Summary: Mr C complained that the Council had failed to tell him he would have to pay for the care he received when he was discharged from hospital. We find the Council told Mr C before the care was arranged, that the care was chargeable but gave him no indication whether he would have to pay for it or how much he would have to pay. This was fault and meant Mr C was unable to make an informed decision about whether to accept the care. The Council has agreed to waive the charges up to the point it notified him in writing how much he had to pay.

The complaint

1. Mr C complains that Essex County Council (the Council) failed to tell him that the care he received after being discharged from hospital was chargeable. He received a bill for £550 two months after the care started which he could not afford to pay.

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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 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

4. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. I have written to Mr C and the Council with my draft decision and considered their comments.

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What I found

Financial assessments

5. The Care Act 2014 states that once a council has assessed a person’s care and support needs it should decide whether the needs are eligible for council support and if so it should then assess a person’s financial resources. These steps should take place before a council creates a personal budget and arranges the services.
6. The guidance states an assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.
7. The guidance goes on to say that a personal budget should specify the amount the service user will have to pay towards the cost of the care, based on the financial assessment. It explains that a personal budget is the mechanism, in conjunction with the care and support plan, that enables the person to exercise greater choice and take control over how their care and support needs are met. It means:

“knowing, before care and support planning begins, an estimate of how much money will be available to meet a person’s assessed needs and, with the final personal budget, having clear information about the total amount of the budget, including the proportion the local authority will pay, and what amount (if any) the person will pay …”

What happened

8. Mr C was due to be discharged from hospital in July 2018. He is elderly with several health conditions and was worried about managing at home on his own.
9. The hospital considered he was not suitable for reablement care (a time-limited, free service to help people regain skills and independence at home after a period in hospital). It referred him to the social care team for an assessment.
10. The case records completed by the social worker say that on 25 July 2018 as part of the care assessment, she explained to Mr C that the proposed care package would be chargeable and the Council would carry out a financial assessment to determine whether, and how much he would pay.
11. This information was repeated on 27 and 31 July 2018. The social worker explained to Mr C that reablement care was not suitable for him and there may be a charge for the longer-term care package.
12. Mr C was discharged from hospital and the care began on 3 August 2018. The Council carried out a review on 7 August 2018 and again advised Mr C that he may have to pay for the care once the Council carried out a financial assessment.
13. On 6 September 2018 the Council booked a financial assessment visit for 17 September 2018. On 18 September 2018 it notified Mr C that he would have to pay £130 per week towards his care.
14. On 18 October 2018 Mr C received an invoice for his care charges. He contacted the Council to say he could not afford to pay, and he thought the care was free. He terminated the care on 19 October 2018.
15. He asked the Council to waive the charges. In January 2019 the Council refused to waive the charges and said they needed to be paid. Mr C paid the bill of around £1400 on 28 January 2019. He said he used money he had saved for his funeral.
16. He complained to the Council in March 2019. The Council replied in May 2019 saying that due process had been followed as he had been advised that the care would be chargeable.
17. Mr C complained to the Ombudsman via a representative in September 2019.

Analysis

18. The Council advised Mr C on several occasions before the care started, that the care package was chargeable and that it would need to carry out a financial assessment. It also explained on several occasions that he was not eligible for reablement care. But the Council only provided this advice orally and did not provide any information as to whether Mr C would have to pay anything and if so, an estimate of how much it might be. Mr C agreed to the care without knowing he would have to pay a significant amount of money for it. This was fault.
19. The Council did not carry out the financial assessment until the care had been in place for over six weeks. This was fault as Mr C was denied the opportunity to choose if he wished to pay that amount for the care over that period. As the Council completed the assessment within a day, I consider it would have been possible to have given Mr C an estimate of his likely contribution at the time he was discharged from hospital to ensure he had full and complete information about his options.
20. It then did not send an invoice to Mr C for another month, so Mr C still did not fully understand how much he had to pay for his care. This was also fault.

Agreed action

21. In recognition of the injustice caused to Mr C, I asked the Council, within one month of my final decision:
• to waive the charges for Mr C’s care for the period from 3 August 2018 until 18 September 2018 when it informed him of the outcome of the financial assessment; and
• to consider changing its procedures to ensure an estimate of care charges is given to service-users before the care is arranged so they are able to make fully informed decisions before the care starts.
22. The Council has agreed to my recommendations. In terms of its procedure it said changes have already taken place with the average assessment being completed within 4-6 weeks, depending on how quickly the service user or their representative completes and returns the form.  A calculator is also available to service users and their representatives to complete on the website which provides an estimate of the charge during the process stage.

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Final decision

23. I consider this is a fair and reasonable way of resolving the complaint and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman