Summary: We will not investigate this complaint about adult social care financial assessment. There is not enough evidence of fault in how the Council completed the financial assessment. There is fault in delay completing an appeal of the financial assessment decision, and sending invoices for payment while the complaint was continuing. The Council has agreed to apologise and make a total payment of £250 to acknowledge the complainant’s distress, time and trouble. We are satisfied with the actions the Council has agreed to take and it is unlikely an investigation would achieve anything further.

The complaint

1. Mr B says the Council has not properly completed a financial assessment for contribution to adult social care costs. When Mr B received a new benefit payment the Council has almost taken it all for care costs. Mr B also says the Council has not properly considered his disability related expenses.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide further investigation would not lead to a different outcome. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
3. 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 considered information provided by the complainant and the Council.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

7. It is unlikely the Ombudsman would find evidence of fault in the Council’s financial assessment for adult social care. When the Department for Work and Pensions awarded Mr B a new benefit that was a change of circumstances which triggered a new financial assessment by the Council. The benefit is considered in the financial assessment according to the rules set by central government, which the Council has followed. This has resulted in Mr B having to pay toward his care support. Which is upsetting for Mr B, but not evidence of fault by the Council. The Council has reconsidered the financial assessment through its complaint and appeal process. It is unlikely an Ombudsman investigation would lead to a different outcome.
8. Financial assessments also consider, and can make allowances for, extra money a person spends because of their disability or medical condition, this is called disability related expenditure (DRE). Mr B says the Council has not properly considered this.
9. The Council has considered and responded to Mr B’s claims for DRE, explaining what it has allowed or why it hasn’t allowed others. The Council has checked its reasoning through an appeal process. There is not enough evidence of fault in the process the Council followed to reach its decision. In Mr B’s complaint to the Ombudsman, he raised DRE items that have not been put to the Council. We cannot criticise the Council for not considering DRE that has not been raised with it. Mr B will need to ask the Council to consider these claims for DRE and provide it any evidence in support.
10. Through its complaint process the Council realised it failed to put on hold its requests for payment while the complaint was continuing. The Council apologised to Mr B and offered him £150 to recognise his distress. We are satisfied with this action to accept fault and acknowledge the impact on Mr B.
11. If we investigated the complaint, it is likely we would find the Council at fault because it accepted it used the wrong process and delayed referring Mr B to an appeal of his charges. Mr B has had unnecessary time and trouble negotiating a complaint process and an appeal process. We therefore asked the Council to consider remedying the injustice caused by its actions by giving Mr B an apology and £100 on top of the £150 already offered.

Agreed action

12. To its credit the Council agreed to resolve the complaint early and will apologise and pay Mr B £100 (or this can be offset from any unpaid care charges). The Council will take this action within one month of this decision.

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Final decision

13. We have upheld this complaint because the Council has agreed to resolve the complaint early by providing a proportionate remedy for the injustice caused to Mr B.
14. We are satisfied with the Council’s actions and the agreed actions and consider an investigation would achieve nothing further.

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Investigator's decision on behalf of the Ombudsman