he Ombudsman dealt with the case in which the health insurance company informed the complainant of a debt in the amount of CZK 1,080 (for one month) for the first time more than five years after it arose. The penalty for that period had already exceeded the debt itself. The insurance company did not inform the complainant that she could apply for waiver of the penalty after having paid the outstanding premiums. The complainant was surprised about the existence of the debt also because she had already been registered with another insurance company for two years.

The Ombudsman stated that a health insurance company should regularly check the performance of the insured persons’ duties in payment of premiums for public health insurance (no less than once a year). If any debt is found, the insurance company has to inform the insured person without delay. At the same time, it should advise him/her of the possibility to apply for waiver of a penalty.

TIn the end, the health insurance company adopted the measures suggested by the Defender – to carry out the relevant checks at least once a year and to properly notify the insured persons.

Norfolk woman was left to care for an elderly vulnerable friend for months before he died while the county council delayed meeting his care, the Local Government and Social Care Ombudsman has found.

The woman had said she was happy to provide some care for her friend, who had dementia and a number of physical health conditions, but repeatedly told social workers she could not do it alone.

The council assessed the man as needing a significant amount of support, but could not decide how that care should be provided. Instead, while it tried to decide on the most cost-effective package for the man, the council failed to provide appropriate care, and relied on the man’s friend to help care for him over and above what she was paid to provide.

The Ombudsman’s investigation found the council at fault for failing to:

• provide a night sitting service
• provide a day sitting service between April and mid-June 2019
• provide morning and evening care visits
• recognise the extent to which the friend was supporting the man
• put support in place for the friend as a carer
• comply with the Care Act in relation to the man’s care needs
• propose suitable alternatives to the care the man was receiving
• explain the reasoning behind the charge for the respite stay to the man or his friend

Michael King, Local Government and Social Care Ombudsman, said:

“This man was clearly vulnerable and had numerous assessed care and support needs, yet Norfolk council did not meet them. It initially failed to implement plans that had been agreed, before going on to leave the man without an agreed plan altogether.

“Councils are entitled to weigh up the cost of a proposed care package and to look at more economic options when deciding what to provide. But cost should not be the primary consideration – and councils should not leave people without the care they need while deferring decisions. In this case the council continually questioned the cost of providing the care package in his own home, where he wanted to remain, without proposing suitable alternatives.

“All this left the man’s friend feeling she had no option but to provide more hours of care for him than she wanted to, or was being paid for, and this placed a significant strain on their relationship.

“I am pleased the council has accepted my recommendations and welcome the steps it has already taken to improve its services.”

The Local Government and Social Care Ombudsman’s role is to remedy injustice and share learning from investigations to help improve public, and adult social care, services. In this case the council has agreed to apologise to the woman and pay her £2,000 to acknowledge the increased strain she was placed under by the council’s faults and to acknowledge the unpaid care she provided that was part of his assessed needs.

It will also refund the man’s estate the expense of funding his own eligible care needs – estimated at around £4,000.

The Ombudsman has the power to make recommendations to improve processes for the wider public. In this case the council has agreed to review its procedures to ensure carers are offered separate carers’ assessments and record the outcome. It will also amend its current procedure to ensure current needs will be met in cases where its funding panel defers or refuses decisions on recommended care packages.

Article date: 27 February 2020

Press release n§18/20

Commission v Greece (Pollution par les nitrates)

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The Court found for the first time that Greece had failed to fulfil its obligations in a judgment of 2015

By judgment of 23 April 2015,1the Court of Justice held that, by having failed to designate as vulnerable zones a number of zones–including those of the Plain of Thessaly and of the river Evros (see paragraph 15 of the judgment in Case C-149/14)–characterised by the presence of bodies of surface water and ground water affected by concentrations of nitrates above 50 milligrams per litre and/or by the phenomenon of eutrophication, and by not having established the action programmes relating to those zones within one year after such designation, Greece had infringed the directive concerning the protection of waters against pollution caused by nitrates from agricultural sources.2