Summary: The Council was at fault for delaying carrying out a financial assessment of Mr Y’s care charges. This has left Mr Y with a significant debt. To remedy the injustice caused, the Council agreed to apologise and write off Mr Y’s debt for care charges until October 2024.

The complaint

1. Ms X complains on behalf of Mr Y that the Council:
• Delayed carrying out a financial assessment of the costs he was supposed to pay towards his care.
• Did not properly consider Mr Y’s disability related expenditure.
2. Ms X said Mr Y has now been left with a very large debt of over £10,000 to pay off.

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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. 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)
5. 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(1), as amended)

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How I considered this complaint

6. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
7. Ms 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

Law and guidance

8. 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)
9. 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. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
10. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
11. Councils can take disability-related benefit 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.

What happened

12. Mr Y is registered blind, has autism and learning disabilities. Ms X is Mr Y’s Shared Lives Carer and provides care and support to him.
13. In November 2021, Mr Y turned 18 and became eligible to pay towards his care costs. Mr Y moved into a supported living placement at this time. Another local authority was paying for the placement and due to invoice the Council as the Council commissioned it.
14. Between 2021 and 2024 Mr Y had several reviews of his care by the Council but the Council did not carry out a financial assessment.
15. In late summer 2024, the Council sent Mr Y an online statement of financial circumstances to complete as the Council realised Mr Y had not been paying towards his care costs. Mr Y completed this with the assistance of Ms X and asked the Council to consider his phone costs, gym membership and physio as DRE.
16. In late October 2024, the Council completed its financial assessment of Mr Y’s care costs and wrote to him explaining how much he had to pay towards his care. The Council said Mr Y should have been paying for his care from November 2021 and calculated how much he owed in backdated charges. The Council also explained it did not consider his gym membership or phone costs should be included as DRE. Its reasoning was Mr Y’s GP should consider whether he was entitled to any service such as physio or gym membership and whether they could offer Mr Y an individual health budget. The Council said it did not include Mr Y’s phone charges as they were excessive and the cost of a phone was a normal cost everyone pays.
17. Ms X complained to the Council in late October 2024 that it had backdated his care costs to November 2021. Ms X said the Council should have completed a financial assessment when his placement was sent up in 2021. Ms X said the backdated charges will cause financial hardship to Mr Y.
18. In November 2024, the Council responded to Ms X’s complaint. The Council said:
• The process of transferring Mr Y to a Shared Lives arrangement was complex as while the Council commissioned the care another Council was responsible for the care scheme in their area. This meant the other Council was paying for the care but there was delays with invoicing and administration.
• When the Council resolved the purchasing arrangements it was not clear whether the other Council had calculated a care contribution.
• It was confident it discussed contributions in the care review in April 2023 so would start Mr Y’s care charges from this point.
19. In February 2025, Ms X set up a payment plan of £500 per month to cover Mr Y’s care fees and pay a small amount towards the debt. At this time Mr Y’s debt was over £10,000. Following this the Council allocated this £500 per month to the debt only so in March and April 2025, Mr Y did not pay care charges.
20. In April 2025, the Council recognised this and set up the direct debit correctly to pay Mr Y’s monthly care charges and a small amount towards the debt.
21. Ms X remained dissatisfied and complained to the Ombudsman.

Findings

22. Once Mr Y’s placement was sent up the Council should have carried out a financial assessment to calculate how much he should be paying towards the costs of his care. Failure to do this was fault.
23. As a result Mr Y has now accumulated a large debt of over £10,000 causing him significant financial hardship. Following Ms X’s complaint the Council agreed to only backdate the care charges to April 2023, when it carried out a care review, and not November 2021. The Council said it likely discussed Mr Y’s care charges at this review. From the information I have, I have not seen any evidence that the Council discussed Mr Y’s care charges or the possibility of care charges with him prior to completing the financial assessment in October 2024.
24. Ms X said she and Mr Y were not aware of whether he had to pay charges towards his care until October 2024. Mr X is registered blind, autistic and has learning disabilities. Evidence provided by the Council of his capacity assessment showed he had little understanding of money. Ms X is also not a professional representative. I am therefore satisfied that they did not know Mr Y was supposed to pay towards his care. Even if the Council had told them and asked Mr Y to put money aside in anticipation of having to pay, I do not consider this appropriate as Mr Y is on benefits. Given the time taken to carry out the financial assessment and scale of the debt, if Mr Y had put money aside this would have impacted on his benefit payments.
25. In relation to Mr Y’s DRE, he only asked for DRE for his phone, gym membership and physiotherapy. I cannot see evidence in the financial assessment form that he asked for DRE for his utilities. If Mr Y still wishes for his utilities to be included as DRE he should ask the Council and provide evidence of the expenditure.
26. The Council has considered whether it should include his gym membership, physiotherapy and phone charges as DRE and explained its reasons. While Ms X and Mr Y may disagree with its decision, the Council has explained its rational and I am satisfied the decision was taken without fault.

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Agreed Action

27. Within one month of my final decision the Council agreed to carry out the following:
• Apologise to Mr Y for the injustice caused to him from the delays carrying out a financial assessment. 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 in my findings.
• Write off Mr Y’s debt for his care charges so that he only starts paying care contributions from October 2024 (when the Council carried out its financial assessment).
28. The Council should provide us with evidence it has complied with the above actions.

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Decision

I find fault causing injustice. The Council agreed to the above actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman