrs Y for her care package from the date she left the hospital until 14 September when she ended the service.
Mr X complained, saying that his mother’s care should have been free for the first six weeks after she left the hospital because she was eligible for a reablement package. He also said the Council continued to charge Mrs Y for care despite her ending the care package in September 2023.
Haringey Council accepted that it could not charge after the date when the package was terminated and that there had been a miscommunication with Mr X about whether the first six weeks of Mrs Y’s care would be treated as free reablement care, but reiterated that it was clear that Mr X was told on 18 April that Mrs Y needed longer-term care so must have understood that a six-week reablement package was not suitable for her needs and that his mother would be charged.
Mr X said he’d relied on the email saying it would be free and that the Council’s financial assessment team told him Mrs Y would be charged for her care from 5 June 2023, six weeks after she left hospital.
Haringey said that the previous September to March package had been wrongly funded as reablement even though it was clearly longer-term ongoing care, its point being that everyone was aware that she already needed ordinary domiciliary care from before the occurrence of the stroke and period in hospital.
What was found
The investigator interpreted Regulation 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014 to mean that reablement care should be free of charge for up to six weeks and that this applies whether or not the person has eligible needs for ongoing care and support. Therefore, the Council should not have charged Mrs Y for the first six weeks of her care after she left the hospital in April 2023.
The information in the email of 20 April was different to that given to Mr X in the telephone call of 18 April. She and her son were wrongly told she must pay for this care whilst thinking it was reablement. The fact that she received a free package for longer than six weeks before her admission to the hospital did not offset the injustice caused to Mrs Y and Mr X by the fault found.
She was charged £1587.60 for the six weeks she was wrongly charged, plus a weekly self-funders fee which totalled £75 for this period. That all needed to be repaid.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public
Another lucky beneficiary of incompetence about the legal framework, in our view, was Mrs Y.
We say that because we think the LGSCO has got it wrong here, if the report is really to be taken to be suggesting that literally everyone who leaves hospital gets free care for up to 6 weeks.
That is not the law, because some people are not assessed as being able or having the capacity to benefit from the focus in reablement services of doing rather than being done unto.
It was always going to be an abject mess after the hospital discharge process in the Guidance known as Discharge to Assess became place-based and varied around the country, with people calling the next stage onwards (– the next episode of care), a series of bizarrely named services – and thus obscuring the application of the legal framework regarding whether the person, the Council or the NHS was financially responsible for what was arranged to happen next.
Regulation 4 of the 2014 Prevention Regulations for the Care Act says this:
‘A local authority must not make a charge under regulation 3(1) where the provision made under section 2(1) of the Act is—
(a) a service which consists of the provision of community equipment (aids and minor adaptations);
(b) intermediate care and reablement support services for the first 6 weeks of the specified period or, if the specified period is less than 6 weeks, for that period.
It is clear from the regulations that the regulations govern charging for prevention – for services under s2 of the Care Act, that is, and not under s18, ie not after a Care Act assessment of eligibility. If these services are provided before a care plan, they are preventive. If they are provided AFTER a care plan, then they can be charged for as ordinary home care, but they do not need to be.
This Council had no doubt that it was going to be providing long-term care: the proof of that is that they were charging this lady a self-funding fee as well as ordinary social care charges. There is no power to do that for preventive services.
The Council has nobody but itself to blame for forgetting that the Care Act is linear and that it hadn’t done an assessment or an eligibility decision despite indicating what it would decide. But the fact that one may need reablement – or NHS funded intermediate care which of course cannot ever be charged for – when leaving the hospital, does not mean that it’s something that everyone now gets, under the Discharge to Assess policy. Since a period of UP to 6 weeks needs to be identified, it’s clear that there’s still supposed to be a decision as to how long the purpose of input counts as this sort of package, and indeed, whether there’s any point to reablement at all. People with significant cognitive decline that is not improving may well not be able to benefit from it, with regard to motivation.
The Care And Support Guidance (the chapter on prevention and reduction duties) explains that terms are used interchangeably but that
“The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example, independent living skills and mobility training for people with visual impairment.”
The Guidance goes on to mention (and this complaint report references this): ‘The National Audit of Intermediate Care’ which lists four types of intermediate care, but without make the funding arrangements clear.
- crisis response – services providing short-term care (up to 48 hours);
[that might be a specific rapid response team and intervention funded by a pooled budget precisely so that it does not have to be decided whether it’s health or social care, because just very short term, but keeping people out of hospital]
- home-based intermediate care – services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists;
[this would be NHS funded, and likely for someone who had been check-listed for a CHC assessment – and this is what interim step-down care is supposed to be, for a package of care for those coming out of hospital but awaiting that sort of an assessment, if only anyone was bothering to do checklists!]
- bed-based intermediate care – services delivered away from home, for example in a community hospital;
[this is more likely to be Council funded too but depending on check listing and setting again. If positively checklisted, and being delivered in a community hospital it will be NHS funded, but if negatively checklisted but with a need to be cared for other than in their own homes, then that could be Council-funded intermediate care.]
- 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.
[this would definitely be Council-funded]
The regulations do not say that councils should consider continuing to provide intermediate care or reablement under s2 of the Care Act without charge because of the preventive benefits as suggested by the Investigator here. It is the Guidance that says that councils should do that, here:
2.62 Whilst they are both time-limited interventions, neither intermediate care nor reablement should have a strict time limit since the period of time for which the support is provided should depend on the needs and outcomes of the individual. In some cases, for instance, a period of rehabilitation for a visually impaired person (a specific form of reablement), may be expected to last longer than 6 weeks. Whilst the local authority does have the power to charge for this where it is provided beyond 6 weeks, local authorities should consider continuing to provide it free of charge beyond 6 weeks in view of the clear preventative benefits to the individual and, in many cases, the reduced risk of hospital admissions.
Para 2.41 of the Guidance says this, which the investigator could have flagged up.
A local authority must establish and maintain a service for providing people with information and advice relating to care and support (see Chapter 3). In addition to any more targeted approaches to communicating with individuals who may benefit from preventative support, this service should include information and advice about preventative services, facilities or resources, so that anyone can find out about the types of support available locally that may meet their individual needs and circumstances, and how to access them.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Haringey Council (23 014 223) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community when posted.
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