Summary: Mr X complains that the Council charged Mrs Y for her care when she understood it would be free. He says the unexpected bill caused her to cancel her care. The Ombudsman finds the Council was not at fault in this.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on behalf of his mother-in-law, Mrs Y. He complains that the Council charged Mrs Y for her care when she believed it would be free.
2. Mr X says Mrs Y was not expecting the charge and immediately cancelled her care which meant her daughter was responsible for providing care. Mr X says the Council should waive all, or some, of the charges.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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)
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). In this case, Mrs Y gave consent for Mr X to bring her complaint on her behalf.

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How I considered this complaint

6. I considered information from the Complainant and from the Council.
7. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

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What I found

Background

8. Intermediate care and reablement support services are for people after they have left hospital or when they are at risk of having to go into hospital. They are time limited and aim to help a person to preserve or regain the ability to live independently.
9. The Care and Support statutory guidance to the Care Act (2014) says:
• Where a local authority arranges care and support to meet a person’s needs, it may charge the adult, except where it is required to arrange care and support free of charge. The local authority must not charge for certain types of care and support which must be arranged free. This includes reablement, which must be provided free of charge for up to six weeks.
• The ‘upper capital limit’ sets out the point at which a person is entitled to access local authority support to meet their eligible needs and is currently £23,250. Below this level, a person can seek means-tested support from the local authority.
• In some circumstances, a local authority may choose to treat a person as if a financial assessment had been carried out. In order to do so, the local authority must be satisfied on the basis of evidence provided by the person that they can afford, and will continue to be able to afford, any charges due. This is known as a ‘light-touch’ financial assessment.
• When deciding whether to undertake a light-touch financial assessment, a local authority should consider both the level of the charge it proposes to make, as well as the evidence the person can provide. They must also inform the person when a light-touch assessment has taken place and make it clear the person has the right to request a full financial assessment.

What happened

10. In late September 2018, the Council assessed Mrs Y’s needs. She had fallen at home and spent some time in hospital. Mrs Y returned home and a free package of enablement care started the same day.
11. Just over one week later, at the start of October, the Council reviewed the care and agreed for a further week to allow Mrs Y more time to recover. She was not improving as expected.
12. After another week, the Council reviewed the care again, Mrs Y was making slow progress. Council records note the assessor and occupational therapist who visited, discussed that Mrs Y would need to pay or contribute towards the cost of her care. Family advised that Mrs Y had savings over the upper threshold and would therefore need to pay in full. The assessor advised that family could buy care privately or ask the Council to arrange it in which case a charge would be payable from the date she sent the request to the brokerage service. Also, a £185 set up fee and ongoing annual administration fee of £65.
13. Another week later, the Council completed another review. Mrs Y had not improved though she still hoped to regain her independence and reduce the care. Records note the Council advised the care would need to be agreed and sent to brokerage to source an agency to provide ongoing care. Mrs Y advised she wanted the Council to source the care.
14. A week later, the Council visited again and agreed to reinstate an evening call so that Mrs Y was to receive four calls a day. The Council confirmed that the current care would continue until it identified a new provider.
15. Two days later, the Council wrote to Mrs Y. The letter said:
• “To help you understand what the full costs are” the attached table explains how much the full costs are for different types of services.
• “I understand that your Social Care Assessor or Practitioner has already told you that your weekly care charges will start from 24 October 2018”.
• “The first bill you receive from us will show your weekly care charges, payable from this date. We will send this to you as soon as we can, hopefully within the next four weeks. After you have received your first bill, future bills will be sent to you every 4 weeks”.
16. Mr X says Mrs Y did not receive this letter and was shocked when the first bill arrived. The care provider had not changed and therefore Mrs Y assumed the care was still free.
17. The Council acknowledged a breakdown in communication and said it would share the findings of its investigation with staff to promote clear communication. It also said it would consider updating the leaflet about charges to mention that the care provider may not change when the free service ends.

Was there fault which caused injustice?

18. Mrs Y received around four weeks of reablement free. However, it was clear that her independence was not improving. The purpose of reablement is to recover independence. The Council decided it was not having the planned effect on her independence and she would need ongoing care. I found no fault here.
19. The Council sent Mrs Y information about charges it would make from 24 October. Although the letter did not arrive, this was not the Council’s fault, and I am satisfied it had discussed this at the review visits with Mrs Y and her family. I found no fault here.
20. Family advised the Council that Mrs Y had savings above the upper threshold and therefore she would need to pay the full cost of her care once the reablement ended. The Council therefore did not complete a financial assessment. Mr X has not suggested that Mrs Y did not have savings above the threshold. I found no fault here, however, the Council should have made it clear that Mrs Y was entitled to a financial assessment if she wanted one. Should family have any doubt about Mrs Y’s eligibility for funding, they should ask the Council to complete a retrospective financial assessment.
21. Some of the Council’s information could have given a little more detail, but not with regards the essential information which it provided in several ways on several occasions. The Council has acknowledged this and identified some actions but this did not amount to fault.

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Final decision

22. I have completed my investigation and do not uphold Mr X’s complaint that the Council charged Mrs Y for her care when she believed it would be free.

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Investigator's decision on behalf of the Ombudsman