Summary: We will not investigate Mr X’s complaint that the Council wrongly charged his father for the costs of his care. There is not enough evidence of fault to justify an investigation.

The complaint

1. Mr X complains the Council told him and his mother, Mrs M, that his father’s care would be free until further notice. He says that eight months later, the family received a bill for £50,000 following the Council’s financial assessment.
2. Mr X says the Council should waive the bill.

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The Ombudsman’s role and powers

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

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How I considered this complaint

4. I considered the information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. In January 2024, Mr M was discharged from hospital to a care home. The NHS confirmed it would fund his care until it had assessed him for Continuing Health Care (CHC) funding. If someone is awarded CHC funding, all their care is free of charge because the NHS will pay for it.
7. The Council says its records note that during a call with Mr M’s wife, Mrs M, in December 2023, she confirmed Mr M had funds over £23,250. This meant he had enough money to pay for the full costs of his care if his CHC funding application was unsuccessful.
8. Mr M’s CHC assessment, which took place in February, was unsuccessful. The NHS says it wrote to the family confirming this. Mr X says the family did not receive the letter. The Council says its records show a Council officer called Mrs M around this time to explain the implications of not receiving CHC funding and to tell her that Mr M would have to pay for his care from the date of the CHC assessment. The notes record Mrs M again said Mr M had enough savings to self-fund his care. The Council advised her to contact it when Mr M’s funds reached the £23,250 threshold.
9. In August, the Care Home contacted the Council to ask for clarification about who should pay for Mr M’s care as the bill was outstanding. The Council says its records show a case worker told the Care Home that Mr M was a self-funder. The case worker also called Mrs M and explained the Care Home would be contacting her about the outstanding amount due. Another call took place a couple of days later between Mrs M and the case worker. Mrs M said that Mr M’s finances were likely to drop below the threshold once he had paid the £50,000 care fees. As a result, the Council arranged for a financial assessment to take place.
10. The Council took appropriate action to ensure Mrs M was aware that Mr M needed to pay for his care. Several conversations took place with Mrs M who confirmed each time Mr M had funds over the £23,250 threshold. Because Mrs M confirmed this, the Council was under no duty to carry out a financial assessment. That was only necessary once Mr M’s funds reduced to the extent he could no longer afford to pay for his care. This took place in a timely manner. There is not enough evidence of fault to justify an investigation.
11. Furthermore, even if we found the Council had not properly informed Mrs M that Mr M would have to pay for his care, we would not waive the fees. Mr M received the care he needed and was assessed as able to afford to pay for it. Therefore, he, or his estate, should do so.
12. In relation to the phone call between Mrs M and the Care Home, the Council’s records show the case worker told Mrs M to expect a call requesting payment. There is not enough evidence of fault to justify an investigation. But in any case, the Council’s complaints response contains an apology for any distress caused and an investigation would achieve nothing further.

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Final decision

13. We will not investigate Mr X’s complaint because there is not enough evidence of fault to justify an investigation.

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Investigator's decision on behalf of the Ombudsman