Summary: Mr S complained the Council delayed completing a financial assessment for his father, Mr F and failed to provide information about the charges. The Council also failed to advise him about the NHS Continuing Healthcare (CHC) scheme. The Council is at fault for failing to refer Mr F to the CHC scheme, failing to provide detailed written information about the financial assessment and failing to complete this within a reasonable timeframe.

The complaint

1. Mr S complained about delay in the Council completing a financial assessment for his father, Mr F. He says the Council also failed to provide Mr F with proper information about what his charges would be and this meant he could not make an informed decision. The Council also failed to advise him about the NHS Continuing Healthcare (CHC) scheme.
2. This has caused emotional and financial distress. Mr S would like the Council to waive the fees, provide the correct package of care and improve communication.

Back to top

The Ombudsman’s role and powers

3. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. 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)
6. 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)

Back to top

How I considered this complaint

7. As part of the investigation I have considered the following:
• The complaint and the documents provided by the complainant.
• Documents provided by the Council and its comments in response to my enquiries.
• The Care Act 2014, The Care and Support (Charging and Assessment of Resources) Regulations 2014, and the Housing Grants, Construction and Regeneration Act 1996.
8. Mr S and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

Back to top

What I found

Relevant legislation

9. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
10. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
11. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
12. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
13. Reablement support services are for people usually after they have left hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. It helps people live independently and is provided in the person’s own home by a team of mainly care and support professionals.
14. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)
15. Disabled Facilities Grants are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to give grants to disabled people for certain adaptations. Before approving a grant, a council must be satisfied the work is necessary, meets the disabled person’s needs, and is reasonable and practicable.
16. Where it appears a person may be eligible for NHS Continuing Healthcare (CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.

The Council’s policies and procedures

17. The Council’s website explains that social care is not free. The Council will complete a Care Needs Assessment which will set out what support an individual needs and how much it will cost to provide. The Council will then offer to complete a financial assessment to work out how much of that cost the Council can cover, and how much the individual will need to pay.
18. This financial assessment considers the amount of income, savings or assets the person has, and explains they may have to contribute towards some or all of their social care and support. An individual will not have to pay for care if they received CHC funding.

What happened

19. I have summarised below the key events; this is not intended to be a detailed account.
20. Mr F has severe health conditions. He has been unwell for several years.
21. Mr F owns a property jointly with his wife. Screening checklists from 2020 show Mr F lived with his son, Mr S at his son’s property.
22. In May 2023, Mr F was in hospital for a major operation. Following the operation, the hospital discharged Mr F to his son’s property.
23. At the beginning of June, Mr S contacted the Council and asked for an assessment for home care support for his father.
24. The Council completed an assessment in the middle of June and provided free care under the Councils reablement scheme. The assessment record says Mr F receives dialysis three times a week and explains the care he needs. It states Mr F lives in a large semi-detached home (belonging to Mr S) with his wife (Mrs M) and their children. It says he has a stairlift (which the family purchased privately) and uses a self-propelled wheelchair to manoeuvre around the house. The record shows a CHC was not applicable.
25. In late June, the Council ordered hoists delivered to Mr S’s property to assist with moving and handling Mr F.
26. Towards the end of July, the Council completed a further assessment. The report says a CHC was not applicable and finances were discussed. Support under the reablement scheme ended and a private company started providing care for Mr F. His care was chargeable from this date. The Council explained to Mr S it needed to do a financial assessment to decide how much Mr F may need to pay in care fees. The Council referred Mr F to the finance team for assessment.
27. A community nurse completed a CHC checklist and referred Mr F to the CHC team in the middle of February. A CHC social worker completed an assessment and funding started at the beginning of March. The assessment says Mr F is living with Mr S at his home and occasionally returns to his own home during the day.
28. In the middle of March, the Council allocated a new Occupational Therapist (OT) to Mr F who visited him at his son’s property at the end of the month. The OT completed an assessment of need and recommended major adaptations. In the middle of April, the panel approved the major adaptations.

The financial assessment

29. The Council contacted Mr S towards the end of November to carry out the financial assessment for Mr F. The officer gathered information over the telephone and completed background checks. The officer explained to Mr S how it completes the assessment, how it considers income, savings, and property and how fees are calculated. The officer also explained how it would consider Mr F’s property which he did not occupy. The officer sent the financial assessment form to Mr S and asked him to complete and return it with evidence within four weeks.
30. The Council did not receive the form and evidence and allowed an extension of two weeks. The officer tried to contact Mr S by telephone but there was no answer. The officer completed the financial assessment based on the information received in November from Mr S. The Council sent a letter to Mr F at the beginning of January 2024 with the result of the financial assessment. It said Mr F was to pay the full cost of his care which was around £550 a week. This was because the Council considered Mr F had capital over the threshold of £23,250 which included his ‘second property.’ The Council said payment was required from the end of November, when the financial assessment was completed and sent an invoice. It did not charge for the period before the financial assessment.
31. When he received the letter, Mr S telephoned the financial team. He said the Council did not tell him he would have to pay for Mr F’s care and he did not receive the financial assessment form. The finance officer emailed a copy of the form to Mr S. Mr S returned the financial assessment form a week later. He included the value of half the property Mr F owns with his wife. The Council recalculated the financial assessment, the result was the same. It said as Mr F did not live in the property, his share of the value was included in the assessment. This meant Mr F had over the £23,250 threshold and was a self-funder.
32. The finance officer telephoned Mr S in late March referencing the invoice for costs for the period November 2023 onwards. Mr S said he was not happy his father had to pay for care and said he should have received CHC funding from the start.
33. At the beginning of April, the finance officer wrote to Mr S and said if the charges were unaffordable, he could appeal. The Council said it has not received an appeal. The Council has also offered to create a payment plan.
34. In response to my enquiries, the Council said Mr F owes around £3,800 for the period from the end of November 2023 to early January 2024. The Council said it did not charge for the period Mr F received care from the end of July to late November, costing around £9,200 which the Council paid. It said it waived these fees because it had not completed the financial assessment. The Council put the invoice on hold until after the Ombudsman has finished investigating. Mr S said it has caused Mr F distress.

The complaint

35. Mr S complained to the Council in early January. He said the Council did not tell the family they would have to pay for Mr F’s costs and did not present a contract to sign their agreement. He complained there was an 18-24 month waiting list for home adaptations which meant Mr F could not live in his own property and moved in with Mr S temporarily where he received care. Mr S complained the Council did not consider if Mr F was eligible for CHC and said it was unlawful to do a financial assessment before a CHC was considered.
36. The Council issued a response in the middle of February. It did not uphold the complaint. It accepted there was a delay actioning the first financial assessment but found officers discussed finances and charges with the family from the outset. The response looked at the assessments on file and said the Council should have referred Mr S for CHC funding because of his high level of needs (2:1 support and weekly dialysis), although it did not consider this was unlawful.
37. The Councils response also accepted the finance team should have provided more information as part of the financial assessment process.
38. Mr S complained to the Ombudsman in February 2024. He said the Council delayed completing a financial assessment and did not consider Mr F’s unique circumstances. He also said the Council failed to provide information about care fees and the CHC scheme.
39. In conversation with me, Mr S said neither the Council nor the family doctor recommended the CHC scheme. Mr S said he had to do his own research and refer his father to the governing body before he could get his father assessed.
40. Mr S said Mr F had always lived in his own home with his wife. He said it was only after the hospital recently discharged Mr F that he could not cope. Mr F’s property is a terraced house with no wheelchair access. Mr F moved into Mr S’s house which was more accessible. Mr S said Mrs M still lives in their shared home and Mr F spends time there when he can.

Analysis

Reablement care and continuing healthcare

41. The Council must not charge for certain types of care and support. It must provide free reablement care for six weeks. The Council provided reablement care for six weeks when Mr F was discharged from hospital. The Council is not at fault.
42. As explained above, where someone may be eligible for CHC, the Council must tell the ICS. The reports show the Council did not consider Mr F needed a CHC during its assessment in July 2023. This was a tick box exercise, there is no supporting information regarding how this decision was made. The Council should have done more to understand whether Mr F was eligible for CHC and included evidence of this within the assessment report. It did not, this is fault.
43. The Council’s complaint response (dated February 2024) referred to case notes which show Mr S asked about CHC funding, the Council advised him to contact Mr F’s doctor and ask for an assessment. As set out above, the Council must tell the relevant ICS where it considers an individual may be eligible for CHC. The Council did not do this. Instead, only when Mr S asked, did it signpost him to the doctor. The Council should have been proactive, told the CHC and advised the family this service may be available. It did not, this is fault.
44. In its complaint response, the Council accepted this and said the CHC scheme ‘should have been considered given his high level of needs (2:1 support required for all cares, receiving weekly dialysis)’. It said it would improve this element of its practice. The high-level of need identified in February 2024 in the complaint response had been present since care was provided on the reablement scheme in June 2023. It is likely, on the balance of probabilities, that had the Council referred Mr F to the ICS in June 2023, he would have received CHC funding from this time. This would have meant he would not have needed a financial assessment and would not have paid for his care privately.

The financial assessment

45. Mr S complained the Council failed to explain the exact costs for his care and failed to provide enough information to make an informed decision. As set out above, the records show that during the assessment process, the Council told Mr F and Mr S there would be charges for care and a financial assessment was needed to calculate how much. The finance officer explained this on the telephone to Mr S in November when they said they sent him the financial assessment forms. I am satisfied the Council told the family there would be charges for Mr F’s care.
46. Information is available online which explains what the Council considers and how it calculates the charges. I would expect Mr S to research this and be aware the Council would conduct a financial assessment and what this meant for his father.
47. The Council gave the above information verbally and in basic terms. There is no evidence the Council confirmed this in writing or gave details about how it would impact on Mr F. The Council should have done more to ensure Mr F and Mr S understood how the financial assessment worked and what charges they could expect to pay. It should have confirmed this in writing. The Council is at fault.
48. The Council referred Mr F for a financial assessment in July 2023. The finance officer discussed the financial assessment with Mr S in November and completed the assessment in January. This is a period of six months. While there is no statutory timeframe to complete the financial assessment, it should be done within a reasonable timeframe. I consider six months to be excessive. This is delay, this is fault. The Council recognised this and funded the care until it started the financial assessment process in November. This would have limited any financial injustice suffered by Mr F. The Council apologised for the delay.
49. The Council said its records show Mr F lived at Mr S’s property between 2020 and 2024. The Council said Mr F received care at Mr S’s property which had been adapted to make it more comfortable and accessible for him, including a stair lift. The hospital records show Mr F gave his sons address. In conversation with me, Mr S said Mr F was living with him temporarily as his own home was not wheelchair accessible. He said Mr F returns to his home some days to spend time with his wife and intends to return full-time once adaptations have been completed. I have not seen evidence the Council asked Mr F and Mr S to explain their living situation or asked for any documentation in support. The Council referred to Mr F’s home as a ‘second property’ in its letter following the financial assessment. This implies Mr F owns the house he lived in with Mr S. While I understand why the Council considers Mr F was living with Mr S, I do not consider it did enough to understand the situation before referring to Mr F’s home as ‘second property’ and making this decision. The Council should have done more. It is at fault.

Summary of fault causing injustice

50. The Council is at fault for failing to refer Mr S to the CHC at an early stage which is more likely than not to have prevented the private care costs being incurred. This would have prevented financial and emotional distress.
51. The Council is also at fault for failing to provide details in writing about the financial assessment, delay in completing the financial assessment and failing to better understand the family property situation. This would have not been necessary had the Council referred Mr S to the CHC scheme. The Councils failings caused added distress.

Back to top

Agreed actions

52. Within four weeks of my final decision, the Council agreed to:
• Waive the invoice for the outstanding care fees detailed above.
• Apologise to Mr F for the financial and emotional distress caused by failing to refer him to the CHC scheme, failing to provide details in writing about the financial assessment and delay completing the assessment (which would not have been necessary had the Council referred Mr S to the CHC).
• Remind staff about the CHC scheme and their duty to refer individuals.
• Review procedures to ensure detailed written information is provided at an early stage about the financial assessment and how this may impact the individual.
53. The Council should provide us with evidence it has complied with the above actions.

Final decision

54. I have completed my investigation. The Council is at fault for failing to refer Mr F to the CHC scheme, failing to provide detailed written information about the financial assessment and failing to complete this within a reasonable timeframe.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman