Summary: The Council overcharged Mrs Y for the care and support it provided to meet her needs and failed to explain how the charges were calculated. It also delayed responding to the complaint Mr X made on her behalf and the complaint response was inadequate. The Council has agreed to apologise to Mr X and Mrs Y and make a payment to acknowledge the uncertainty and frustration they were caused. It has also agreed to revise the invoices and provide training or guidance to staff about responding appropriately to complaints.

The complaint

1. Mr X complained the Council has overcharged his mother Mrs Y for the care and support she was provided to meet her care needs. He complained it initially provided more support than Mrs Y needed, delayed reducing the care package and charged her for more time than the actual visits took. The Council revised the bill in response to Mr X’s complaint but has failed to clearly explain how it calculated the charges leaving Mr X and Mrs Y uncertain over the accuracy of the charges and causing them both frustration.

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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. 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. I have exercised my discretion to consider what has happened since May 2022 when Mrs Y started receiving care due to the continued confusion about her care charges since then and the Council’s delay in responding to the complaint.
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 evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
6. I gave Mr X and the Council an opportunity to comment on this draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

7. The Care Act 2014 sets out the legal framework for charging. Councils can make charges for care and support services they provide or arrange. They must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014. Charges may only cover the cost the council incurs.
8. Councils must assess a person’s finances to calculate how much an individual should contribute to the cost of their care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25% (also known as the minimum income guarantee).
9. The Care and Support Statutory Guidance sets out key principles councils should take into account when making decisions on charging. The principles include that the approach to charging should be clear and transparent, so people know what they will be charged.

The Council’s charging policy

10. The Council charges for care and support in line with the regulations. It charges for a minimum of 15 minutes. Since November 2023, after 15 minutes, charges are rounded up or down to blocks of five minutes. Prior to this date, charges were by minute with a minimum call length of 15 minutes. The length of a call is determined by the care plan.

What happened

11. Mrs Y has physical health conditions which limit her use of one arm. In early 2022 the Council assessed Mrs Y’s care needs and agreed to arrange a care package of 30 minutes each day to assist with personal care and getting dressed. The social worker explained the financial assessment process. Mr X said Mrs Y complained about the frequency and length of calls as she decided she only needed three visits per week.
12. In July 2022 Mrs Y asked the Council to reduce the care package to three visits per week. The notes record the Council agreed to this. In September 2022 Mrs Y asked the Council to look at the invoices as she was being charged for one hour of care per visit when the care workers stayed around 15 minutes.
13. The Council wrote to Ms X in January 2023. It cancelled Ms Y’s invoices from May 2022 to 7 August 2022 ‘due to lack of supporting information’.
14. In March 2023 the Council reviewed Mrs Y’s care package. It noted Mrs Y was mostly independent but needed some support with washing and dressing and had eligible needs under the Care Act.
15. Mr X contacted the Council in March, April and May 2023 to dispute the invoices received each month, again stating the care workers stayed 15 minutes, not an hour. The invoices showed Mrs Y was being billed for three one hour visits each week. The Council revised one of the invoices charging Mrs Y for two hours of support per week rather than three.
16. The Council wrote to Mrs Y in mid-July 2023. The letter said that based upon the evidence provided, it would cancel and reissue the invoices. All the invoices were reissued based upon a weekly care package of three 30 minute visits a week.
17. Mr X contacted the Council again in late July 2023. He said Mrs Y had received a maximum of 15 minutes a day so should be charged for 45 minutes a week. He contacted the Council again in late August 2023 to dispute the next invoice. Mrs Y did not pay any of the invoices.
18. The Council wrote to Mrs Y in September 2023. It agreed to reissue the invoice covering the period mid-February to mid-March 2023. Mr X complained about the invoice received in September 2023. The Council agreed to cancel and reissue the invoice. By now Mrs Y owed the Council just under £2000.
19. In January 2024 the Council spoke with Mr X about the debt. Mr X explained that Mrs Y had not paid due to the continuous billing issues. The Council advised him to submit a formal complaint.
20. In January 2024 Mr X complained to the Council on Mrs Y’s behalf. He complained she only wanted three care visits per week and received seven. He said the visits lasted around 15 minutes but she was charged for 30 minutes. Mr X said Mrs Y would not pay the invoices as they were incorrect.
21. The Council contacted the Care Provider. It said the care package was reduced to one hour each day for three days. The Council held a meeting in March 2024 where it established the decrease in the care package to 1.5 hours a week was not reflected on its system. The Care Provider confirmed it was actually providing three 30 minute visits a week
22. The Council responded to Mr X in May 2024. It apologised for the delay. It said the charges between 10 April 23 and 18 February 2024 would be reduced from £1086.91 to £580.88. The breakdown the Council has provided to me shows the charges were revised based on the length of visits.
23. Mr X contacted the Council in July 2024 complaining about the charges. The Council spoke with Mr X in early September 2024. He had not received the Council’s letter of May 2024 which it agreed to re-send.
24. In response to our enquiries, the Council said Mrs Y was overcharged. It said it agreed to reduce her care package to 1.5 hours from 3.5 hours but this was not communicated clearly internally and there were further discrepancies in communication with the Care Provider so the care package was reduced by 0.5 hours rather than 2 hours. It said it used call monitoring data of actual calls to recalculate the invoice.

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Findings

25. Mrs Y has received care and, in line with the law and the Council’s policy, is required to pay for it. However, the Council has failed to accurately bill Mrs Y and has overcharged her for the care she received. This was fault. From the start of the care package in May 2022 Mrs Y disputed the invoices she had received. It was not until May 2024 that the Council established it had failed to accurately record her care package on its system. This appears to be an isolated error rather than a systemic failing and so does not warrant a service improvement.
26. The Council revised Mrs Y’s care charges from 10 April 2023 onwards based on the actual call time and since November 2023 the charges have been calculated based on actual visits rounded up or down in five-minute blocks in line with its charging policy. This was appropriate and there is no evidence of fault in the way it recalculated these care charges. However, the Council did not revise the invoices for the 35 weeks from 8 August 2022 until 9 April 2023. There are several weeks where Mrs Y has been charged for over one hour and 30 minutes and eight weeks where she has been charged for two hours or more, despite Mr X and Mrs Y repeatedly saying the calls lasted around 15 minutes. This was fault.
27. On balance, it is likely the charges for this period are inaccurate and Mrs Y has been overcharged. It would be very difficult to establish now exactly how long the care calls were during that time period. Considering the actual call times from April 2023 are on average 45 minutes per week I have therefore recommended that Mrs Y’s invoiced are revised and she is charged for three 15 minute calls a week for this period.
28. The Council delayed responding to Mr X’s complaint. This was fault. In the complaint response it set out that the charges had been reduced but it failed to clearly explain why Mrs Y was overcharged, how the charges were now calculated and how this related to its charging policy. This was fault and meant Mr X and Mrs Y were left with a sense of uncertainty over whether the bills were revised correctly.

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Agreed Action

29. Within one month of the final decision the Council has agreed to:
1. apologise to Mr X and Mrs Y and pay them £150 each to acknowledge the frustration and uncertainty caused by the inaccurate invoices and delay and lack of detail in the complaint response. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended.
2. revise the invoices for the period 08/08/22 to 09/04/23 (35 weeks) to charge Mrs Y for 45 minutes per week.
3. write to Mrs Y clearly setting out what she owes in total, based on the revised invoices.
30. Within two months of the final decision the Council has agreed to provide guidance or training to officers to ensure that complaint responses are comprehensive enough to address the concerns raised and provide a clear explanation of the findings and recommendations of the complaint investigation.
31. The Council should provide us with evidence it has complied with the above actions.

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Decision

32. The Council was at fault causing an injustice which it has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman