Summary: Mr X complained on behalf of Mrs Y the Council failed to consider evidence relating to Disability Related Expenditure. Mr X also says officers made comments that Mrs Y should not be entitled to various Disability Related Expenditure and there was no support plan in place for Mrs Y. Mr X is also unhappy with how the Council dealt with his complaint. We have not found fault in the Council’s actions.

The complaint

1. Mr X complained on behalf of Mrs Y the Council failed to consider evidence relating to Disability Related Expenditure (DRE). Mr X also says officers made comments that Mrs Y should not be entitled to various Disability Related Expenditure and there was no support plan in place for Mrs Y. Mr X is also unhappy with how the Council dealt with his complaint.
2. Mr X says this has caused both him and Mrs Y distress and financial losses.

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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 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 evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
6. Mr X and the Council were invited to comment on my draft decision. I have considered any comments before making a final decision.

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What I found

7. 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)
8. 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. A council must treat each person individually.

Disability Related Expenditure (DRE)

9. Councils can take disability-related benefits into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.

Care and Support Statutory Guidance

10. The Guidance sets out the principles guiding the approach to charging for care and support needs including the following:

• ensure that people are not charged more than it is reasonably practicable for them to pay;
• be comprehensive, to reduce variation in the way people are assessed and charged; and
• promote wellbeing, social inclusion, and support the vision of personalisation, independence, choice and control. (paragraph 8.2)

11. The intent of the regulations and guidance is to support local authorities to assess what a person can afford to contribute towards their care costs. Local authorities should also consider how to use their discretion to support the objectives of care and support charging. (paragraph 8.40)
12. Local authorities have flexibility within this framework for example, they may choose to disregard additional sources of income, set maximum charges or charge a person a percentage of their disposable income…Although local authorities have this discretion, this should not lead to two people with similar needs and receiving similar types of care and support being charged differently. (paragraph 8.42 - 43)

The Councils policy

13. The Councils policy says DRE will be considered where expenditure is required to ad independent living and where a service user has little or no choice but to incur the expense specifically due to their disability/illness. Its policy says a service users support plan that sets out how an individual’s adult social care needs are to be met will be used to consider whether disability related expenditure applies.

Section 22 of the Care Act

14. This says that a local authority may not meet a person’s care and support needs by providing or arranging the provision of a service or facility that is required to be provided by the NHS unless doing so would be merely incidental or ancillary to doing something else to meet needs under those sections and the service or facility in question would be of a nature that the local authority could be expected to provide.

What happened

15. Mr X completed a financial assessment for Mrs Y in early March 2024 and sent it to the Council. Mr X stated on the assessment he had included extra expenses for the Council to assess and included those in an email.
16. Mr X chased the Council in mid-March for the outcome of the assessment. The Council replied to Mr X the following day to say it would complete his assessment in date order and it would contact him once it had done the assessment.
17. The Council completed Mrs Y’s assessment in mid-May 2024 and updated its information about her DRE’s. The Council also submitted some of Mrs Y’s requests for DRE to panel.
18. The Council contacted Mrs Y in mid-May 2024 and told her the outcome of the assessment.
19. Mr Y contacted the Council in early June 2024 to say he was unhappy with the increased charges Mrs Y would have to pay. He said he felt the Council had not considered all the items he had requested as DRE’s. The Council told Mr X it had referred some items to the panel. If the panel agreed it should consider these, any change would be backdated. The Council said if the panel did not agree, the assessed charge would stand.
20. The Council reviewed Mrs Y’s case again in early June and accepted some items Mr X had included as DRE’s such as items for the bed and mattress, warranty and shower chair. But did not include an additional mattress and asked for medical evidence for other items.
21. The Council spoke to Mr X in June and asked for receipts for items which he was claiming for DRE. Mr X said he did not know he should have kept receipts but would look for them. The Council also confirmed it would look at Mrs Y’s support plan before allowing any DRE’s. Mr X said he would like it to revisit Mrs Y’s support plan. The Council provided the details of the correct place to contact about this.
22. Mr X provided further information to the Council in June 2024. The Council reviewed this and reduced Mrs Y’s contribution. The Council wrote to Mrs Y to confirm this.
23. Mr X contacted the Council again in mid-July to say it had not considered all the items he put forward. The Council’s notes say Mr X told it he would not ask for a doctor’s letter about Mrs Y’s needs as the doctors would charge him for it. Mr X provided some further information about the items Mrs Y was having to buy.
24. The Council considered the further information Mr X had sent in late July 2024 and rejected some items Mr X had asked it to consider. The Council confirmed it would need medical evidence to confirm why these items were not prescribed or why they were beneficial to Mrs Y’s health.
25. Mr X spoke to the Council in late July to ask whether it would cover the costs of getting the medical evidence it had asked for. The Council confirmed it would not cover these costs. Mr X also asked for a copy of the Care and Support Plan for Mrs Y.
26. The Council advised in late July it had asked the relevant department to send the plan to Mr X and again confirmed it would not cover the costs of getting the medical evidence.
27. Mr X provided medical evidence for some of the items he asked to be included as DRE’s in early August 2024.
28. The Council contacted Mr X in late-August 2024 to try to arrange to complete a review of Mrs Y’s needs. However, Mr X advised Mrs Y was away.
29. Mr X provided further medical evidence in early September 2024 and the Council again tried to arrange a suitable time to complete an assessment of Mrs Y’s needs but could not do so.
30. Mr X raised a complaint in mid-September 2024 about the Council failing to include items as DRE. Mr X also complained about an officer’s comments about what was included as DRE’s, requesting further medical evidence and having to pay for this.
31. The Council contacted Mr X again in late September to arrange a suitable time to complete a needs assessment for Mrs Y and said if it did not receive any contact it would close the matter.
32. The Council issued a complaint response in mid-October 2024 and said it had allowed some DRE’s and had followed the correct procedure. It said its officer had agreed with the assessment completed by their colleague and confirmed that it would not allow DRE’s which were not noted in Mrs Y’s are plan. The Council said it would need Mr X to provide medical evidence as requested.
33. Mr X sent further evidence to the Council following its complaint response and asked it to consider Mrs Y’s utility bills as she was spending higher than average. The Council responded to Mr X in early November and asked for evidence of utility bills for the last 12 months.
34. The Council completed a review of Mrs Y’s DRE’s at its resolution panel in late November 2024. It included some items as DRE but did not accept the cost of obtaining medical evidence.
35. I understand from the Council it is yet to receive the evidence of Mrs Y’s utility bills to allow it to consider these.

Analysis

36. The Ombudsman is not an appeal body. It is not our role to carry out financial assessments, decide what contribution someone should make to their care costs, or decide whether certain expenses should be classed as DRE. Our role is to investigate the process a council followed, to assess whether it made its decision properly. We look for evidence of fault causing injustice to the complainant. We cannot question the professional judgment of council decision makers where the process was not affected by fault.
37. The Council reviewed the information Mr X submitted in March 2024 and wrote to Mrs Y in May 2024 to confirm it had completed her assessment. The Council gave details of what her new contribution would be. The Council also sent items to its panel to consider whether they could be included as a DRE.
38. Mr X then gave further information at various stages which the Council reviewed and made amendments. The Council also explained some items Mr X wanted to include as DRE’s would need to be noted in Mrs Y’s support plan, or it would need to receive medical evidence.
39. The Council confirmed it would not cover the cost of getting the medical evidence and tried to arrange a review of Mrs Y’s support plan.
40. The Council reviewed Mr X’s complaint and upheld the decision made by the assessor. However, when the panel reviewed the matter, it allowed some items which had previously been declined. The Council reviewed the evidence it had received and decided based on the information it had. The Councils request for medical evidence was appropriate to allow it to consider the items Mr X asked it to.
41. Mr X says he is unhappy that a colleague upheld the view of the assessor regarding what would/would not be considered a DRE. It is not fault that one officer has the same opinion as another or that this differs from Mr X’s view.
42. Mr X has said there was no support plan in place for Mrs Y. However, the Council has provided a copy of the plan and took steps to review this when Mr X asked. I understand the Council was not able to complete the review as it was unable to arrange a suitable time with Mr X or Mrs Y.
43. Mr X says he is unhappy with how the Council reviewed his complaint. I have not found any fault in the way the Council assessed Mr X’s complaint.

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Decision

I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman