Summary: There was a delay in completing a financial assessment which caused avoidable confusion, uncertainty and the shock of a large first bill. The Council has already reduced the bill and apologised, which is a partial remedy. It will offer a repayment plan and ensure there are enough staff to complete financial assessments without delay.

The complaint

1. Ms X complained for her relative Ms Y about an unacceptable delay in completing a financial assessment for charges for Ms Y’s care. Mrs X said she agreed to Ms Y’s care package after the Council’s on-line calculator said the weekly charge would be just under £6. However, when the Council completed a full financial assessment four months later, the actual charge was ten times higher. Ms X said this caused avoidable distress and a debt of almost £1000 which they cannot afford to pay. Ms X said she would not have agreed to the care package if she had been given accurate information at the start.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I considered the complaint to us, the Council’s response and information in this statement.
5. Ms X and the Council had an opportunity to comment on my draft decision. I took comments into account before issuing a final decision.

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What I found

Relevant law and guidance

6. Councils can charge for care and support. To work out the charge, they carry out a financial assessment. Most types of income, including pensions and benefits, are taken into account.
7. A personal budget is a statement which specifies:
• The cost to the council of meeting an adult’s care and support needs
• The amount the adult must pay, on the basis of their financial assessment
• The amount the council must pay. (Care Act 2014, section 26)
8. Guidance says a personal budget enables a person with care and support needs to take control over meeting their needs. It means people know before care and support planning begins, an estimate of how much money is available to meet their needs and with the final personal budget, having clear information about the total budget including what the council will pay and what the person will pay. The process of allocating the personal budget should be completed in a timely manner. (Care and Support Statutory Guidance, paragraphs 11.3 and 11.5).

What happened

9. Ms X manages Ms Y’s finances for her.
10. In June 2023, Ms X completed an on-line financial form for Ms Y on the Council’s website which calculated a weekly charge for Ms Y’s care of just under £6. The website said that it was an early indication of how much people would pay towards their care and the Council would need to verify the information provided.
11. I have considered the on-line form. It includes a question about whether the applicant (so in this case, Ms Y) has an underlying entitlement to carer’s allowance. An explanatory section after the question says” answer “yes” if you have claimed carer’s allowance but are not receiving payment because you are receiving another benefit instead. This will be shown as ‘underlying entitlement’ on your benefit award letter.”
12. On the basis of a charge of around £6, Ms X agreed to Ms Y’s care package.
13. In October 2023, the Council did a full financial assessment for Ms Y and the weekly charge was just under £55. It issued an invoice for over £1000. Ms X cancelled the care package in October and complained to the Council.
14. The Council’s complaint response apologised for the delay and said:
• The reason for the difference is because she answered yes to the question “do you have an underlying entitlement to carer’s allowance?”. However, information from the Department for Work and Pensions is that Ms Y had no such entitlement. If she had evidence Ms Y had an underlying entitlement to carer’s allowance, then Ms X needed to provide it. Her (incorrect) answer explained the difference between the on-line calculation and the assessed charge; and
• It accepted there had been an unreasonable delay in assessing the charge. This was due to high demand. It was moving on to a new work system next year and this should speed up processing times.
15. The Council offered a 10% reduction in the bill.
16. Unhappy with the Council’s response, Ms X contacted us.

Findings

17. There was fault by the Council. Care and Support Statutory Guidance says people should receive their personal budget, which includes how much they need to pay for their care, before or as their care starts. The Council accepts there has been unreasonable delay of four months. This was fault which caused avoidable confusion and uncertainty about the charge and the shock of a large bill.
18. There is no evidence there is an issue with the question about carer’s allowance. The DWP issues letters to those who have an underlying entitlement. It is a specialist question, but not an ambiguous one. Those affected will have their entitlement letter and will be able to supply it to the Council. Ms Y is not.

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Agreed action

19. We do not generally recommend reimbursement of care charges if there has been delay by a council in completing a financial assessment. In this case, I have taken into account Ms X’s mistake in completing the form contributed to the problem. If she had answered the question correctly, then there would have been no issue because she would have received an indicative charge which would have been accurate. However, if the Council had not taken four months to verify the information Ms X had given, there would not have been a large first bill. The Council has reduced the bill by 10% and apologised. This is an appropriate financial remedy. In addition, the Council should offer an affordable repayment plan within a month of my final decision.
20. Within three months of my final decision, the Council needs to ensure it has sufficient staff to process financial assessments without delay. It should tell us in writing what changes it has made to the service.
21. The Council should provide us with evidence it has complied with the above actions in paragraphs 19 and 20.

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Final decision

22. There was a delay in completing a financial assessment which caused avoidable confusion, uncertainty and the shock of a large first bill. The Council has already reduced the bill and apologised, which is a partial remedy. The Council will offer a repayment plan and ensure there are enough staff to complete financial assessments without delay.
23. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman