Summary: There was fault in the way the Council considered Mrs Y's claimed social transport costs, heating and gardening costs as disability-related expenditure. The Council did not provide a clear explanation for refusing these claims and there is no evidence it properly considered Mrs Y's individual circumstances. This caused uncertainty about whether it would have reached a different decision had it done so. There was no fault in the Council's care assessment or support planning for Mrs Y.

The complaint

1. Mr X complains of behalf of his mother, Mrs Y. He says the Council:

• made its assessment of Mrs Y’s care based on its budget restrictions and not on her needs;
• failed to put in place sufficient care provision to meet Mrs Y’s care needs;
• failed to consider Mrs Y’s anxiety when determining her level of care;
• failed to follow guidance on Disability Related Expenses (DRE) and wrongly denied funding for Mrs Y’s DRE expenses.

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The Ombudsman’s role and powers

2. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I have:

• considered the information provided by Mr X, including the Council’s response to his complaint;
• considered information the Council provide in response to enquiries from this office;
• considered relevant legislation;
• offered Mr X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. A council must carry out an assessment of any adult who seems to need care and support. 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 appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). Having identified eligible needs through a needs assessment, the council has a duty to meet those needs. (Care Act 2014, section 18)
6. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. The care and support plan should consider what 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. 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.
7. The Care and Support Statutory Guidance sets out that authorities should conduct a periodic review of the care and support plan. It says ‘The periodic review should be proportionate to the needs to be met, and the process should not contain any surprises for the person concerned. Periodic reviews and reviews in general must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstances.
8. 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.
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. Disability related expenditure is considered as a necessary additional expense to meet needs that are not met by the Council that a person incurs due to disability or condition. Decisions for claims of DRE will be based on a care plan and in consultation with a Social Worker.

Mr X’s complaints

12. Mrs Y is a centenarian and lives in her own home.
13. Mr X complains the Council's care assessment did not properly reflect Mrs Y's care and support needs. He says the assessment was driven by the Council's policies and budget constraints rather than her individual circumstances. Mr X says Mrs Y is frail, has mobility difficulties, a history of falls, hospital admissions, memory problems and anxiety. He considers the level of care funded by the Council to be insufficient to meet her needs and does not take account of her anxiety or fear of being alone. He says this has resulted in the family arranging and funding live-in care.
14. Mr X also complains the Council wrongly refused several DRE claims as part of Mrs Y's financial assessment. He says the expenses claimed were consistent with Government guidance and should have been allowed. Mr X says the Council's decision has increased the financial burden on Mrs Y and her family, as she must meet the cost of these expenses herself. He wants the Council to accept the disputed DRE items and backdate any resulting adjustments to the date of the original claim.

Key facts

15. The Council completed a Care Act assessment of Mrs Y in February 2025. The assessment recorded that Mrs Y had two hospital admissions during the previous year for significant health issues, which had resulted in weakness and short-term memory loss. At the time, Mrs Y was receiving support from a live-in carer.
16. The assessment recorded that Mrs Y was largely independent with personal care and dressing, requiring only occasional minimal assistance from her live-in carer. It noted she received support with meal preparation and that family members assisted with shopping.
17. The assessor concluded that Mrs Y's eligible needs were being met by her live-in carer. The assessment identified that these needs could be met through a care package comprising three daily visits to assist with meals, washing, dressing and, if required, medication management. However, Mrs Y and her family said they preferred a live-in care arrangement as they considered this essential to her sense of security and wellbeing, particularly overnight. The assessment records that Mrs Y described herself as "completely independent" but said she needed someone present in case of an emergency.
18. Mrs Y's family told the assessor they were concerned about her being alone overnight. While they accepted her physical care needs could be met through daily care visits, they said she had a significant emotional need for reassurance and felt safer with someone present. The assessor concluded Mrs Y did not meet the criteria for 24-hour care and explained that the Council is required to meet eligible care and support needs rather than a person's preferred care arrangements.
19. A support plan completed in May 2025 identified the following outcomes: maintaining adequate nutrition, managing personal hygiene, ensuring clothing needs were met, and maintaining a suitable home environment.
20. The Council allocated a direct payment to fund 12.25 hours of support per week to provide assistance with meals, personal care, laundry and domestic tasks. A personal budget of £292.77 per week was allocated. The funds contribute towards the cost of Mrs Y’s live-in-carer.
21. Mr X was dissatisfied with the outcome of the assessment believing it to be dictated by budget restrictions, rather than Mrs Y’s needs and submitted a formal complaint to the Council on 4 June 2025.
22. The Council reviewed Mrs Y’s support plan on 28 July 2025. Care arrangements were deemed stable and the reviewing officer told Mrs Y her needs would be reviewed annually.
23. Mr X remains dissatisfied and says Mrs Y is self-funding her live-in-carer.

Financial assessment & Disability Related Expenditure

24. In March 2025 the Council completed a financial assessment and recorded Mrs Y’s DRE request.

• Private cleaner x 1 weekly at 1.5 hours £14ph
• Gardener x 3 per month £15ph
• Window cleaner, once a quarter £20ph

25. It approved the expense for a private cleaner but refused costs for window cleaning and gardening. It concluded Mrs Y’s maximum weekly assessed charge to be £207.43 per week payable from 6 February 2025.
26. In April 2025 the Council sent Mrs Y a letter explaining its decision.
27. Mr X appealed the Council’s decision not to allow the claimed DRE and provided a detailed breakdown of expenses for consideration. He says during this period Mrs Y’s capital fell below the lower threshold level.
28. On 2 July 2025, the Council issued its complaint response to Mr X Following further correspondence, the Council acknowledged that key information had been omitted from the original complaint response and apologised for the delay in addressing all Mr X’s concerns.
29. The Council subsequently reviewed the financial assessment and wrote to Mr X setting out each of the DRE’s applied for and reasons for its decisions on each item:

• Household cleaning costs were partially accepted as a disability-related expense.
• Gardening costs were only accepted insofar as they related to clearing access pathways; general gardening costs were not considered eligible.
• Window cleaning costs were not accepted on the basis that they were regarded as a general household expense.
• Shopping and delivery costs were not accepted because the assessment recorded that Mrs Y received support from her daughter-in-law with shopping and nutritional needs. The Council also advised that, as Mrs Y receives the mobility component of Personal Independence Payment (PIP), these costs may potentially be met through that benefit.
• Additional heating costs were not accepted because the Council's policy only allows such costs where they are directly linked to medical equipment or a specific care need, neither of which had been identified during the assessment.
• Social transport costs were not accepted because the Council does not reimburse travel costs as a disability-related expense.

30. Separately, the Council’s reviewed the financial assessment after being notified of a drop in Mrs Y’s savings. savings. Following receipts of bank statements, the assessment was amended and backdated to 17 April 2025 when Mrs Y’s savings fell below the threshold. A revised weekly charge of £196.75 was issued.
31. The Council partially upheld this aspect of the complaint because the financial assessment should have been reviewed due to the change in Mrs Y’s savings.
32. Mr X remains dissatisfied with the Council's decision and says all the expenses applied for should be considered as disability-related expenditure.

Analysis

Care assessment & support planning

33. It is not the Ombudsman’s role to decide what level of care Mrs Y should receive. The Ombudsman’s role is to consider whether the Council properly assessed her needs and acted in line with the law.
34. Under the Care Act 2014, councils must carry out a proportionate but thorough assessment of need. This should take account of physical and mental health needs, any risks to wellbeing, fluctuating conditions, and the outcomes the person wants to achieve. Decisions must be based on evidence, and care and support should be kept under review where appropriate.
35. The Council completed a Care Act assessment in February 2025 and considered Mrs Y’s physical health, memory issues, mobility, hospital admissions and current care arrangements. It also recorded the views of Mrs Y and her family, including concerns about her being alone overnight and their preference for live-in care for reassurance and safety.
36. The assessment concluded that Mrs Y’s eligible needs could be met through a package of daily care visits rather than 24-hour live-in care. While Mr X disagrees with this conclusion, disagreement is not, on its own, evidence of fault. In the absence of evidence of fault in the decision-making process, the Ombudsman cannot question the merits (or outcome) of the decision itself. I have not seen evidence that the Council failed to consider relevant information or that it based its decision on budget constraints rather than assessed need.
37. On that basis, I have not found fault in the way the Council assessed Mrs Y’s needs or developed her support plan.

Financial assessment and DRE

38. Councils must consider DRE as part of financial assessments under the Care Act 2014 and associated regulations and guidance. This requires them to consider whether costs arise because of a person’s disability and are reasonably incurred, taking account of individual circumstances.
39. The Council initially failed to address all the DRE items raised by Mr X in its complaint response. It later accepted information had been omitted and apologised for the delay. This was fault because it meant Mr X did not receive a complete response at the time.
40. When the Council did revisit the matter, it set out its position on each item. It accepted some household cleaning costs but refused others, including gardening, window cleaning, shopping and delivery costs, additional heating costs and social transport.
41. There is a concern that, particularly with gardening costs, the Council appeared to have taken a rigid approach by treating these as generally not allowed, without fully looking at whether any part of the cost might be needed because of Mrs Y’s disability.
42. While councils can have policies to help with consistency, they still need to look at each case individually and not rely on fixed rules. This is because they must keep an open mind when making decisions and be prepared to consider whether an exception is needed based on a person’s specific circumstances. If a council treats a policy as something that must always be followed, without properly considering individual facts, this is known as “fettering its discretion”, meaning it has limited its ability to make a fair, case-by-case decision.
43. In this case, the key point is whether the cost is needed because of the person’s disability and is reasonably incurred in their situation. The same applies to the other items. The Council should consider whether each cost is linked to Mrs Y’s disability and whether there is evidence it is reasonably needed, rather than relying mainly on general policy statements.
44. The Council explained it does not currently provide or reimburse travel costs as disability-related expenditure and referred to Mrs Y's receipt of the mobility component of PIP However, the Council did not explain whether it had considered the nature of the claimed costs or Mrs Y's individual circumstances before reaching its decision. In the absence of such reasoning, it is unclear whether it exercised its discretion or instead relied on a blanket policy position. This caused uncertainty about whether it would have reached a different decision.

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Agreed Action

45. Withing four weeks of the final decision, the Council should:

• should reconsider the claim for DRE relating to heating, social transport costs, and gardening costs. In doing so, it should consider Mrs Y’s individual circumstances and provide clear reasons for its decision. The Council should not rely solely on any general policy position during this assessment;
• provide evidence of the above to this office.

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Final Decision

46. There was fault in the way the Council considered Mrs Y's claimed social transport costs, heating and gardening costs as DRE. The Council did not provide a clear explanation for refusing these claims and there is no evidence it properly considered Mrs Y's individual circumstances. This caused uncertainty about whether it would have reached a different decision had it done so. However, there was no fault in the Council's care assessment or support planning for Mrs Y.
47. The above recommendations are a suitable way to settle the complaint.
48. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman