Decision Date: 29 October 2024
Summary
The Care Provider for Mrs C was found at fault regarding the care she received when living at Meadway Court care home between 2021 and 2022. Mr B, Mrs C’s son, was incorrectly invoiced in person for the care. The Care Provider recognised the invoice error and apologised to Mr B, acknowledging that he could not be liable to the home.
What happened
Mr B complained about the care his mother Mrs C received, at Meadway Court Care home which was operated by Borough Care Ltd, from 2021 to 2022 – concerning assault and poor quality care and an invoice HE received just a few days after Mrs C died.
During 2021 Mrs C entered the care home funded by an NHS commissioning care group (CCG) (now known as an ICB).
In May 2022, the CCG had contacted the Care Provider to state that since October 2021, it had been wrongly funding Mrs C’s care. It stopped the funding and took back the money it paid for Mrs C’s care after that date.
Mrs C did not have capacity to manage her financial affairs, and there was no-one with legal power or authority to act on her behalf.
The Care Provider decided to send an invoice to Mr B, in excess of £30,000. The Provider wrote to Mr B several times in 2022 but there was no response.
There were several incidents involving Mrs C at the care home, which led the local social services authority to carry out a safeguarding investigation. Mr B said that Mrs C suffered several assaults, including one where the police investigated. Mr B provided details of the injuries Mrs C had suffered.
In August 2022, Mrs C was admitted to hospital. She did not return to the care home, and spent time in different accommodation, before her death in February 2024. This was AFTER the period of care for which the CCG had clawed back 7 months’ worth of fees from the care home, however.
A few days after Mrs C’s death, Mr B received another invoice from the Care Provider, chasing what it referred to as the unpaid debt, which generated a formal complaint from Mr B.
After the complaint, the care home responded and apologised that Mr B had on occasion found Mrs C in different clothes to her own.
The management could not account for this as there was no record the care home looked into this at the time.
The home also said that following a safeguarding referral to the local authority it dismissed staff for the injuries Mrs C had received and the management apologised for this. It said that Mrs C received injuries due to conflict with other residents, as well as a result of a fall, but there were no witnesses to this incident.
The care home said it accepted that Mr B was distressed due to the invoice, but said it only sent it to seek “payment in line with the contractual agreement” which was in place.
The Care Provider ultimately acknowledged that there was no contract in place for Mrs C’s care once NHS funding stopped. And whilst it contacted Mr B with a contract for signature, it had not received any response. As a result, it was acknowledged that the provider would have to attempt to seek reimbursement of the care charges from Mrs C’s local authority or from the NHS.
The Care Provider wrote to Mr B saying he would receive no further invoice charges for Mrs C’s care, and apologised for not solving the issue sooner.
What was found
It was found that the Care Provider was at fault regarding the invoices sent to Mr B. The Care Provider should not have sent him the invoice because it was not in any form of contract with his mother or with him.
On the CCG’s withdrawal from funding for Mrs C’s care in 2022, the provider should have enquired to find who had the authority to handle her finances. If no-one had authority, responsibility would fall to her local social services authority unless or until it was determined that there was someone else willing to make direct arrangements for her. A placement under the Care Act based on her incapacity and the absence of any willing party for direct arrangements would have funded her care until her financial situation was understood properly or pending the appointment of someone with legal authority to handle them.
It was fault to approach Mr B for the funds reclaimed by the CCG, and fault that the Provider let matters drift over 12 months before contacting Mr B again.
Yet, the Ombudsman decided to discontinue the investigation into the complaint. This was because of a number of reasons, one of which was that Mr B had waited 20 months after Mrs C had left the care home and only complained to the care home itself, 2 months before that.
Mr B asked the Ombudsman to consider the stress he experienced in August 2022. Yet, there was not so strong an evidential picture justifying his delay in complaining.
The Ombudsman considered the Care Provider’s acknowledgements and actions to have remedied any injustice caused to Mr B via the Care Provider’s faults.
The Ombudsman also reminded the care home that the fundamental standards of care (regulated by the CQC) include that care providers have effective complaint procedures, ensuring that complainants know where to go next if unhappy with a reply to a complaint. The Care Provider should also tell them they can complain to the Ombudsman and this care provider did not do that, which was fault.
The Care Provider accepted the Ombudsman’s findings, and has changed its procedure to signpost complainants and avoid delay when chasing debts.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
It is hard to understand why the Ombudsman does not detail the reason why the CCG withdrew from funding the woman’s care. The CHC National Framework guidance is clear that:
“Where reassessment of eligibility for NHS Continuing Healthcare is required, a new DST must be completed by a properly constituted multidisciplinary team (MDT), as set out in this National Framework. Where appropriate, comparison should be made to the information provided in the previous DST. ICBs are reminded that they must (in so far as is reasonably practicable) consult with the local authority before making an NHS Continuing Healthcare eligibility decision, including any re-assessment of eligibility. This duty is normally discharged by the involvement of the local authority in the MDT process, as set out in the Assessment of Eligibility section of this National Framework. ICBs should ensure an individual’s needs continue to be met during this reassessment of eligibility process.
210. It is a core principle that neither an ICB nor a local authority should unilaterally withdraw from an existing funding arrangement without a joint reassessment of the individual, and without first consulting one another and the individual about the proposed change of arrangement. Therefore, if there is a change in eligibility, it is essential that alternative funding arrangements are agreed and put into effect before any withdrawal of existing funding, in order to ensure continuity of care. Any proposed change should be put in writing to the individual by the organisation that is proposing to make such a change. If agreement between the local authority and the NHS cannot be reached on the proposed change, the local disputes procedure should be invoked, and current funding and care management responsibilities should remain in place until the dispute has been resolved.
Of course referral to the local authority must be made – because a person who lacks capacity to contract but who loses eligibility for CHC status cannot be made liable for fees, yet continues in place, and benefiting from the services. That is not fair to any provider.
We feel for the provider which must have been ignorant of this material – we suspect that it was signed up to an ICB contract that allowed recoupment to occur administratively against fees that were properly due for some other client. The provider might not have grasped the significance of that action at the time.
The provider would need to make a fuss about the failure of the CCG (now the ICB) to have complied with the above guidance.
It would be a difficult claim to make out without any evidence of local authority knowledge of the withdrawal of CHC status. So there is a lot that we are not being told in this report, we have to say.
If the woman’s means were above threshold and no relative wanted to organise finance and property deputyship, then the Council would have to take that one or refer her to an outside solicitor for payment of scale fees.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Meadway Court (24 001 871) report.
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