Summary: Mrs X complained about the Council’s poor communication in relation to her adult son Mr Y’s care charges. The Council was at fault for not following up the failure to return the financial assessment and for poor communication when Mrs X raised concerns about the care charges. The Council has agreed to apologise to Mr Y, pay him £250 and offer a repayment plan. It also agreed to remind its social care and finance teams, in writing, of the importance of good communication.

The complaint

1. Mrs X complained about poor communication from the Council regarding her son, Mr Y’s, care charges for a care package jointly funded by the Council and Integrated Care Board, from August 2022 to January 2023. She says the Council never told them there would be any care charges for the social care element of the care plan until it issued an invoice in November 2022. She says the Council still did not explain what the charges were for and sent a further invoice in January 2023.
2. Mrs X says the invoices caused her son anxiety, distress and a decline in his mental health.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I have considered the information provided by Mrs X and have discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries.
6. Mrs X and the Council had the opportunity to comment on this draft decision. I considered any comments I received in reaching a final decision.

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What I found

Relevant law and guidance

Charging for adult social care

7. The Care Act 2014 sets out the legal framework for charging. Councils can make charges for care and support services they provide or arrange. They must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014. Charges may only cover the cost the council incurs.
8. Councils must assess a person’s finances to calculate how much an individual should contribute to the cost of their care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25% (also known as the minimum income guarantee).
9. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. This is called disability related expenditure (DRE).
10. The Care and Support Statutory Guidance sets out key principles the councils should taken into account when making decisions on charging. The principles include that the approach to charging should be clear and transparent, so people know what they will be charged.

What happened

11. Mr Y lives with Mr and Mrs X. In early 2022, following a hospital admission, Mr Y received support from a company (Company A) that supported those with mental health needs in their own home. This was funded by the NHS Integrated Care Board (ICB).
12. In July 2022 Mr Y received a home visit from staff from the ICB; Mr Y’s social worker attended virtually. At the meeting the ICB advised it would stop funding Mr Y’s care from 8 August 2022 as it was agreed Mr Y’s needs were primarily social care needs.
13. The social worker visited Mr Y to assess his care needs. They noted Mr Y wanted support from Company A to continue. He required support with managing his everyday living tasks including organising and accessing activities, prompting with personal care and support with managing his finances and maintaining his home. The social worker assessed Mr Y required 20 hours of support per week. The social worker noted Mr Y required a financial assessment and made a referral to the Council’s finance team. Mr Y’s support plan set out ’20 hours per week support split 50/50 between CHC and ASC. His personal budget was £215 (for the 10 hours Council funded support). There is no evidence the needs assessment or support plan were shared with Mr Y.
14. The day after the assessment the social worker sent Mr Y a link to a leaflet about charging for care. In the email they stated ‘it may be overwhelming for you [Mr Y] so don’t worry if you don’t understand it all, I am sure mum or your support workers will help you through it’.
15. Mrs X contacted the social worker as she could not open the link the social worker sent so the social worker re-sent it. The leaflet set out that the Council could ask people receiving adult social care services to contribute to the cost of the support they receive. It stated ‘everyone will be offered a financial assessment to work out how much they can afford to pay towards the cost of their care’.
16. In early August 2022 the ICB and Council agreed to jointly fund the 20 hours per week of support. Around this time Mr Y was admitted to hospital for around 10 days.
17. In late August 2022 the Council sent Mr Y a letter and form for a financial assessment. The letter stated ‘without a full financial assessment, you would be charged the maximum amount for any service you receive so it is important you complete and return this form within 21 days if you want a full financial assessment’. Mrs X says they never received this letter and form.
18. In late October 2022 the Learning Disabilities nurse from the NHS contacted Mr Y’s social worker raising concerns about his finances and budgeting skills. The social worker responded they would look at supporting with finance if Mr Y wished.
19. As it did not receive a financial assessment form, in November 2022, the Council sent Mr Y an invoice for the full cost of his care package (10 hours per week of Council funded support). Mrs X contacted the Council’s Learning Disabilities (LD) Team to request an explanation for the invoice. The LD Nurse contacted the social worker. The notes record the LD Nurse said they thought it was agreed Mr Y would not pay for his care. The social worker responded and explained the care package was jointly funded and the social care part was chargeable. They added they believed a financial assessment would have been completed to determine Mr Y’s contribution.
20. The LD Nurse responded further that they understood he did not need to contribute. Mr Y was struggling with his finances in general. They said they thought it would be useful to do a capacity assessment around finances ‘so we can help him manage money if need be’. The social worker reiterated that all support by the Council was financially assessed, and the package of support was shared between the Council and ICB.
21. In January 2023 the Council sent Mr Y another invoice which Mrs X says caused him distress and anxiety. Later that month Mr Y was admitted to hospital, where he stayed until the end of the month. During this time, the care provider ended the care package as it considered it was not meeting Mr Y’s needs.
22. In early February 2023 the Council sent Mr Y a letter about the debt. Mrs X contacted the finance team. She said she understood health were paying for the care package and there would not be any charges. The finance team advised her to speak with the social worker. Mrs X also advised she had not received a financial assessment from so the Council agreed to send another. Mrs X contacted the social worker who said they had discussed finances when they visited in July 2022 and had explained that when the Council took over Mr Y’s care he would be financially assessed to see what he would contribute. Mrs X said she had spoken to the LD Nurse who said health were continuing to pay for the care so Mr Y would not be charged. The notes record the social worker explained that from the date health was due to stop funding (in early August), the Council took over part of the funding as they had discussed. Mrs X returned the completed financial assessment form to the Council in late February 2023.
23. In mid-March 2023 the Council completed the financial assessment. It assessed Mr Y needed to pay around £90 a week towards his care charges. Mrs X called the social worker about the care charges. They advised her to call the finance team who discussed the assessment with Mrs X. They noted Mr Y required a revised invoice as he was being charged the full cost of his care.
24. In April 2023 the Council issued a revised invoice, based on Mr Y’s assessed contribution. This reduced the amount owed from over £5,000 to around £2,500.
25. Mrs X complained to the Council in April 2023. She said she was not aware of a formal care plan and Mr Y was distressed about being charged when he had little idea of what the care plan was and what was being provided. Mr Y was admitted to hospital again in April 2023 where he remained until June 2023.
26. The Council responded to Mrs X’s complaint in early June 2023. It said it sent a form to Mr Y in August 2022. It was not returned so it applied the maximum charge. It said its records showed Mrs X contacted the finance team in February 2023 so it issued a second form which was returned later that month.
27. It said Mr Y received care services between August 2022 and January 2023 and so was liable for the cost. It said it had carried out a financial assessment to calculate his contribution to his care costs and the social worker had sent Mrs X charging information in July 2022. It said the case notes showed the care package was working well in October 2022 but it could not see that the care plan was shared with Mr Y. It apologised for this.
28. Mrs X remained unhappy and complained to us.

Findings

29. Mr Y’s care was initially funded by the NHS. When the Council became involved in funding his care, the social worker explained Mr Y may be required to contribute to his care costs and that he would be financially assessed. Mr Y’s needs assessment set out that he required a financial assessment and his support plan set out the cost to the Council for Mr Y’s care. However, the Council failed to send a copy of these to Mr Y. This was fault.
30. The Council is entitled to charge for the care and support it provides and the evidence shows the Council sent Mr Y a financial assessment form in August 2022. Mrs X says they never received this but that is not the fault of the Council.
31. The Council did not receive a completed form and so charged Mr Y the full cost of the care package (for 10 hours of care per week as 10 hours was ICB funded). This meant the first Mr Y and Mrs X knew of the charges was when the Council sent Mr Y an invoice in November 2022. This was for the full care costs and so caused Mr Y anxiety and distress.
32. When Mrs X raised this with the LD Nurse in November 2022 the LD Nurse contacted the Council. The notes suggest the LD Nurse was under the impression Mr Y would not be required to pay any care costs. The social worker explained to the LD Nurse that Mr Y would be assessed for his care charges and that he was required to pay a contribution for his Council funded care. I cannot look at the actions of NHS staff and what Mrs X was advised by the LD Nurse. However, the Council did not contact Mr Y or Mrs X to ensure they understood what was expected of them in relation to Mr Y’s care costs or to seek to resolve this. The Council therefore missed an opportunity to resolve the issue sooner and to explain to Mr Y and Mrs X the need to contribute to the care costs. This was fault.
33. The needs assessment noted Mr Y needed support managing his finances and in October 2022 and January 2023 the LD Nurse raised concerns about Mr Y’s ability to manage his finances and that he had received an invoice which caused him anxiety. In February 2023 the LD Nurse also suggested a mental capacity assessment around Mr Y’s ability to manage his finances. There is no evidence the Council contacted Mr Y to establish if he required more support to manage his finances. There is no evidence the finance team contacted the social worker to advise it had not received the completed form or that the social worker enquired whether Mr Y was paying his care charges. This is fault and meant the Council missed further opportunities to resolve this sooner.
34. When the Council sent a debt letter to Mr Y in early February 2023 Mrs X contacted the Council to establish why Mr Y owed the debt as they did not understand that he was required to pay. The Council then became aware Mr Y had not received the financial assessment form. It re-sent the letter and the form. Mr Y and Mrs X completed and returned it.
35. The Council was then able to complete the financial assessment. Mr Y received a care package which was jointly funded by the ICB and Council. The Council was entitled to charge Mr Y a contribution towards the cost of his social care package. It calculated Ms X’s contribution in line with the relevant statutory guidance and the regulations and there was no fault in the way it did this. It has issued Mr Y with a revised invoice so Mr Y is now being charged his contribution and not the full care costs.
36. Without the Council’s faults, Mr Y would still have been required to pay his contribution to his care costs. However, he would have been aware of this sooner and would not have accrued such a debt which has caused him anxiety and distress. Mrs X believes this contributed to his hospital admission however I cannot make that link.

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Agreed action

37. Within one month of the final decision on this complaint the Council has agreed to:
1. Apologise to Mr Y and pay him £250 to acknowledge the distress and anxiety caused by the faults identified.
2. Explore whether Mr Y requires formal support with his finances.
3. Offer an affordable repayment plan with Mr Y or his representative.
38. The Council has also agreed to remind its social care and finance teams, in writing, of the importance of good communication between the teams and their customers in relation to charges, particularly where concerns are raised or there is a lack of clarity. It should do this within two months of the date of the final decision.
39. The Council should provide us with evidence it has complied with the above actions.

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Final decision

40. I have completed my investigation. The Council was at fault causing injustice which it has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman