Summary: Ms X complained on behalf of her mother about the way the Council handled her mother’s social care package when she was discharged home from hospital. The Ombudsman finds the Council was at fault in the way it handled the financial elements of the care. The Council has agreed a payment of £250 to acknowledge distress caused to Ms X’s mother and a payment of £100 to Ms X for her time and trouble sorting out the finances for her mother. The Council has also agreed to review its procedures to prevent invoicing delays in future.

The complaint

1. Ms X complained on behalf of her mother, Ms Y, that the Council failed to properly handle Ms Y’s needs for social care when she was discharged home from hospital. Ms X says the Council:
• delayed allocating a social worker;
• delayed completing a financial assessment;
• failed to take into account all relevant expenditure in the first financial assessment; and
• continued to invoice incorrectly.
2. Ms X says this caused injustice:
• to Ms Y because, although she received the care she needed at home, delays and incorrect assessment and invoicing made her worried about the costs;
• to Ms X because she has spent time and trouble trying to sort everything out.
3. Ms Y died in October 2019.

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The Ombudsman’s role and powers

4. 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)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
6. 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

7. I have considered information from:
• Ms X’s complaint and from telephone conversations with her;
• the Council’s response to my enquiries, including a telephone conversation with a Council officer.
8. I have also considered:
• The Care Act 2014
• The Care and Support Statutory Guidance 2014 (“the Guidance”)
• The Care and Support (Charging and Assessment of Resources) Regulations 2014 (“the Regulations”)
9. I gave Ms X and the Council the opportunity to comment on a draft of this decision. I considered the comments received before making this final decision.

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What I found

Charging for social care

10. Where a council arranges care and support to meet a person's needs at home, the Care Act says it may charge for service provision. Essex County Council makes such charges.
11. Where a council has decided to charge, it must carry out a financial assessment of what the person can afford to pay and, once complete, must give a written record of that assessment to the person. The Regulations set out what councils must take into account in the assessment.

Providing information

12. The Care Act says councils must provide information and advice about care and support for people in its area. The Guidance says councils should make all reasonable efforts to ensure information and advice they give meets an individual’s requirements, is comprehensive and is given at an early stage. It says councils must seek to ensure all relevant information is available to people for them to make the best informed decision in their particular circumstances.

Ms Y’s circumstances before April 2018

13. Ms Y lived at home on her own. She had some physical difficulties and a history of poor mental health. She paid for people to provide gardening, cleaning, hairdressing, food shopping and foot treatment. Ms X did not live nearby but handled Ms Y’s bills. Ms Y had a step daughter who lived nearer and had some involvement with her care.

What happened from April 2018 onwards

April – September 2018

14. In April 2018 Ms Y went into hospital. While in hospital a Council social worker discussed with her what help she would need if she was discharged home. The social worker confirmed Ms Y would initially need care visits four times a day. He said this would be a reablement or short term care package for six weeks and was free. He said the Council would review the package before the six weeks ended.
15. The Council’s records show:
• it originally planned a short term care package for Ms Y at home, to run from mid June to late July 2018;
• it understood Ms Y was discharged home in mid June 2018 as planned but re-admitted a few days later, then discharged again at the beginning of July.
• on 27 July 2018 it noted Ms Y’s care package started again on 3 July and would be in place until 11 August at no cost to Ms Y.
16. Ms X says Ms Y did not go home at all until the beginning of July 2018. She also says the Council told the care agency to start two weeks early while Ms Y was still in hospital.
17. The Council’s case notes show a review of Ms Y’s short term care was arranged for 6 August 2018. The notes say Ms Y’s daughter was to be present. This was not Ms X but may have been Ms Y’s step daughter. I have not seen a record of the review. Later assessments refer to the August review, saying Ms Y had made some progress and she agreed to reduce the visits to three a day. The case notes show the reduced package was to start on 14 August 2018 and carry on until further notice.
18. There is no reference to the August 2018 review covering the need for a financial assessment of whether Ms Y could contribute towards the cost of her care after the six weeks free package ended. The Council accepts the review overlooked this aspect. It says it should have referred Ms Y’s case for a financial assessment at that point but did not.

October – December 2018

19. In early October 2018 Ms Y received the first invoice from the Council for the care she received at home. It invoiced her for full charges of over £200 a week from
    29 July 2018. Ms X says this caused Ms Y great concern and she could not afford such charges.
20. The Council also reviewed Ms Y’s care needs again in early October 2018. A social worker visited Ms Y at home. The record says the care package was working well. The Council says it realised at that point it should not have charged Ms Y from 29 July. After the review Ms Y’s case was referred for a financial assessment to assess how much she should contribute to her care costs.
21. The Council wrote to Ms Y on 11 October to confirm the date at the end of the month when an officer would visit to carry out a financial assessment. The letter said if a financial assessment had not been completed by the time Ms Y started receiving services she would be invoiced for the cost of the services and the invoice would be adjusted once her assessed charge was known.
22. A financial assessor visited Ms Y at the end of October 2018. The outcome of the assessment was Ms Y had to pay £90.96 a week towards the cost of her home care. However the officer did not take into account some expenses Ms Y had because of her disabilities. These are called disability related expenditure.
23. On 1 November 2018 Ms X complained to the Council about the way it had billed Ms Y. She said the Council had not catered for the six weeks of free care agreed. She said the financial assessment should have been carried out much earlier. She said, when the financial assessment was done, it had not taken into account the various expenses Ms Y already paid for services to enable her to keep living independently. She said Ms Y could not afford £90.96 a week and asked for a second financial assessment. Ms Y said the first bill for home care sent in early October had sent Ms Y into a nervous state to the point where she struggled to make conversation. She said the financial assessment result caused Ms Y more distress.
24. At the end of November 2018 the Council sent Ms Y another invoice. It set out
• unpaid full charges from 29 July to 22 September amounting to £1780.68;
• new full charges payable from 23 September to 6 October;
• new charges for 7 October to 20 October at the assessed contribution level of £90.96; and
• the total payable was £2380.08.
25. In early December 2018 Ms X paid the Council £181.92 which she said was for the £90.96 a week assessed contribution for 7 October to 20 October. She told the Council she was paying ‘under protest’ and was still waiting for a response to her complaint. A week later the Council sent Ms Y a letter asking her to contact it about the £2380.80 still due. The Council said the amount was payable in five days.
26. Ms X contacted the Council while she was staying with Ms Y over Christmas. An officer told her the Council was in the process of reviewing Ms Y’s disability related expenditure in response to Ms X’s complaint.

January – May 2019

27. On 3 January 2019 the Council sent Ms Y another invoice. The invoice:
• showed a balance brought forward of £2380.08;
• acknowledged the payment made so far;
• cancelled the charges for 29 July – 11 August 2018;
• set out new charges for her care from 21 October to 17 November 2018 at the assessed contribution level of £90.96 a week; and
• said the total amount owed was £2025.24.
28. Ms X paid the charge for 21 October to 17 November 2018 as a sign of good will and again ‘under protest.’
29. Also in early January 2019 the Council carried out a new financial assessment. The new assessment took into account the cleaning and chiropody Ms Y was paying for. It did not take into account hairdressing, gardening and shopping.
    Ms X and Ms Y decided not to pursue those expenses further. The Council calculated Ms Y’s contribution to be £79.63 a week.
30. On 24 January 2019 the Council sent Ms Y another invoice. The invoice:
• showed a balance brought forward of £2025.24;
• acknowledged the last payment made;
• set out the charge for her care from 18 November to 15 December 2018 at the assessed contribution level of £90.96 a week; and
• said the total amount owed was £1964.10.
31. On 11 February 2019 Ms X paid the Council the charge for 18 November to
    15 December 2018. She said she would not pay for the period 11 August – 7 October 2018 because Ms Y should have had a financial assessment before that so she could decide whether she could afford the care or not. However, Ms X agrees Ms Y needed the care and not having the care was not an option.
32. In February 2019 the Council responded to Ms X’s complaint. It confirmed Ms Y’s care was free for 3 July to 11 August 2019. It confirmed the disability related expenditure approved in the January financial assessment. It said adjustments would be made to the invoices to reflect the increased level of disability related expenditure.
33. From late January to June 2019 the Council did not invoice Ms Y for her care charges. It says this was because the care agency concerned did not invoice the Council for some months and the Council would not invoice the person using the service until it has an invoice from the agency. But it did periodically send invoices for the outstanding balance of £1,763.37. This equated to the full cost of care provided from 12 August to 6 October 2018 and was not based on Ms Y’s calculated contribution to her care costs.

June 2019

34. The Council sent a revised invoice to Ms Y on 13 June 2019. There was no covering letter with it. The invoice corrected Ms Y’s account as follows:
• it replaced the full costs charged from 12 August to 6 October 2018 with weekly contributions of £79.63, as assessed in January 2019;
• it replaced the weekly contributions of £90.96 charged from 7 October to
  15 December 2018 with weekly contributions of £79.63, as assessed in January 2019;
• weekly contributions of £79.63 were now due for 16 December 2018 to
  13 April 2019;
• increased weekly contributions of £89.22 were now due for 14 April to
  4 May 2019; and
• the total amount payable was now £2,258.41.
35. Ms X paid all the charges due except the £637.04 due for 12 August to
    6 October 2018. She accepted Ms Y needed the care and received it during that time. However, she considered Ms Y should not have to pay for care provided before the Council carried out its financial assessment.

The Council’s response to my enquiries

36. In response to my enquiries about the complaint the Council accepted there were a number of shortfalls in its processes. It offered to credit Ms Y’s care account with £250 as a gesture of good will for the inconvenience and upset caused due to the incorrect care charges being applied. The Council has confirmed it is still prepared to do this.

Findings

37. Ms Y received the care she needed when she returned home. The Council was at fault in the way it handled the financial elements of that care. However, as Ms Y received the care, she needed to pay for it.
38. From October 2018 to June 2019 the Council sent Ms Y incorrect invoices which said she owed considerably more for her care than she really did. This was due to the following faults:
• The Council did not have accurate records of when Ms Y went home so it started the charging period too early.
• The Council failed to refer Ms Y for a financial assessment when it reviewed Ms Y’s care in August 2018 and it did not provide her with information about the potential costs of the care package. It had a duty to seek to ensure Ms Y had the information she needed to make informed decisions about paying for her care. The Council carried out the first financial assessment three months after Ms Y returned home. That was an avoidable delay. It meant Ms Y’s first invoice charged her the full cost of her care and the Council had given her no indication of how much that might reduce after a financial assessment.
• The first financial assessment should have taken into account Ms Y’s disability related expenditure but did not, so her assessed contribution started off as too high.
• When the Council applied the outcome of the first financial assessment to
  Ms Y’s care account it should have backdated her assessed contribution to 12 August 2018. The Council only backdated the contribution to
  7 October so Ms Y continued to be charged too much.
• Between January and June 2019 the Council failed to ensure Ms Y was accurately billed in a timely manner for her care charges. It failed to ensure it kept up to date with the ongoing services its contractor, the care agency, provided Ms Y and the charges due for those services. This contributed to the delay sending Ms Y a corrected invoice. The Council told Ms X in February 2019 it would adjust Ms Y’s invoices to reflect her revised assessed contribution. It failed to do so until 13 June 2019, four months later. During those four months Ms Y periodically got incorrect invoices for a continued outstanding amount.
39. The Council correctly billed Ms Y in June 2019, eight months after it sent the first wrong invoice. Between October 2018 and June 2019 Ms Y was caused distress by receiving incorrect invoices that charged her too much. I cannot remedy the distress caused to Ms Y because she has since died. However, as a goodwill gesture the Council offered to pay Ms Y £250 and it is still prepared to make this payment. It is open to the Council to offset this against any outstanding debt owed and I consider that is still an appropriate remedy.
40. Due to the Council’s fault, Ms X spent time and trouble trying to sort out the finances for her mother. The Council should also make a payment to her to acknowledge this.

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Agreed action

41. The Council has agreed:
• within four weeks of this decision it will credit Ms Y’s care account with £250 as it has already agreed to do;
• within four weeks of this decision it will pay Ms X £100 to acknowledge her time and trouble trying to sort out the finances for her mother; and
• within three months of this decision, it will review the way it monitors its contracts with the care agencies it uses to provide social care on its behalf, and amend its procedures to ensure that people receiving social care from those agencies do not experience the type of invoicing delays identified in this investigation.

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Final decision

42. I have now completed my investigation because the Council’s agreed actions will remedy the injustice arising from the faults identified.

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Investigator's decision on behalf of the Ombudsman