Summary: The complaint about the arrangements to meet Mr C’s health needs is not within our jurisdiction. Although the Council is arranging the support, it does so on behalf of the Clinical Commissioning Group who is an NHS body. We do not have powers to investigate NHS bodies, so have referred the case to the Parliamentary and Health Service Ombudsman.

The complaint

1. The complainant, who I will call Ms B, says the Council has failed to allocate adequate funding to meet her son’s (Mr C’s) needs, and will not be flexible in the use of Mr C’s personal budget. Ms B cannot secure adequate carers with the hourly rate provided. The communication has been poor, and Ms B has experienced delayed responses and a delay in getting agreed funding.

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The Ombudsman’s role and powers

2. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
3. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as a Clinical Commissioning Group. (Local Government Act 1974, sections 25 and 34A, as amended)
4. We cannot investigate a complaint where the body complained about is not responsible for the issue being raised. (Local Government Act 1974, section 24A(1), as amended)

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How I considered this complaint

5. I contacted the Council for information about the commissioning of Mr C’s support package. I referred the complaint for assessment by our ‘Joint Working Team’ who work with the Parliamentary and Health Service Ombudsman. I spoke with Ms B.

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What I found

6. Mr C has a primary health need and has been assessed by the NHS Clinical Commissioning Group (CCG) as eligible for NHS Continuing Healthcare (CHC). In Cambridgeshire the NHS has a ‘Section 75’ agreement with the Local Authority that the Council has lead commissioning responsibility and holds the pooled budget for health and social care services.
7. The Council has assessed Mr C’s needs and is arranging his package of care. All of Mrs B’s dealings to arrange Mr C’s support has been with the Council.
8. This is not a shared package of care between the NHS and Council, it is completely funded by the NHS.
9. Section 165 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (the main guidance for CHC-funded care) sets out that “[w]here an individual is eligible for NHS Continuing Healthcare, the CCG is responsible for care planning, commissioning services, and for case management.” Section 169 of the Framework expands upon this, clarifying that “[i]n the context of NHS Continuing Healthcare case management necessarily entails management of the whole package, not just the healthcare aspects” and that the CCG is responsible for “ensuring that the agreed care and support package continues to meet the individual’s assessed health and associated care and support needs and agreed outcomes”.
10. Although there is a local mechanism in place for delivery of CHC services (the section 75 agreement) that means the Council manages care provision for eligible service users, our position is that the ultimate duty for providing these services rests with the CCG. In other words, while the CCG can delegate the function to the Council, it cannot delegate the duty.
11. Because Mr C’s package of care is provided by the CCG (an NHS body), albeit managed by the Council, it is not in our jurisdiction to investigate. In this situation the Council is not completing an administrative function it is responsible for, it is acting on behalf of the CCG.

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Final decision

12. The complaint is not within our jurisdiction to investigate, because the Council is acting on behalf of the CCG who we do not have the powers to investigate.
13. The Parliamentary and Health Service Ombudsman has the power to investigate NHS bodies, so we have referred this complaint to them with Ms B’s permission.

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Investigator's decision on behalf of the Ombudsman