Summary: Mr X complains about the way the Council charged Mr Y and the lack of explanation it provided about a significant increase in Mr Y’s contribution to his care costs. He says this put Mr Y in significant debt and caused him significant undue anxiety. We found the Council at fault and it agreed to apologise and waive all the accrued debt owed by Mr Y. It also agreed to take action to ensure similar problems do not arise in future.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on behalf of Mr Y, that the Council:
• did not adequately explain the charging process to Mr Y.
• did not provide an explanation for an increase of over 100% when asked.
• did not provide bank details so Mr Y could pay his contribution.
• gave no explanation of what charges it waived or wrote off so Mr Y was unclear what was due.
2. Mr Y says this has affected his ability to manage his money and left him in debt. He wants to know how his contribution is calculated and why it changed so much. He would also like the Council to waive all contributions until he gets this information, to provide the bank details and be clear about the date from which the contribution will apply.

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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). Mr Y has given his consent for Ms X to bring this complaint on his 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 decisions for comment and took account of the comments I received in response.

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What I found

Background

8. Councils have discretion to charge for non-residential services. Where a council decides to charge it must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations and have regard to the Care and Support Statutory Guidance (CSSG). 
9. Where a council has decided to charge, it must carry out a financial assessment of what a person can afford to pay. The council must not charge more than the cost it incurs in meeting the assessed needs of the individual. It must also regularly reassess a person’s ability to meet the cost of their care to take account of any changes in their resources. 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.

What happened

10. Mr Y has learning difficulties and had previously been looked after by the Council’s children’s services. The Council considers Mr Y to have the mental capacity to decide about his care.
11. In 2015, the Council wrote to Mr Y’s key worker (from the care provider) to advise that Mr Y would have to pay up to £38.22 towards his care costs.
12. On 19 April 2018, the Council says it wrote to Mr Y asking for financial information by 9 May, so it could review his contribution to his care costs. It included a leaflet “Getting Ready for your Finance and Benefits (FAB) Assessment” which explains about the assessment. This was because it had made changes to the way it completed financial assessments following the introduction of the Care Act 2014. The Council says it wrote again on 22 May and 18 July as it had not received the information it had requested. It also sent Mr Y invoices for his contribution which amounted to several thousand pounds. The invoices included the information he needed to make payments on the reverse. Mr Y threw these away.
13. Mr Y completed the forms with help from his key worker. The Council wrote to him on 23 July advising that his contribution would be up to a maximum of £80.30 per week from 14 August. It enclosed details of how it had calculated this amount and a leaflet “What to do if you are concerned about your assessed contribution”.
14. In November, Council records note a problem with Mr Y’s contribution. It noted “I am unsure if [Mr Y] understands he needs to pay the client contribution, also I don’t believe the agency have claimed this money”. At this point, Mr Y did not have an allocated social worker.
15. In February 2019, the Council found Mr Y had not paid his contribution since 2017. This was because the Council expected the care agencies concerned to collect the contribution, but they did not. This meant Mr Y was in debt by £1,915.73 up to 14 August 2018. It also suggests no one had explained about the charges to Mr Y.
16. In April 2019, Mr Y’s care provider arranged for an advocate (Mr X) to work with Mr Y to find out what was happening. Mr Y was receiving bills and letters from the Council that he did not understand. Mr X noted that Mr Y did not have the ability to understand and control his finances. He also sent an email to the finance team “after four attempts to call”, asking for details of the money owing. At the end of the month, the Council allocated a social worker to work with Mr Y.
17. In May, the Council telephoned Mr Y to arrange a visit to discuss his support and the contribution issues. During the telephone conversation, Mr Y advised the Council he did not believe he should pay a contribution for his care. The Council noted that Mr Y felt if he could be a bit more independent, he could manage without support anyway. The Council visited as planned and Mr Y’s support worker and advocate (Mr X) were present. They agreed to reduce Mr Y’s support from 6 hours a day to 3 hours a day. The social worker explained to Mr Y that all people over 18 pay a contribution to their care package and a financial assessment assesses how much. They discussed the outstanding debt and the Council agreed to review its position on this and to complete a fresh assessment of Mr Y’s care needs.
18. A week later, the social worker met again with Mr Y, Mr X, and another of Mr Y’s support workers to discuss Mr Y’s contribution. The Council told Mr Y it would set up a payment plan and advised him to make a minimum payment of £50 per month, preferably £100. Mr X’s notes show that Mr Y said he did not want care and did not want to pay for it. He agreed to 15 hours a week to be reviewed in 6 months. The social worker noted that Mr Y and Mr X had asked to have a meeting with someone in finance to explain the situation and she would look into this.
19. In June, the Council sent invoices to Mr X. He noticed that Mr Y’s contribution had increased from £38.33 per week to £80 per week and emailed the social worker asking for details of how this was calculated. The social worker responded saying the contribution was calculated on Mr Y’s income at the time of the assessment. Mr X replied and asked if that meant Mr Y’s income had doubled. He thanked her for still trying to set up the meeting with the finance team. He asked if it would help if he complained to the Council that the finance team were taking so long. The social worker replied saying she understood the finance department was “going through some changes” and she was “still trying to contact the manager”.
20. On 2 July, the Council telephoned Mr Y. He advised that he no longer wanted support and felt he could cope on his own as care staff did not always attend anyway. Mr Y said he still felt he should not have to pay for his support as he did not know he would have to and had not wanted support anyway. The Council said it would look into the carers not visiting and agreed to review the original assessment to see what was agreed. Mr X emailed the Care Provider saying he was still trying to arrange a meeting with the finance team to discuss the bills that [Mr Y] had received.
21. A week later, another social worker telephoned Mr Y and he said he wanted to cancel the care as he could manage without and he never wanted care in the first place. The social worker told him that as he had received the care and not cancelled, he was expected to pay. The following week, the support worker told Mr X the Council was still not collecting Mr Y’s contribution so his debt was still increasing by £80 per week.
22. On 15 July 2019, as the social worker had not made any progress with arranging a meeting with finance, Mr X complained to the Council on Mr Y’s behalf. He said Mr Y had not had a social worker for a long time in 2018/2019 and the contribution was never explained to him. Mr X said he tried to speak to someone at the Council about this for ten months without success. Mr Y now owed several thousand pounds and he had not been told why his weekly contribution had increased by over 100% despite requests.
23. In late August, the social worker telephoned Mr Y again. He said the carers had improved and he agreed to meet with her, and Mr X, in September.
24. The social worker visited as planned. Mr Y had been declining support and said he would not pay £80 per week for care. When she advised his care would have to stop if he did not pay for it, he said that would be fine as he wanted to be independent. The Care Provider expressed concerns that he still needed support. The social worker agreed to explore reducing his support but Mr Y left the meeting and so it did not reach a decision. Mr X noted that the social worker had still not heard from finance so he did not know what charges the Council would waive.
25. The social worker spoke to Mr X and said it needed to explore Mr Y’s support options. Mr X said he would speak to Mr Y about this. He explained that Mr Y was confused, anxious and frustrated about the current situation. He said this was due to limited information about starting to pay a contribution and how much the Council would waive. The social worker agreed to clarify this for Mr X and Mr Y.
26. The Council responded to Mr Y’s complaint and agreed there was not a full explanation or confirmation that Mr Y was given clear guidance or advice about paying the contribution. It confirmed that his complaint had been upheld and Mr Y’s contribution waived “between the dates agreed”. The Council said it did not receive any request for a review of the financial assessment.
27. On 6 September, the social worker telephoned someone in finance to set up arrangements for Mr Y to pay his contribution in future. They agreed an invoice would be sent including details of how to pay. With help from Mr X or his support worker, Mr Y could set up a standing order to pay this weekly.
28. On the same day, due to the unsatisfactory response from the Council, he complained to us. Mr X noted the main issue was that the Council had not confirmed what charges it had waived. It had also not explained how it would calculate future charges, and he said Mr Y had no means of paying future contributions.
29. On 18 September, the social worker confirmed the Council would waive Mr Y’s contribution to August 2018. It said this was because the Council had discussed the need for a contribution with Mr Y and his key worker then.
30. Mr Y advised his support workers that he did not want to pay a contribution in the future and did not want support anyway. He declined all options suggested. Mr Y’s support worker said she thought Mr Y still needed support. The Council decided to complete a new assessment of Mr Y’s needs and offer him 10 hours a week. Mr X remained insistent about not wanting support in a meeting with the social worker at the end of October. In November, the Council ended his support.
31. In the Council’s response to my further enquiries following my revised draft decision, it said the Council had waived Mr Y’s unpaid contribution from August 2018 to 20 November 2019.

Was there fault which caused injustice?

32. The Council was at fault in not dealing with the non-payment of Mr Y’s contributions sooner and ensuring Mr Y understood about this. It should have waived the outstanding payments sooner so Mr Y and Mr X could be clear about his situation. However, it has now waived all the unpaid contributions, so this has remedied the financial injustice it caused here.
33. Having noted that he may not understand, the Council did not take enough action to help Mr Y understand. There was no evidence the Council explained to Mr Y, or Mr X, why his contribution increased from £38 to £80 a week. Mr X asked for help from the finance team many times, without success. This was fault and caused Mr Y significant anxiety and put him at greater risk of declining support he had been assessed as needing. I have decided that concern about the debt he owed, and his lack of understanding around why he was being charged, increased Mr Y’s reluctance to pay and accept support.

Agreed action

34. To remedy the injustice identified above, I recommended the Council:
1. Apologise to Mr Y and Mr X in writing setting out the faults identified above and the action the Council has taken to put this right.
2. Waive all outstanding fees from August 2018. The Council has already completed this.
3. Ensure people are properly supported to understand charging issues, promptly.
• Complete actions a) and c), within two months of the final decisions and provide evidence to the Ombudsman. Suitable evidence would include an action plan showing progress.

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Final decision

35. I have completed my investigation and uphold Mr X’s complaint that the Council:
• did not adequately explain the charging process to Mr Y.
• did not provide an explanation for an increase of over 100% when asked.
• gave no explanation of what charges it waived or wrote off so Mr Y was unclear what was due.
36. I do not uphold Mr X’s complaint that the Council did not provide bank details so Mr Y could pay his contribution.
37. I am satisfied the action the Council has agreed to take is sufficient to remedy the injustice it caused to Mr Y and Mr X.

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Investigator's decision on behalf of the Ombudsman