Summary: Mrs Y complains about how the Council dealt with her mother’s National Health Service(NHS) joint package of health and social care and her care charges. There was fault by the Council which caused injustice to Mrs X and Mrs Y. The Council has agreed to remedy the outstanding injustice caused to Mrs Y.

The complaint

1. Mrs Y complains on behalf of her mother (Mrs X). She complains about how the Council dealt with Mrs X’s care package and charges. In particular, she says the Council:
1. did not make the agreed weekly payment of NHS funding into Mrs X’s account at the start of her social care in January 2021
2. did not inform the NHS when there was an increase in the hourly rate which resulted in Mrs X being overcharged
3. repeatedly made errors with Mrs X’s care charges due to its unclear and poor invoicing system
4. did not properly deal with Mrs Y’s complaint.
2. Mrs Y says as a result, Mrs X was overcharged for her care, and she also lost out on funded care that she was entitled to. Mrs Y also said the matter caused her significant distress, frustration and avoidable time and trouble chasing the Council.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. 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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What I have and have not investigated

6. The period of my investigation is from January 2021 to December 2023. The earlier date is when Mrs X became eligible for a joint package of health and social care and the latter date is when the Council issued its final response to Mrs Y’s complaint. There is good reason for Mrs Y to complain to us after 12 months because the evidence indicates the Council took too long to respond to her complaint.

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How I considered this complaint

7. I considered the information Mrs Y and the Council provided about this complaint.
8. I sent Mrs Y and the Council a copy of my draft decision and took all comments into account before reaching this final decision.

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What I found

Law and guidance

9. Individuals may need social care and support provided by their local council and health services arranged by the Integrated Care Board (ICB).
10. A joint package of health and social care is where care and support is commissioned or funded by a council and an ICB. A joint package of care includes NHS funding and other NHS services that are beyond the powers of a council to meet. The NHS part of a joint package is free whereas social care and support provided by a council is chargeable.
11. A Lasting Power of Attorney (LPA) is a legal document, which allows people to choose one person (or several) to make decisions about their health and welfare and/or finances and property, for when they become unable to do so for themselves. The ‘attorney’ is the person chosen to make a decision, which has to be in the person’s best interests, on their behalf.

Key events

12. Mrs Y has an LPA to manage Mrs X’s property and finances.

2021

13. In January, Mrs X was assessed by the NHS and found her eligible for a joint package of health and social care. Mrs X’s joint package was made up of a 10.5‑hour per week NHS funding/element and a 1.5-hour per day social care element. The Council contracted with a care provider to provide Mrs X with the NHS care element.
14. The Integrated Care Board (ICB) was responsible for transferring the NHS funding of 10.5 hours funds to the Council which then made the payments to the care provider.
15. In August, Mrs Y said she noticed the NHS part of Mrs X’s joint care package was no longer being paid into her account. She said care calls were cancelled by the care provider. Mrs Y said she thought Mrs X no longer qualified for the NHS funding, so she started to take on some of Mrs X’s care.
16. Mrs Y said from December to February 2022, she provided the 10.5-hour per week care (NHS element) to Mrs X due to care calls being cancelled by the care provider.

2022

17. In March, Mrs Y said the care provider resumed providing Mrs X with the agreed NHS care calls.
18. In April, Mrs Y contacted the Council to question an invoice which it sent to her for Mrs X’s care. Mrs Y said the Council told her there had been an overcharge on Mrs X’s account because the NHS funds had not been applied to Mrs X’s account.
19. Mrs Y continued to notice errors in Mrs X’s care charges, and she contacted the Council on several occasions to try and resolve the matter.
20. In June, the Council refunded Mrs X with a £3,980.69 overcharge and a further refund of £3,404.93 was made in October following a subsequent overcharge error. This was for the same reason and the Council had failed to apply the NHS funding to invoices.
21. In October, Mrs Y made a formal complaint to the Council about the matters she has raised with us. Mrs Y said Mrs X lost out on approximately £3,000 of NHS funding when care calls were cancelled, and she had to provide care to Mrs X. She asked the Council to pay the £3,000 into Mrs X’s account.

2023

22. The Council’s first response to Mrs Y’s complaint in April said:

• Mrs X’s care had two parts: 1) free NHS care and 2) chargeable social care
• its system wrongly recorded Mrs X’s joint funding package and wrongly applied a charge to her whole package
• its invoices were poor and unclear
• there was poor communication and disjointed working practices between its different teams to resolve errors in Mrs X’s case
• it had not charged for care that had been cancelled by the care provider
• the ICB would not pay Mrs Y for being Mrs X’s carer unless there was an employment contract, so it could not credit Mrs X’s account and any unused NHS funding would need to be returned to the ICB
• it apologised for all the faults and said it would credit Mrs X’s account with £1,370.10. This included £300 for the distress caused, a further £652.20 overcharge and the £417.90 incurred on Mrs X’s overcharges.

23. Mrs Y was dissatisfied with the Council’s response. She maintained Mrs X lost approximately £3,000. In May, Mrs Y asked the Council to escalate her complaint.
24. In December, the Council issued its stage two complaint response. The Council reiterated its response to Mrs Y at stage one and attached a summary of the breakdown of Mrs X’s care charges including the NHS funding element. It apologised again to Mrs Y for the continued challenges she had faced with getting Mrs X’s finances reconciled due to its errors. The Council said it would put in place some changes to services to minimise the risk of recurrence.
25. Mrs Y remained dissatisfied with the Council’s responses, and she made a complaint to the Ombudsman.
26. In response to my enquiries, the Council accepted it made a series of failings with how it dealt with Mrs X’s joint package of health and social care as it had previously stated in its responses to Mrs Y’s complaint. As regards other service users’ accounts, the Council confirmed it reviewed all other joint packages of care over the last 6 months and it identified some variances with some records which it said are being corrected. The Council confirmed these anomalies have had no impact on the contributions of the service users with the affected records.
27. The Council said it has put several processes in place to improve its services. The Council:

• has developed regular reconciliation reports and a robust monitoring dashboard for joint funding cases which it now uses to identify variances between the ICB funding and the Council’s expectation. It said these reports also identify changes in package without accompanying reviews of ICB funding and it highlights in advance of any invoicing errors to allow for prompt resolution where applicable.
• will involve the ICB in the reviews of joint funding cases to ensure funding is recorded against any revised service.
• has issued reminders to all social workers and their managers to check when reviewing a case and authorising a review of a case for joint funding.
• has increased the frequency of reconciliations of payments with the ICB from annually to quarterly as of the financial year 2024/2025. This is to ensure errors are identified in a timely manner.

Analysis

My findings are:

28. The Council had accepted it made various errors administering Mrs X’s joint package of health and social care as I have summarised in paragraph 22. These were faults and resulted in Mrs X being overcharged on a couple of occasions. The Council’s failings also caused Mrs Y confusion, distress, frustration and the time and trouble chasing the Council to rectify the errors it made in Mrs X’s case.
29. The Council's failure to work effectively with the ICB and its failure to correctly record the two funding elements in Mrs X’s case caused Mrs X a loss of care and meant Mrs Y had little choice but to step in and provide unpaid care. The Council’s failings led to the care provider cancelling Mrs X’s care calls on several occasions. I note the Council’s point about returning unspent NHS funding to the ICB and this would appear to be the NHS’s policy which is outside our remit. However, due to the Council’s failure to correctly apply the agreed NHS funding to Mrs X’s account, I find Mrs Y provided unpaid care to Mrs X between December 2021 and February 2022 when the care provider cancelled care calls.
30. The Council took approximately 14 months (October 2022 to December 2023) to deal with Mrs Y’s complaint. This was a significant delay and was not in line with the Council’s complaint policy or our expectations. This was fault and caused Mrs Y further avoidable distress, frustration and time and trouble.
31. The Council has already apologised to Mrs Y, credited Mrs X’s account with the overcharges, the interest incurred and a made a payment to recognise the distress caused to Mrs X. The Council has also made several service improvements to minimise the risk of recurrence of the errors it made in Mrs X’s case. These are all welcome, but they are only a partial remedy and do not recognise the time Mrs Y spent delivering Mrs X’s care as I have set out in paragraph 29, or the avoidable distress, confusion and frustration caused by the several errors made with Mrs X’s joint package and by the delay in complaint handling.

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Agreed action

32. To remedy the injustice caused by the faults identified in paragraphs 28 to 31, , the Council has agreed within one month of the final decision to:

• apologise in writing to Mrs Y and make her a symbolic payment of £1,000 to acknowledge the injustice caused to her by the Council’s failings as identified above. The apology should be in accordance with our guidance, Making an effective apology
• by training or other means remind relevant staff of the importance of adhering to the Council’s complaint policy times

33. The Council should provide us with evidence it has complied with the above actions in paragraph 32.

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Final decision

34. I find evidence of fault leading to injustice. The Council has agreed to take action to remedy the injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman