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London Borough of Hillingdon (17 008 637)

Category : Adult care services > Charging

Decision : Not upheld

Decision date : 20 Mar 2018

The Ombudsman's final decision:

Summary: Mr and Mrs Y complain the Council failed to tell them they would have to contribute towards the cost of a six-week care package, following Mr Y’s discharge from hospital. I have found no evidence of fault in the way the Council told Mr and Mrs Y about these charges.

The complaint

  1. Mr and Mrs Y complain the Council failed to tell them that they would have to contribute towards the cost of a six-week care package, following Mr Y’s discharge from hospital. They also complain the care agency charged them for visits that did not take place.

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The Ombudsman’s role and powers

  1. 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)
  2. If we are satisfied with a council’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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How I considered this complaint

  1. I considered documents provided by Mrs Y and the Council. I also asked questions of the Council.
  2. Mr and Mrs Y and the Council had the opportunity to comment on a draft of this decision.

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What I found

  1. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14)
  2. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. The scheme must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25%. The Council can take a person’s capital and savings into account subject to certain conditions. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)
  3. Intermediate care services or ‘reablement’ are time limited services to assist a person to regain the ability to live independently after they have left hospital. Regulations say a council must not charge for the first six weeks of reablement services.

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Background

  1. In December 2016 Mr Y was admitted to hospital after having a stroke. He was then transferred to a stroke unit and finally a rehabilitation unit.
  2. Occupational Therapy assessed Mr Y in hospital and decided he was not eligible for reablement support due to his mobility issues and long-term needs.
  3. In April 2017, the Council assigned Mr Y a Social Worker, Officer A. He visited Mr Y at the hospital to discuss his continuing care and finances. This overwhelmed Mr Y and they agreed that Officer A would speak to Mrs Y instead.
  4. Later that day Officer A called Mrs Y on her mobile phone and recalls discussing the Council’s Fairer Charging Policy. He says he told Mrs Y she would need to complete a financial assessment to decide how much their contribution toward Mr Y’s care would be. He states that Mrs Y accepted this and she agreed he would arrange care for Mr Y.
  5. On 2 May 2017, Mr Y was discharged from hospital with a package of care that included visits from two carers four times a day for his first six weeks at home. Mr and Mrs Y were told he would be reassessed during this six-week period to consider his continuing care and support needs.
  6. The Council wrote to Mr Y on 2 May enclosing his care and support plan. The letter stated ‘Your plan also provides details of your personal budget, which is the cost of meeting your eligible needs and outcomes. The amount that you must pay towards these costs is determined by your financial assessment, with the remainder being the amount the local authority must pay”.
  7. On 3 May 2017, the Council sent a financial assessment form and booklet explaining care charges to Mr and Mrs Y. The letter advised that the financial assessment effective date was 8 May 2017. Mrs Y says she received the letter but does not recall receiving the booklet.
  8. Officer A visited Mr Y on 19 May to review his care package. He noted that Mr and Mrs Y were happy with the care Mr Y was receiving. Mrs Y confirmed she had completed the financial assessment and sent in extra information the day before.
  9. On 2 June 2017, the Council carried out the financial assessment and sent Mr and Mrs Y a letter advising them of their weekly financial contribution towards Mr Y’s care with effect from 8 May 2017.
  10. Mrs Y contacted the Council’s finance department after receiving this letter and told them she had given up work. The Council asked her to send in her last payslip and a bank statement from the previous month. Mrs Y also stated that she felt the carers did not stay long enough so she would be reducing care services to two visits a day. The finance officer told Mrs Y to contact Adult Social Care directly.
  11. Mrs Y then spoke to Adult Social Care. She asked to reduce Mr Y’s care package from four visits a day to two. She stated that the carers had not provided four calls a day for the previous two weeks.
  12. The Council queried this with the care agency. It told the Council that carers had been visiting Mr Y four times a day but that, on occasion, Mrs Y had told the carers not to come for the next visit. However, as these were short notice cancellations it would still charge for the visits.
  13. The Council called Mrs Y to explain that they would still be charged for the care visits she had cancelled with less than 24 hours notice. Mrs Y told the Community Care Worker, Officer B, that she had been misled and believed the first six weeks care Mr Y received would be free of charge. As Mrs Y had now left work and was able to care for Mr Y herself she cancelled the package of care for Mr Y from 5 June 2017.
  14. Mr and Mrs Y disputed the charges and complained to the Council. They also complained about charges for dates when carers did not attend.
  15. Mr and Mrs Y were unhappy with the Council’s response and complained to the Ombudsman.

Analysis

  1. The Council says it took a decision not to send finance forms to clients at their home address while they are in hospital, as previously people had complained of feeling ‘harassed’ on their return home. It now tracks hospital cases weekly and sends forms out once patients are discharged, as was the case with Mr Y. I find no fault with this decision.
  2. Mr Y’s Social Worker, Officer A, called Mrs Y before Mr Y was discharged and states that he explained the Council’s Fairer Charging Policy. This is recorded on Mr Y’s care records and I have no reason to doubt this is the case.
  3. The Council sent Mr Y a letter on 2 May 2017 which advised he would be required to contribute to his care cost following a financial assessment. The support plan makes no reference to reablement.
  4. The Council sent Mr and Mrs Y a letter on 3 May 2017 which it states contained a Financial Assessment Form and a booklet on care charges. This booklet is comprehensive and the policy is clear. Mrs Y does not recall receiving this booklet and I cannot now know whether the booklet was sent or not. However, Mrs Y did receive the letter which stated clearly that the effective date for financial contributions was 8 May 2017. The Council was entitled to charge Mr Y for the care he received and is not at fault.
  5. Mrs Y believed Mr Y would receive reablement for the first six weeks after his discharge from hospital. However, there is no evidence the Council told Mrs Y at any time that Mr Y would receive reablement support. Mr Y was not eligible for this type of support due to his mobility issues and long-term care needs.
  6. The care agency has charged for visits Mrs Y says carers did not attend. The care agency will charge for visits if they are cancelled without 24 hours notice. Mrs Y did not cancel the appointments before the 24-hour notice period and so the care agency was entitled to charge for the cancelled visits. The Council is not at fault.

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Final decision

  1. I have closed my investigation. I have found no fault in the way the Council told Mr and Mrs Y about these charges.

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Investigator's decision on behalf of the Ombudsman

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