Summary: Miss Y complains about the Council’s communication regarding Direct Payments and client contributions. She says her allocated social worker did not provide clear advice, which led to a care provider seeking payment for unpaid invoices. In our view, the Council failed to act promptly once it became aware that Miss Y was not paying her client contributions. This delay allowed the debt on the account to increase. The Council has agreed to apologise and write to Miss Y to confirm the amount and status of any money owed.

The complaint

1. Miss Y complains there was a consistent lack of effective communication from the Council and her previous social worker.
2. In relation to ongoing problems Miss Y had with Direct Payments (DPs), she said the social worker provided inconsistent and contradictory information to different parties. This led to a care agency wrongly demanding payment directly from Miss Y and threatening legal action.
3. When Miss Y’s Personal Assistants (PAs) were unable to work due to a period of sickness, the Council did not respond to urgent emails which placed Miss Y at risk of being left without care.
4. As a result of the breakdown in communication between Miss Y and her allocated social worker at the time, there was a significant overspend on the Direct Payment account which the Council did not identify nor audit at the time.
5. Miss Y says these matters have caused significant emotional distress and deterioration in her physical and mental health.

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The Ombudsman’s role and powers

6. 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)
7. 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)
8. 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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What I have and have not investigated

9. For the reasons explained in paragraph six of this statement, I have limited the scope of my investigation to look back 12 months prior to Miss Y’s approach to us. The start date of our investigation is therefore April 2024. I have not investigated anything which happened before this as I am not persuaded there is good reason to exercise the Ombudsman’s discretion.

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How I considered this complaint

10. I considered evidence provided by Miss Y and the Council as well as relevant law, policy and guidance.
11. Miss Y 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

What happened

12. This section summarises the key events relevant to Miss Y’s complaint and is not intended to set out every action in full.
13. Although this investigation does not cover events prior to April 2024, some earlier incidents are mentioned here to provide relevant context.
14. In March 2016 Miss Y signed an agreement for Direct Payments (DPs). The relevant parts of that agreement said the following.
• If you have had a fairer charging assessment, your contributions will be deducted at source, you are therefore reminded to pay your contribution of £_ into your DP bank account every four weeks in advance, preferably by standing order.
• The service user or their representative agrees to maintain contact with the DP team and to submit a financial return at the end of each quarter of the financial year. Dates for the returns are provided in the financial return calendar which will be supplied.
• The service user or their representative will be expected to ensure that he/she has made provisions for cover in emergency situations or when their Personal Assistant is not able to or not due to attend, such as in the case of annual leave and sickness.
15. Records show that from 2019, Miss Y reported being unable to pay her client contributions. In an email to the Council dated 15 December 2019, she explained that she had received a letter regarding her contributions but was facing financial hardship and the threat of eviction from her home due to rent arrears caused by high living expenses.
16. In March 2022 the Council completed a DP ‘Initial Check Form’ and noted “Client has accrued a large debt of almost £12k – current package does not cover the cost as 120 hours are at £12.92ph – client is using a mix of [care providers names removed], both spot providers”.
17. Following the issues around the client contributions, the Council sent a financial assessment form on 6 November 2023 to reassess Miss Y’s circumstances. The records show that Miss Y did not complete and return the form.
18. The Council sent a further financial assessment form to Miss Y on 24 April 2024 following a change to her DP hours. There is no evidence to show Miss Y completed and returned the form.
19. An internal case note dated 30 August 2024 records a DP officer saying: “… since the DP started [Miss Y] has never paid for her client contributions”. A further note made three days later states: “[Miss Y] has never paid for her contributions or completed a financial form”.
20. The following month, the Council noted an “overspend” on Miss Y’s DP account and an agreement to notify the payroll company used by Miss Y to disallow any further overpayments.
21. On 24 January 2025 the payroll company emailed the Council to notify it of an overspend on Miss Y’s account and £1675.35 arrears. A further case note recorded by the Council explained: “[Miss Y] explained that over the Christmas period, two of her PAs were off sick for 2-3 weeks. To cover this period, her carers arranged for [other agency name] to step on. She stated that [payroll company] informed her that [carer name] had been paid, but she would need to pay her PAs herself as there is no money in her account”.

“She also clarified that the PA’s were not paid for their time off due to sickness. I informed [Miss Y] that she should have notified us when her PAs were off sick and [carer name] was providing cover”

22. On 3 February 2025 Miss Y’s father emailed the Council to ask for ‘urgent support’ following Miss Y’s care agency looking to cancel the care package due to non-payment. Miss Y’s social worker emailed Miss Y to arrange a home visit to discuss the issues relating to her DP account and the reported overspends.
23. Miss Y responded the next day, explaining that due to her health issues, she was unable to have a home visit and requested that any meetings take place virtually. In response, the social worker stated that a home visit was needed, in their opinion, to properly evaluate the difficulties Miss Y was experiencing.
24. Miss Y’s father emailed the social worker again in February 2025 to reiterate concerns about Miss Y’s carers not receiving payment due to a lack of funds in the account.
25. On 6 March 2025 the Council received an email from a care agency to say they had provided ‘cover’ for Miss Y throughout January and February due to her usual carers being absent from work due to sickness. The replacement agency expressed concern that its staff had not been paid for all hours delivered.
26. The Council agreed to commission the agency to take over the care package temporarily and during the period of sickness. This meant the Council paid the agency directly, instead of to Miss Y as a DP. On 7 March 2025 the Council emailed Miss Y to inform her of the change.
27. The Council emailed Miss Y on 28 March 2025 to reiterate that her client contributions needed to be paid. Miss Y responded to say she had not received any financial assessment forms since 2014. She asked for another to be sent, and extra time allowed for completion due to her disabilities.
28. The Council noted on 23 April 2025 that, “there are minuses of £16,229.98” on Miss Y’s DP account. The Council arranged a meeting the following day to discuss the issues with Miss Y’s DP account. The records show the following points of discussion.
• The Council informed Miss Y that her DPs will be terminated due to non-payment of client contributions and the impact on her health.
• Miss Y said she has been too unwell to complete the financial assessment forms and needs more time.
• The Council advised Miss Y to provide her PAs with four weeks’ notice to terminate their employment.
• The Council reminded Miss Y to complete and return the financial assessment form.
• Miss Y to cross-check disputed timesheets from the agency and her PAs.
29. The Council completed a financial assessment on 29 April 2025. This confirmed the following:
• Total income from benefits: £509.30
• Total savings: £3538.69
• Disregards: £121.56. This includes £40 in Disability Related Expenditure (DRE), £5.81 Council Tax and Personal Independence Payments (PIP) mobility element £75.75
• Net income - £387.74
• Minimum Income Guarantee (MIG): £192.35
• Chargeable income - £195.39
• Max charge - £195.39
30. Miss Y quickly contacted the Council to say she had received the outcome of the financial assessment and expressed that she could not afford to pay her assessed client contribution.
31. The Council ended Miss Y’s DPs on 22 May 2025, moved her to a commissioned service and allocated a different social worker.
32. On 5 June 2025 the payroll company emailed the Council to provide a summary of outstanding payments. It said that Miss Y’s account balance was £2215.33 but just over £5000 was due to the PAs and care agency.
33. On 7 July 2025 the Council noted a “one off” payment provisioned for £2953.28 to cover the “outstanding care delivery payments prior to 23 May 2025”.
34. In response to our enquiries, the Council said the relevant team: “…worked hard to support [Miss Y] to make sure that she is safeguarded and that was why they continued to make all the one-off payments which top over £100,000 over a couple of years to ensure that [Miss Y] was not exposed and they continued to do this until they were able to assess [Miss Y’s] care”.
35. In response to our question about the debt on Miss Y’s account, the Council said: “Adult Social care had continued to cover the shortfall until they were able to reassess and make alternative arrangements to enable direct payments to be ended”.

Was there fault causing injustice by the Council?

36. Part of Miss Y’s complaint concerns poor communication from her allocated social worker during 2024 and early 2025. I have reviewed the available records to assess whether the social worker provided misleading or inconsistent information. I found no evidence of this. On the contrary, once the social worker became aware of issues relating to sick pay and non-payment of wages, as reported by the payroll provider and Miss Y’s father, they acted promptly to arrange a meeting with Miss Y to try and resolve the problems.
37. Part of the complaint also relates to the Council’s failure to support Miss Y when she was unable to pay her contributions. The Council operates a net model for personal contributions, under which the service user’s assessed contribution is deducted at source and must then be paid by them into the DP account. In Miss Y’s case, these payments were not made, as she stated she was unable to meet the contributions due to financial hardship. The records dating back to 2019 show that Miss Y was aware of a requirement to contribute to her care costs.
38. In my view, the overspends on Miss Y’s DP account were not caused by Council fault. Miss Y was the employer of her PAs and was responsible for contingency planning in emergency situations. Miss Y’s contract makes clear that she was expected to contact the Council in the event of employee sickness so that interim arrangements could be agreed, arranged, and funded. There is no evidence that Miss Y or her representatives contacted the Council at the time of the sick leave. Contact occurred only after the overspend had already arisen. The records show the Council agreed a one-off payment in July 2025, which is broadly equivalent to the debt identified by the payroll company between January and May 2025. This suggests that this part of Miss Y’s complaint has already been remedied.
39. With that said, the records show that the Council had been aware for many years that Miss Y was struggling to manage her DPs due to an inability to pay her client contributions. The DP contract requires the Council to carry out quarterly audits to identify and address issues with DP accounts. While the allocated social worker responded appropriately to the concerns raised about sick pay in early 2025, the records show a longstanding failure to address issues with Miss Y’s account. Allowing the situation to continue is fault by the Council.
40. Under Section 27 of the Care Act 2014, the Council is required to keep care and support plans under review and revise them where appropriate. This includes circumstances where:
• The DP arrangement is no longer working as intended.
• The person is unable to meet their assessed contribution.
• The care package is becoming financially unsustainable.
41. Where a service user’s circumstances change significantly, the Council has a duty to review the care and support plan and the financial assessment. Factors such as an ongoing inability to pay the assessed contribution or a growing overspend on a DP account likely demonstrate the existing arrangements are not sustainable. In such circumstances, the Council should reassess the person’s financial situation and consider whether the DP arrangement remains appropriate.
42. I have considered the injustice arising from this fault. I am mindful that Miss Y has at times struggled to engage with the Council and to complete financial assessment forms. However, there is no evidence that the Council considered or offered alternative ways to support Miss Y with those difficulties, despite its knowledge of her disabilities and need for high-level support.
43. In addition, the Council has not confirmed whether any debt remains outstanding. Its response to our enquiry on this point is unclear and refers broadly to approximately £100,000 in payments made. To remedy the confusion caused, we recommend that the Council writes to Miss Y to clearly set out any arrears and its intentions in relation to them.
44. If the Council decides that Miss Y is required to repay any overspent DPs, it must ensure that the recent decision to increase the agreed disability-related expenditure (DRE) is appropriately backdated.

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Action

45. Within four weeks of our final decision, the Council has agreed to:
• Apologise to Miss Y for the fault we have found with allowing the problems to drift without reviewing Miss Y’s case and considering ways to support her with the completion of forms and assessments.
• Write to Miss Y to confirm whether any debt is outstanding. If so, the Council should specify the amount, provide a breakdown and explain how a repayment plan can be arranged. Miss Y may wish to raise a further complaint if she is dissatisfied with the Council’s decision.
46. The Council will provide us with evidence it has complied with the above actions.

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Decision

47. I find fault causing injustice. The Council will complete the above actions to remedy the injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman