Summary: We will not investigate this complaint about financial assessment for adult social care costs, specifically how the Council considered disability related expenditure. This is because it is unlikely we would find evidence of fault in the Council’s decision-making. The complainant has challenged the decision, and two senior officers with relevant experience have reviewed the original decision, taking account relevant law, guidance, and policy.

The complaint

1. Mr B says the Council has made the wrong decision on its consideration of disability related expenditure when completing the financial assessment for the contribution toward care costs for his relative, Ms C. Mr B says this causes Ms C financial hardship and means she cannot continue with activities which meet her wellbeing and other assessed needs.

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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:

• there is not enough evidence of fault to justify investigating, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.
6. I considered the Care Act 2014 and associated statutory guidance.

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My assessment

7. Ms C has adult social care needs which the Council is responsible to meet. The Council must assess what, if anything, Ms C can pay toward her care support. Part of that financial assessment looks at disability related expenditure (DRE). This is extra money you may need to spend because of your disability or medical condition to meet any needs the council or NHS are not meeting.
8. It is not the Ombudsman’s role to decide what is DRE, but to look at how the Council made its decision.
9. Mr B says for many years Ms C has attended weekly activities which are essential for her independence, sociability, communication skills and mental wellbeing. A recent financial assessment decided Ms C must pay more toward her care support, which means she has less disposable income for these activities. Mr B asked the Council to allow the cost of the activities as DRE, but the Council has refused.
10. The Council has explained its view that the activities are not required to meet Ms C’s needs because it is meeting Ms C’s needs by her care and support plan. The Council considers the activities to be a choice rather than a need because of illness or disability so will not include the costs. This is a decision the Council is entitled to make. The Council has considered Mr B’s arguments and evidence through two appeals, which have been conducted by suitably senior and relevant officers. The Council has considered its charging policy and relevant law and guidance.

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Final decision

11. We will not investigate Mr B’s complaint because even though Mr B strongly disagrees with the Council’s decision, it is unlikely we would find enough evidence of fault in the decision-making process. The Council has considered relevant law, guidance, and policy. Mr B has had an opportunity to challenge the decision, and two senior officers with relevant experience have independently reviewed the decision and Mr B’s challenge. It is unlikely we would add to the Council’s investigation or reach a different outcome.

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Investigator's decision on behalf of the Ombudsman