Summary: Mr X complained about a delay providing his relative Ms Y with additional care and about fault in the financial assessment for her care charge. The Council is at fault. It took too long to make Ms Y’s direct payment available to her after revising her care and support plan to include extra care. The Council made an incorrect statement about Ms Y’s mobility vehicle which caused avoidable distress. The Council will apologise and make a symbolic payment.

The complaint

1. Mr X complained for Ms Y. He said the Council:
1. Delayed providing additional care from February 2024 when Ms Y’s needs had increased;
2. Failed to properly consider disability related expenditure (DRE) in the financial assessment; and
3. Failed to consider debt repayments.
2. Mr X also complained the Council:
1. delayed arranging care in 2023;
2. used the wrong figure (minimum income guarantee) when completing Ms Y’s financial assessment;
3. Failed to deduct housing costs from the financial assessment; and
4. Gave advice about claiming a benefit that meant Ms Y had to pay a charge for her care.
3. Mr X said this caused a deterioration in Ms Y’s condition and avoidable distress.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. We provide a free service and so 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
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement.

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

7. 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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What I have and have not investigated

8. The period of my investigation is from February 2024 to February 2025. Matters before February 2024 are late and there is no good reason for the delay complaining to us. So I have not extended the investigation timeframe beyond 12 months before the date of the complaint to the LGSCO. Where I have referred to events before February 2024, it is for context and background only.
9. I have investigated the complaints in paragraph one. I have not investigated the complaints in paragraph two because:
• Complaint 2(a) is late with no good reason for the delay complaining to us.
• The Council amended the minimum income guarantee in complaint 2(b) so there is no injustice requiring a remedy.
• For complaint 2(c), the Council revised the financial assessment on receipt of evidence from Ms Y about household expenses (mortgage and council tax). There is no fault as everyone in receipt of chargeable council social care services is required to provide evidence of income and expenses for their financial assessment. And there is no outstanding injustice requiring a remedy in any event because the Council revised the financial assessment.
• There is no fault in complaint 2(d) as this is part of the information and advice around income maximisation that councils give during a financial assessment as per Care and Support Statutory Guidance (see paragraph 17).

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How I considered this complaint

10. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
11. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

12. A care and support plan is a document describing the person’s care needs identified in their social care assessment. The plan explains if the needs meet national eligibility criteria and how the council intends to meet those needs. If some or all needs are to be met by a direct payment (money to the person to arrange their own care) the plan sets the amount and frequency of payments. (Care Act 2014, section 25)
13. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs. (Care Act 2014, section 26)
14. There are three ways in which a personal budget can be used:
• As a managed account held by the local authority with support provided in line with the persons wishes;
• As a managed account held by a third party with support provided in line with the persons wishes;
• As a direct payment (DP). (Care and Support Statutory Guidance 2014)
15. Statutory Guidance explains a council should review a care and support plan at least every year, on request or in response to a change in circumstances. The purpose of a review is to see how a care and support plan has been working and to decide if any revisions need to be made to it. The council should act promptly after receiving a request for a review. (Care and Support Statutory Guidance, Paragraphs 13.19-21 and 13.32)
16. A council should revise a care and support plan where circumstances have changed in a way that affects the plan. (Care Act 2014, sections 27(4) and (5))
17. Councils may charge for home care and must be transparent so people know what they will be charged. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3) Information and advice provided by a council should include information about disability benefits (Care and Support Statutory Guidance, paragraph 3.24)
18. Councils work out a person’s care charge by carrying out a financial assessment (FA). Some types of income are not taken into account in a financial assessment. This is called ‘disregarded income’ and includes some benefits, earnings and some tax credits.
19. Disability Related Expenditure (DRE) are expenses a person has to pay connected to their disability. They are an allowance in a person’s financial assessment which reduces their weekly charge. DRE can include specialist items and services such as wheelchairs. They can include extra heating or laundry costs, equipment and aids and regular payments such as wheelchair insurance and gardening costs. Statutory guidance says:
• A council must leave a person with enough money to pay for necessary DRE to meet needs that are not being met by the local authority
• It may be reasonable for a council not to allow for items where a reasonable alternative is available at lesser cost
• The care plan may be a starting point for considering DRE, but councils need to be flexible. (Care and Support Statutory Guidance Annex C, 39 and 41)
20. The Council’s policy is to allow a standard weekly DRE of £23. People can ask for an individual assessment of their DRE on provision of evidence of expenditure. If a person fails to tell the Council their income has increased and the Council later finds out about an increase, then the Council will backdate any additional charge to the date of the increase.

What happened

21. Ms Y is eligible for care and support and had a care package of 10 and a half hours a week which the Council commissioned using a care agency.

Finance

22. Case notes indicate a social worker discussed the Council’s policy on charging for social care services in September 2023 and sent Ms Y a financial assessment form to complete. The email also had a link to information on the Council’s website about charging called ‘Paying for Adult Social Care.’ At the end of October 2023, the finance team completed an FA and wrote to Ms Y about her care charge. She did not have to pay anything because her income at the time was so low. The letter advised Ms Y to apply for universal credit and asked her to tell the finance team about changes to her financial circumstances, about housing related costs and about DRE over £23 a week.
23. The Council reassessed Ms Y’s charge in May 2024 to take into account changes to her benefits and income. The finance team wrote to her in the middle of July 2024. It said the new charge would be backdated to May 2024. The letter included a breakdown of the calculation of the charge.
24. Mr X queried the new FA. He sent the Council a list of Ms Y’s medical and therapy appointments. He also supplied a copy of Ms Y’s utility bills and housing and council tax expenses as well as her debts.
25. There was an email exchange between the finance team and Mr X starting in August 2024. Mr X raised queries about Ms Y’s latest FA. The finance team replied to his questions.
26. Mr X asked the Council to consider whether the charge was affordable for Ms Y given her debts. He said a mortgage debt was on hold, Ms Y was paying another debt off at £148 a month and an energy debt at £10 a week. The finance team said Ms Y needed to seek independent advice about the debts and signposted Mr X to the Council’s complaints team for him to complain if he wanted to take matters further.
27. Mr X did not complain at this stage. At the end of October, he submitted a request for DRE for Ms Y for:
• Food costs
• Petrol costs for health appointments. He enclosed records of appointments and mileage from January 2023 to October 2024. These came to £6 a week. He was asking for a weekly fuel allowance of £10.
• Therapy
• Internet
• New mattress.
28. The finance team replied saying:
• Food costs were not awarded because Ms Y’s child’s costs of food were expected to be covered by their disability benefits
• An allowance for fuel was not granted no matter what type of motability vehicle, because having a motability vehicle is a personal lifestyle choice
• Internet is a household expense
• A mattress at £4.80 and therapy at £11.85 were awarded. But this came to less than the standard DRE allowance.
• Mr X could use the Council’s complaint procedure if he remained unhappy
29. The Council reassessed Ms Y’s charge and reduced it in January 2025. The lower charge reflected allowances for mortgage and council tax payments.

Care

30. Ms Y went into hospital in February 2024. The hospital told the social worker Ms Y was medically fit for discharge. Ms Y’s social worker told the hospital discharge team to complete a form if the ward staff felt she needed additional care. The hospital did not complete this form. Ms Y was discharged from hospital and stayed with her parents for a couple of nights before returning to her own home. The social worker contacted the care agency to restart Ms Y’s care. Ms Y’s mother asked for an urgent increase in care. The social worker booked a visit for the following week.
31. The records indicate the social worker visited Ms Y at the end of February and started a review/reassessment of Ms Y’s care and support. The social worker finished the review at the start of May and recommended an increase in care from 10 and a half to 15 hours a week. Ms Y wanted a direct payment (DP) to arrange her own care with a different agency.
32. Between February and May 2024 community therapists were trying to arrange to assess Ms Y’s physical abilities to move about and use her home and the equipment service was also trying to arrange to assess her. Case notes indicate it was not always easy for officers to make appointments to see Ms Y; she sometimes cancelled due to health issues or other commitments and on occasion she went out when visits had been scheduled.
33. The Council set up a holding account for Ms Y at the end of June which was for her to use while the switch over from commissioned care to a DP was happening. The case notes indicate Ms Y said she could not afford the charge for her care and wanted to suspend care temporarily.
34. Records indicate Ms Y’s preferred care agency may not have been available to provide staff to do the care calls at the times Ms Y wanted. Her care with the preferred agency started in the middle of August 2024. Mr X also said in emails to the social worker that Ms X was providing Ms Y with care.

The Council’s response to the complaint

35. Mr X complained to the Council about the same matters he has raised with the LGSCO. The Council provided a comprehensive response to Ms X’s complaint. I have summarised the response to the matters I have investigated:
• There were lots of attempts to set up the extra care Ms Y needed. Workers had difficulty reaching Ms Y. There was room for improvement on the Council’s side around DP processes and the time taken to set up the DP.
• The finance team was made aware in July 2024 that Ms Y had a change in her care package in May and so this triggered a financial assessment. Information from the DWP showed Ms Y had started getting new benefits and so this information was considered in a new financial assessment.
• The finance team delayed processing the change in Ms Y’s circumstances and backdated the charge to 5 May.
• Ms Y was told several times to complete the DRE form.
• Ms Y has support in her care and support plan to prepare and/or heat meals so ready meals would not be allowed as a DRE.
• Ms Y has chosen a particular car which is more expensive than other cars available on the motability scheme that doesn’t leave her with any PIP to pay for petrol.
• The Council agreed therapy costs and new mattress.
• Internet is a general household cost. She does not need it to shop. She went shopping while in hospital and can drive herself to shop on a good day.
• Regarding debts: Ms Y has received information and advice about organisations that can support her with debt advice.

Information from the Council

36. I asked the Council to explain a statement from the finance team about Ms Y’s motability car being a lifestyle choice. The Council told me it had spoken to the officer concerned who lacked knowledge and clarified that this is not correct and for many adults with complex needs who need to attend frequent appointments, it is the cheapest form of transport.
37. I also asked the Council to explain why it said Ms Y had chosen a particular car that does not leave her with any mobility Personal Independence Payment (PIP) to pay for petrol. The Council told me Ms Y had opted for a premium model which required an additional payment beyond the standard contribution covered by the PIP mobility component.

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Findings

Delay providing additional care from February 2024 when Ms Y’s needs had increased

38. The review of Ms Y’s care and support plan took from February to May 2024. The Council needed information from therapists to inform the review and the evidence indicates Ms Y was not easily available for appointments. There is not enough evidence of delay by the social worker in completing the review. On the evidence available and taking into account Ms Y’s varying availability, the review was completed within a reasonable timeframe so there is no fault.
39. The decision to increase Ms Y’s care from 10 and a half hours to 15 was made in May 2024. Four weeks is a reasonable period to set up and put in place a DP so it should have been in payment by June 2024. The Council has accepted it took too long to action the DP. This was fault causing avoidable distress.
40. The Council has a duty to meet Ms Y’s eligible unmet needs. It should have at least offered to commission the existing agency to provide the extra hours it had assessed Ms Y as needing from May 2024. This would have meant eligible unmet Ms Y’s care needs were being provided for while her DP was being set up. The failure to offer to commission the additional hours in May was fault. The records indicate Ms Y’s mother stepped in and provided some additional care during this period and so the injustice to Ms Y is limited to the avoidable distress of not being in control of managing her own care and support sooner.

Failed to properly consider disability related expenditure (DRE) in the financial assessment

41. The Council has a standard allowance for DRE. Mr X asked for an individual assessment of Ms Y’s expenses and the Council completed this. The Council said it would not allow her fuel as a DRE because a ‘motability vehicle is a lifestyle choice’. This statement was not accurate and was fault causing avoidable distress.
42. The Council considered the request for mileage as a DRE. It decided Ms X had opted for a more expensive car and this meant she had to pay extra costs towards this car that would have been available to spend on fuel otherwise. CSSG Annex C allows a council to reject a DRE claim if a cheaper alternative is available. If Ms X had purchased a standard model, she would not have to supplement the cost with an additional payment from her income. There is no fault in the Council rejecting fuel as a DRE on that basis.
43. In terms of the remaining DRE requests: the Council has considered each item individually and has explained why it is not a cost associated with Ms Y’s disability or has rejected the item because the cost is already provided for in the care and support plan. This is in line with Annex C of CSSG and there is no fault.

Failed to consider debt repayments

44. There is no specific requirement in CSSG for councils to take into account a person’s debts in their financial assessment. The Council referred Ms X to agencies for debt advice. There is no fault.

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Agreed Action

45. Within one month of my final decision, the Council will apologise and make a symbolic payment of £150 to Ms Y for the avoidable distress caused by giving incorrect information about motability vehicles being a lifestyle choice and for the delay in making a DP available. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended in my findings.
46. The Council should provide us with evidence it has complied with the above actions.

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Decision

47. I find fault causing injustice. The Council has agreed actions to remedy the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman