Date of decision: 14 July 2025
Summary
Portsmouth City Council failed to notify Mrs X when she became responsible for funding her own care, causing personal distress, uncertainty, and unforeseen debt. The complaint highlighted a procedural lapse by the Council as it completely failed to do a financial assessment.
What happened
In early 2023, after a hospital stay, Mrs X was discharged to a care home under the Discharge to Assess (D2A) process, which was managed by the Isle of Wight Healthcare Trust. The local Pathway 3 protocol treated people with complex needs as needing a CHC assessment so the NHS paid for the first care home placement.
This meant that the Council was not involved in her placement at that stage.
Later that same year, an NHS Continuing Healthcare (CHC) assessment was conducted, and Mrs X was found not to be eligible for full NHS funding. However, Mrs X did qualify for NHS-Funded Nursing Care (FNC). Letters informing Mrs X and the care home of the outcome were sent, though Mrs X later stated she had not received any letters [the report does not clarify whether these letters were ICB letters, as should have been sent after the DST].
Three months after this, a review [we think that this must have been by the home] confirmed her continued eligibility for FNC contributions.
In 2024, the care home contacted the Council to report they had received no payment for Mrs X’s care fees. The Council discovered Mrs X had not been transferred to the Council’s social work team after the CHC decision, and no financial assessment was carried out. The Council then visited Mrs X, explained the issue, and completed a financial assessment. The assessment found she had savings above the upper capital limit and was liable for the full cost of her care fees (minus the FNC contribution) backdated to mid-2023, though the total amount owing is not stated in the Ombudsman’s report.
Mrs X lodged a complaint, stating she had not ever been advised about her new financial responsibility and requested a reduction in the charges due to the Council’s error. The Council rejected Mrs X’s complaint, citing letters sent after the CHC assessment and review, and also stating she had been verbally informed during these processes. The Council later assisted Mrs X in applying for her state pension and relevant benefits, indicating she had not been claiming even basic entitlements. Mrs X escalated her complaint, stating she had not ever received any letters and had been unaware of her potential benefit entitlement, which may have meant she missed out on significant financial support. The Council’s final complaint response re-asserted that the letters were sent and that she had been verbally advised of being responsible for the cost of her care. It said benefits advice was not the remit of social workers.
Later that month, the Council offered £1,000 in recognition of the error.
In response to the Ombudsman’s enquiries, the Council explained this offer was made due to uncertainty about who was responsible for transferring Mrs X to the social work team, and added the CHC nurse (who worked for the Council-managed CHC community team) discussed financial responsibilities verbally with Mrs X. However, no evidence of this conversation existed in Council records.
What was found
Mrs X should have been transferred to the Council’s social work team and offered a financial assessment after she was found ineligible for full NHS funded care but eligible for FNC in mid-2023. This did not happen, which was fault.
Although the Council initially stated there was ambiguity around who was responsible for transferring Mrs X to the Council’s social work team, it later clarified that the CHC team operating at the time was managed by the Council, and that the CHC nurse was the lead professional involved. Therefore the responsibility for ensuring a non-CHC-eligible person was transferred for a financial assessment rested with the Council.
The lack of documentation of the supposed conversation with the CHC nurse at the DST was fault.
If a financial assessment had been carried out at that time, the Council would have determined that Mrs X was a self-funder as her savings exceeded the upper capital limit. She would have been informed of her financial responsibilities earlier, avoiding the later distress.
During a financial assessment, the Council should also inform individuals about any benefits they may be eligible for. While the Ombudsman could not determine even on the balance of probabilities whether Mrs X would have been entitled to benefits or applied for them sooner, the failure to conduct a financial assessment left uncertainty about this.
Once the Council became aware in 2024 that the home was not receiving payment for Mrs X’s care, it acted quickly and appropriately. The Ombudsman found no fault with the Council’s actions from this point onwards.
The Council’s £1,000 offer was more generous than the Ombudsman would normally recommend in such circumstances, and was therefore accepted as sufficient remedy. The Ombudsman did not recommend any further service improvements as the relevant process was updated by the Council in 2023.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
We note that the Council said that during the CHC assessment process, Mrs X informed the CHC nurse that she had savings exceeding £23,250. The CHC nurse then advised Mrs X that she would be responsible for paying the full cost of her care. However, this conversation was not recorded in writing and there are no case notes to evidence it.
We are surprised that it was thought to be an appropriate topic for a DST / MDT discussion because it implies that the MDT was assuming that the recommendation/rationale it had just provided for the ICB that she was not CHC-eligible would automatically be ratified!
The core principles of community care law require local authorities to conduct financial assessments promptly, once responsibility for funding care transfers is established, regardless of referral uncertainties. Not advising a person of potential financial liability, and failing to record key communications, obviously constitutes fault.
Adherence to Care Act guidance means ensuring every eligible person receives timely, understandable information about their financial position, charges, and entitlement to benefits..
Councils should ensure that transfer processes between health and social care teams are robust and transparent, and that all staff understand the law relating to care charging, assessment procedures, and the necessity of keeping full, accurate records. Timely written notification is not only good practice, it is a statutory requirement, under Care Act s17 and must be fulfilled whether the transition occurs within multidisciplinary teams or across agencies.
In practice, councils and professionals should review and reinforce referral pathways to prevent gaps, proactively consider the need for benefits advice in the context of financial assessments, including social care responsibilities, are transferred. Professionals should be aware of local authority responsibilities to provide information on how to access independent financial advice, as set out in s4 of the Care Act. The Statutory Guidance sets out the need for Councils to ensure that the provision of information and advice meeting an individual’s requirements, is comprehensive and given at an early stage. The Council’s initial position that ‘benefits advice is not the remit of social workers’ suggests a worrying lack of awareness of the statute and guidance in this context.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Portsmouth City Council (24 016 978) 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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