Date of decision: 29 January 2026
Summary
Mr X complained that Liverpool City Council failed to explain that a short-term residential placement arranged for his elderly father, Mr Z, under the discharge-to-assess (D2A) Protocol would become chargeable after the initial period. The Ombudsman found the Council did not provide clear or timely information about charging, which led the family reasonably to believe the placement would be free. This caused distress when a substantial bill later arrived. Given the lack of explanation about when charges would start, the Ombudsman considered it appropriate for the Council to apologise and waive the fees for the chargeable period.
What happened
Mr X’s father, Mr Z, had previously been discharged from hospital to a reablement hub between 17 April and 2 June 2024 on what was specifically called a reablement pathway, which was non-chargeable under Community Care Charging Regulations.
In June 2024, after a further fall at home, Mr Z was readmitted to hospital, and the hospital recommended a discharge to assess (D2A) residential placement for up to 28 days or until a needs assessment was completed.
On 24 July 2024, Mr Z was discharged from the hospital to a care home placement under D2A arrangements. [The dates that follow are important for understanding the story and findings.]
On 20 August 2024, the Council met Mr Z in the care home to complete a Care Act needs assessment, recording that his named daughter and son held a Lasting Power of Attorney; that he was happy to update his adult children, that he had had numerous hospital admissions over the previous year, and that he had been given a charging leaflet.
The Council said the leaflet referred to in that assessment meeting had previously been provided on 16 November 2023 and discussed with him on 17 November 2023, but there was no record that this assessment document or charging information was ever shared with his family.
Following the assessment, on 21 August, the Council told Mr Z’s family that he no longer met the criteria for residential care and would instead need a home care package plus community support, such as a day centre, to enable his return home.
On 2 September there were two Council notes of contact with Mr Z’s daughter: she expressed concern that her father would be at risk of falling and re-admission to hospital if he left the care home at this point, and later the same day the social worker recorded that they had advised her that a financial assessment would be carried out from the date of the assessment (20 August) to determine any contribution towards the cost of his care. Mr Z’s daughter positively disputed being told that any charges would apply to the short-term stay at that time. We suspect that in the context of the earlier conversation about the risk of going home, the social worker would have been likely to have said he would be chargeable if and while he remained in the care home.]
On 11 September, the Council identified a package of home care to support Mr Z’s return home.
A note dated 12 September records that Mr Z’s daughter had discussed his return home with him, was arranging a visit on the Saturday, and wanted the move home to take place on Sunday, requesting that the care package start on Sunday afternoon. The Council explained that care packages did not start at weekends, and arranged for the care package to start on Monday, 16 September instead.
On 16 September, the Council contacted the care home to confirm that Mr Z had returned home; the home reported that he had not, as he had been overwhelmed after a home visit with his daughter, and the daughter discussed his staying longer at the care home for rehabilitation because she was worried about how he would cope at home. The same morning, the Council left a message saying it could not fund Mr Z’s bed at the care home because no 24-hour care needs had been identified, but that there was an option for him to self-fund the placement if he wished to stay. Mr Z, in fact, returned home on 16 September.
On 8 October, the Council wrote to Mr Z c/o Mr X, enclosing a financial assessment form and asking for it to be completed within one month, warning that if no financial information was provided, it would treat this as agreement to pay the full cost of the placement.
On 21 October, the Council completed a Care and Support Plan for Mr Z, which recorded that the charging policy was discussed with his daughter on that date.
On 29 October, the Council sent a reminder that the financial assessment form must be returned within 14 days.
On 5 November, Mr X contacted the Council, saying he had received a financial assessment form in relation to a bill they had not been told about at the time of the placement.
On 14 November, the Council wrote again to Mr Z c/o Mr X, stating that because no financial information had been provided, Mr Z would be responsible for the full cost of his care from 20 August to 15 September 2024, at a weekly cost of £687.91.
Mr X made a formal complaint on 14 November 2024, and the Council responded on 26 February 2025, accepting that while Mr Z had capacity and consented to the discharge plan and that he had been previously told in 2023 that care might be chargeable subject to a financial assessment, it had failed at the relevant time to provide appropriate information about the D2A care home placement being non-chargeable for up to 28 days or until completion of the needs assessment.
The Council acknowledged that this omission caused uncertainty, apologised, accepted that there was a 13‑day delay between the 20 August assessment and telling the family that Mr Z might need to contribute towards his care, and offered a £50 time and trouble payment for the delay in its complaint handling, while maintaining that no financial loss had occurred during the non‑chargeable D2A period.
It also told the Ombudsman it had issued a reminder to the relevant team about providing clear communication to patients and families, including explaining the D2A pathway and financial implications.
What was found
The Ombudsman considered the Council’s argument that prior general charging information from 2023 meant Mr Z knew he might have to pay towards care, but placed weight on the fact that this was given under different circumstances and that the specific D2A rules and transition to chargeable status were not properly explained at the time of the 2024 D2A placement in the care home.
The Ombudsman noted that any alleged advice on 2 September that charges would apply from 20 August came 13 days after the non‑chargeable D2A period ended.
Separately, it was an obvious issue that the family could not realistically have moved Mr Z any earlier because the care package was not finalised until 11 September, and that their request for a short delay to 16 September for his return home was consistent with the man and the family not understanding that the Care Home stay had become chargeable. The Ombudsman also considered that their previous experience of a free reablement placement after an earlier hospital discharge would reasonably have reinforced their belief that this continuing but (strictly speaking) second short‑term placement was similarly non‑chargeable unless clearly told otherwise, which they were not.
The Ombudsman found the Council at fault for failing to provide clear, timely and specific information to Mr Z and his family about the financial implications of the D2A care home placement, including that it was free only for up to 28 days or until completion of the needs assessment and that charges would apply thereafter.
The Council also delayed by 13 days after the 20 August assessment before communicating that Mr Z might have to contribute to his care, by which time the non‑chargeable period had ended, and the family had limited ability to change plans, compounding the lack of clear advice.
This maladministration caused injustice in the form of distress, uncertainty and the shock of an unexpected bill for the period 20 August to 15 September 2024, especially against the background of a previous non‑charged reablement stay that had reasonably shaped the family’s expectations.
Although the Ombudsman normally expects people to pay for care they have received unless clearly misled, in this complaint the absence of a contemporaneous explanation about when the D2A stay would become chargeable meant the family were effectively misled by omission, so it was proportionate to recommend the Council waive (or reimburse) the fees for that chargeable period rather than only a small symbolic payment.
The Ombudsman noted the Council had already reminded staff about the need for clear communication with patients and families on D2A pathways and financial implications and therefore did not require further service improvements, but did require the Council to apologise formally to Mr X and Mr Z, cancel the charges for 20 August to 15 September 2024, and pay the previously‑offered £50 for time and trouble in relation to complaint handling delay. No additional compensatory sum for distress beyond the fee waiver and £50 was ordered.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
First, councils need to be very clear about when a short-term stay in a care home will start to be charged for, especially where someone has recently had a free reablement stay after hospital discharge, to avoid families being misled by assumption or past experience.
We think the real issue here is that local D2A protocols assume that D2A funding can stop after 4 weeks, even if the Council isn’t ready to commission services such as have been decided to be appropriate for eligible needs, or the NHS has not done its CHC assessment. The purpose of D2A funding in terms of the legal framework is what is being lost sight of; this is, in part, related to the evaporation of checklisting positively or negatively for an appearance of need for CHC, and is the critical legal problem.
We note that in these reports, the Ombudsman always cites The National Audit of Intermediate Care, which lists four types of intermediate care:
- crisis response – services providing short-term care (up to 48 hours);
- home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
- bed-based intermediate care – services delivered away from home, for example in a community hospital; and
- 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.
…without ever mentioning that this list does not relate to legal framework definitions at all but is simply an audit of what is happening in practice, and is no longer published, having been replaced by an NHS benchmarking tool, Intermediate Care Framework for rehabilitation, reablement and recovery. That new document makes no reference to 28-day or 48-hour limits to any form of service.
The national guidance is explicit that no one should be left without care because assessments are pending or funding routes are undetermined. The main statutory guidance states: “no one is left without this care and support or, if needed, an assessment of long-term needs at the end of this period”. The practical effect of the 28-day/4-week rule in the 2023 discharge fund guidance was not to end NHS provision, but to shift funding responsibility between the ICB and the local authority depending on who caused the delay — with the ICB remaining on the hook if the CHC assessment delay was on the NHS side.
Second, information about charging needs to be given at the right time and to the right people, including attorneys and close relatives where the person has agreed to involve them, instead of relying on older, general information that was given in a different context. Hospital discharge funding has changed so much since Covid that it is virtually impossible to know what rules are applicable nationally, let alone locally. Even where councils believe that general charging leaflets have been given previously, good practice is to confirm in writing what will be charged for this specific placement, from what date, and on what basis, and to record clearly that this has been explained and understood, to prevent disputes and complaints of this kind in future.
If the care plan to return home is still being finalised, councils should be cautious about backdating charges to a point when the person and their family had no realistic option other than for the person to remain in the care home.
We were intrigued to see that the report once again completely overlooks the repeal of Schedule 3 to the Care Act regarding hospital discharge whilst referencing D2A guidance in the following terms: As discharge to assess is underpinned by simple principles rather than rigid criteria, there is no fixed delivery model.
National requirements DO encourage local supposedly integrated care systems to develop their own protocols in accordance with this guidance but what that (and this LGSCO report) fail to grasp is that there is an existing legal framework for the Care Act into which D2A protocols must fit!
On the facts, the Council completed the assessment almost a month after the D2A placement started and then took a further 13 days before telling the family that the stay would become chargeable, even though the care plan and home care package were not yet able to be implemented.
In this case, the Ombudsman recognises that there was a 13‑day delay after the assessment before any suggestion that charges would apply, and that the family could not realistically move Mr Z earlier because the home care package had only just been identified and then had to be arranged to start on a weekday.
The Ombudsman criticises the timing and clarity of the council’s communications, but treats the matter primarily as a one‑off failure in information‑giving that is adequately remedied by waiving the fees for the chargeable period and paying a modest time‑and‑trouble amount. A public law analysis would question whether the daughter’s views were properly considered within the needs assessment. Given that Mr Z was admitted to hospital twice during June 2024, we think her concerns were understandable.
The same conversation that confirms the person no longer needs residential care and can go home with support ought to include clear, written information about what happens if they stay on in the home and how, if at all, that will be funded.
Councils should review their discharge to assess processes to ensure that assessment outcomes, home‑care planning, any extension of short‑term residential stays and the point at which charging starts are addressed in a single, well‑documented discussion with the person and, where appropriate, their attorneys or close relatives.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Liverpool City Council (25 003 656) 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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