Upheld in whole or in part
Non-public interest report issued: complaint upheld
Betsi Cadwaladr University Health Board
Mr A complained about the failure by Betsi Cadwaladr University Health Board (“the Health Board”) and Flintshire County Council (“the Council”) to tell him in a timely manner that the multi-disciplinary team’s recommendation for NHS Funded Continuing Health Care (“CHC”) which would have covered the cost of his wife’s care home fees was disputed by the Health Board’s CHC Panel. Mr A was also dissatisfied with the Health Board and the Council’s complaint handling and the robustness of their complaint response. Finally, Mr A was unhappy with the Council’s role in his wife’s discharge planning from hospital and the funding of her care at the care home.
The Ombudsman’s investigation found that failings in both the Health Board and the Council’s processes had contributed to Mrs A, who has end stage dementia and lacks mental capacity, having an outstanding social care debt of £19,787.51.
The Ombudsman upheld Mr A’s complaint about not being told by both the Health Board and the Council in a timely manner of the disputed CHC funding and the failings regarding complaint handling.
The Ombudsman also concluded that in terms of Mrs A’s discharge planning and funding, the Council should have ensured that Mr A was made aware of the financial implications of chargeable social care costs, in the event that CHC funding was not put in place. It should also have discussed with Mr A, prior to Mrs A’s discharge, the need to complete a financial assessment that would have reduced the chargeable social care costs Mrs A subsequently incurred. This part of Mr A’s complaint was also upheld.
The Ombudsman considered that Mr A had been caused an injustice by the Council and the Health Board’s failings as it added to Mr A’s stress and anxiety.
Although the Ombudsman is not able to make definitive findings of breach he considered that Mr and Mrs A’s Article 8 rights had been engaged, in that Mr A’s time with his wife had been blighted by the stress of dealing with the enormity of the debt that his wife, through no fault of her own, had accumulated. This had been exacerbated at times by the uncertainties regarding Mrs A’s living arrangements, and the past threats Mrs A had faced of eviction from the care home.
The Ombudsman’s recommendations to the Health Board and the Council included an apology. The recommendations also addressed the care home fees incurred with the net effect of there being no outstanding fees for the relevant period. Both the Health Board and the Council were also each asked to make a redress payment of £1,000 to Mr A in recognition of the distress and inconvenience caused to him.