Summary: Mrs Y complained about the way the Council managed her husband’s contributions towards his care. We find no fault with the Council’s reviews of his contributions, or its decision not to issue a direct payment card. However, we do find fault in the Council’s flawed decision-making regarding disability related expenditure costs, its failure to explain all financial assessment letters it sent and its complaint handling. The Council has agreed to apologise and make a payment to Mrs Y.

The complaint

1. Mrs Y complained about the way the Council dealt with her husband, Mr X’s contributions towards his care. She says the Council:
1. reviewed the amount Mr X must contribute towards the cost of his care without carrying out a formal reassessment involving her and Mr X;
2. sent conflicting financial contribution letters that did not clearly explain the reasons for changes to Mr X’s assessed contribution;
3. delayed providing a direct payment card needed to pay for a day centre; and
4. failed to approve Mr X’s disability-related expenditure despite receiving evidence.
2. Mrs Y says these failings meant Mr X missed out on vital day centre support, while further delays in communication held up his access to services and care. She also says the Council’s actions caused her significant distress, uncertainty, and financial strain.

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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(1), as amended)

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How I considered this complaint

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

Assessment

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Care plan

8. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Charging for social care services

9. 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)

Financial assessments

10. 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. Councils have no power to assess couples according to their joint financial resources. 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.

Disability Related Expenditure

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.

Direct payments

12. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

Council complaint procedure

13. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman. (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

What happened

14. In January 2024, the Council completed a care and support assessment for Mr X. It found he was eligible for support at home and to attend a day centre (Centre A).
15. In June 2024, the Council carried out a financial assessment by telephone, with Mrs Y taking part. It calculated Mr X’s contribution towards his care costs. During the call, Mrs Y told the Council that Mr X had also been attending another day centre (Centre B) since March 2024. The Council asked her to provide evidence of Centre B’s costs and said it would temporarily include part of the cost as a disability-related expenditure (DRE) until that evidence was received.
16. Shortly afterwards, the Council sent two financial assessment letters to Mrs Y, one covering the period up to April 2024, and another for April 2024 to April 2025. These letters explained that Mr X’s contributions would be reviewed annually, or sooner if his financial circumstances or care arrangements changed.
17. In July, Mrs Y sent evidence of Centre B’s costs and asked the Council to include the full amount as a DRE.
18. In August, the Council reviewed Mr X’s care and support plan. It approved a change of day centre from Centre A to Centre B and agreed to fund Centre B through a direct payment, as it is not a Council-commissioned service. The Council explained to Mrs X that because Mr X’s assessed contribution was higher than the direct payment amount for Centre B, he would not receive the direct payment in the usual way (for example, into a separate account or via a direct payment card). Instead, the direct payment amount would be deducted from the invoices for his care and support. As a result, he would continue to pay for his activities privately.
19. Later that month, the Council decided not to include Centre B’s full costs as DRE, believing they related to transporting him to the centre, and issued a revised financial assessment to reflect this.
20. Mrs Y asked for this decision to be reviewed. In October, the Council upheld its position and removed the temporary DRE for Centre B, noting these costs were now covered by the direct payment. A further revised financial assessment letter was issued.
21. Around the same time, Mrs Y complained to the Council. She said she had received numerous financial letters with conflicting and confusing information that had not been clearly explained to her, and the DRE costs had been wrongly refused. The Council acknowledged her complaint and said a full response would follow.
22. In November, the Council issued its complaint response. It explained the additional financial letters were the result of revisions made following adjustments to Mr X’s benefits and care package. The Council also stated that the DRE for Centre B had not been increased because his transport costs were expected to be covered by his Attendance Allowance benefit. It added that the temporary DRE should have been removed in August, when the cost of attending Centre B began to be funded through a direct payment.
23. In December, Mrs Y escalated her complaint. She said the Council should not have changed Mr X’s care package before a formal review and that his contribution should not have changed until April 2025. She also said the Council had failed to allow the full cost of Centre B as a DRE despite sending the evidence required.
24. The Council later reviewed the previous DRE evidence and agreed to allow the full cost of Centre B as DRE for the period from March to August 2024, before the direct payment began. It then reviewed all financial assessments and issued five revised assessments covering February 2024 to April 2025. This adjustment reduced Mr X’s assessed contribution and showed that, for some periods, he had paid more towards his care than he should have. The Council resolved this by applying a credit to his account. It then wrote to Mrs X to explain when and why the changes to Mr X’s care had occurred and provided detailed explanations of the revised financial assessments and the credit applied.
25. In early 2025, Mrs Y provided details of new day centre services for Mr X. The Council reviewed these and, in February 2025, provisionally agreed to increase his direct payment to cover the new costs, confirming that these could not also be claimed as DRE.
26. In April 2025, Mrs Y brought her complaint to the Ombudsman.
27. In response to my enquiries, the Council acknowledged that sending multiple financial assessment letters had caused confusion. It offered Mrs Y £250 to recognise the time and trouble involved and said it is working with its system providers to reduce the number of letters sent in the future.
28. The Council has also acknowledged that it failed to escalate Mrs Y’s complaint to stage two of its complaint’s procedure.

My findings

Review of Mr X’s contributions without a formal reassessment

29. The Council carried out a financial assessment for Mr X in June 2024, with Mrs Y taking part by telephone. This was appropriate and met the requirements for a supported assessment. The Council later completed several financial reviews because:
• Mrs Y asked for certain costs to be treated as DRE; and
• Mr X’s care package changed in August 2024, when he stopped attending Centre A and began receiving a direct payment to attend Centre B.
30. These were financial reviews rather than full reassessments. It is standard practice for councils to review financial assessments when care arrangements or income change.
31. Although Mrs Y says she was not directly involved in the later reviews, the Council was entitled to base them on the information already held. Each time it issued an updated assessment, it invited Mrs Y to check the figures and raise any concerns. I therefore find no fault in how the Council reviewed Mr X’s financial contributions.

Confusing and conflicting financial contribution letters

32. In June 2024, the Council sent two financial assessment letters, one covering the period up to April 2024 and another for April 2024 to April 2025. Further letters were then issued when DRE requests, care changes and direct payments were introduced.
33. In October 2024, the Council removed the temporary DRE for Centre B after introducing a direct payment to fund those costs. However, its letter did not clearly explain that change. That omission was fault and understandably caused Mrs Y confusion.
34. In December 2024, the Council agreed to backdate the DRE for Centre B and issued five revised financial assessments with a clear explanation of all the changes between February 2024 and April 2025. This resolved the matter, but by then Mrs Y had spent time and effort trying to understand the earlier correspondence.
35. The Council has recognised that sending multiple letters can be confusing and is working with its system providers to reduce this. I consider this an appropriate step to improve the matter.

Disability-related expenditure (DRE) decision

36. In June 2024, Mrs Y asked the Council to include the full cost of Centre B as a DRE. The Council initially agreed part of the cost temporarily but later refused to include it in full, believing it related to transport.
37. In December 2024, after further clarification, the Council accepted that the cost was for the day centre service itself and agreed to include the full amount as DRE for the period March to August 2024. After which the cost was covered as a direct payment.
38. The Council’s decisions in August and October were flawed as it misunderstood the request made by Mrs X. This was fault. However, the Council has corrected the records, credited Mr X’s account, and apologised. This appropriately remedies the financial impact. However, the delay also caused Mrs Y avoidable frustration and time and trouble pursuing the matter.

Direct payment card for day centre attendance

39. When Mr X’s care plan was reviewed in August 2024, the Council agreed to fund Centre B through a direct payment. As the direct payment amount was deducted from Mr X’s assessed contribution, no separate payment card was required.
40. This arrangement allowed Mr X to continue attending the day centre without interruption. While the process was confusing for Mrs Y, there is no evidence of fault in how the Council arranged or explained the direct payment.

Complaint handling

41. Mrs Y made her formal complaint in October 2024. The Council acknowledged it and issued its stage one response in late November, within the stated timescale. It reviewed the case again in December 2024 to address outstanding concerns about DRE and financial assessments. However, it did not escalate the complaint or provide a stage two response in line with its complaint’s procedure.
42. Although the Council’s responses were generally timely, and it took steps to clarify and correct matters, its failure to follow its own complains procedure was fault. I have concluded, however, that this did not cause Mrs Y a significant injustice, as the Council continued to respond to her concerns and had already informed her of how to escalate her complaint to us.

Conclusion

43. Having reviewed all the evidence for this case, I am satisfied that the Council has corrected the DRE decision and updated all relevant financial assessments. The Council was entitled to review Mr X’s contributions when his care or income changed and made evidenced decisions, but it did not always explain them clearly to Mrs Y. Delays and some poor communication caused Mrs Y avoidable effort and confusion.
44. The Council has since offered £250 to recognise this and is working to reduce the number of financial assessment letters it sends. I have considered whether this remedy is in line with the expectations set out in our Guidance on Remedies. In my view, the amount offered is suitable, so I make no further recommendations.

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Action

45. To remedy the injustice caused by the above faults, within four weeks of the date of my final decision, the Council has agreed to:
• apologise to Mrs Y for the confusion and time and trouble caused by the Council’s faults; and
• pay Mrs Y its proposed remedy of £250.
46. I have not recommended any further action for the Council to improve its complaint handling. This is because, in May 2025, the Council launched a new Adult Care Services Complaints Team to improve the administration and oversight of adult care complaints, with an increased focus on learning from complaints to improve practice.
47. The Council should provide us with evidence it has complied with the above actions.

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Decision

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

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Investigator's decision on behalf of the Ombudsman