Summary: Mrs X complains about the way the Council dealt with the charges for Mr X’s domiciliary care package resulting in her owing backdated fees causing distress. The Ombudsman has found no evidence of fault in the way the Council considered these matters and has completed his investigation.

The complaint

1. Mrs X complains for her husband Mr X the Council initially provided him with a direct payment for his domiciliary care package in July 2019. The Council stopped the direct payment three months later and asked her to pay for Mr X’s care from July 2019. Mrs X says the Council’s communications about charging were confusing and no one has explained what the figures mean. Further, the Council kept passing her from department to department.
2. Mrs X says the Council’s decision has caused her distress as she is in debt. Mr X cannot afford to pay for four days of support for his needs, so she has reduced it to three. So, Mr X is not receiving the amount of support he needs during the day. Mrs X says the Council should void the charges for fees between July and October 2019.

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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)

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How I considered this complaint

5. I have read the papers submitted by Mrs X and spoken to her about the complaint. I considered the Council’s comments on the complaint and the supporting documents it provided.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Legal and administrative information

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
8. Where the adult has eligible needs, the council should prepare a care and support plan setting out how the person’s needs can be met.

Financial assessment

9. Councils can make charges for care and support services they provide or arrange. They must assess a person’s finances to decide what contribution they should make.
10. Councils should ensure there is sufficient information and advice available to ensure the person needing care or their representative can understand any contributions they are asked to make.

The Council’s information

11. The Council’s web site gives information about care and support needs. It says that the Council can arrange care and support for a person, and it is chargeable from the first day of service. The amount a person must pay towards the care and support depends on several factors. Once the care and support needs have been established the Council draws up a personal budget to identify the amount needed to pay for those needs. The Council will carry out a financial assessment to identify the contribution a person may need to make.
12. The Council issues a leaflet ‘Client Financial Services (CFS) - how much will I have to pay for my social care’. It explains a person may have to contribute towards their care and support needs. This will be backdated to the start of funding for the person’s care and support.
13. The Council issues fact sheets 13 and 14 which contain information about using a pre-paid card and direct payments. It says if a person has eligible care and support needs and choses to use a direct payment the Council will give them a prepaid card to use to pay for their care and support. The Council makes payments to the card account every four weeks in advance. This will be the amount agreed to be paid as a direct payment from the person’s personal budget. If the person needs to contribute to the care, they can set up a direct debt to transfer it onto the care account. The card can only be used to pay for support that has been agreed and details in the support plan.

Key events leading to the complaint

14. Mr X has advanced dementia and Mrs X acts as his carer. Mr X attended a day care centre for four days a week. Mr and Mrs X paid for the cost of the day care centre from financial support Mr X received. In June 2019 Mrs X contacted the Council and told a social worker the costs of attending the day centre had increased and asked for help towards Mr X’s costs.
15. The social worker told Mrs X the Council would not pay for Mr X’s transport costs to the centre as it expected him to use his Attendance Allowance for that. Mrs X accepted this and asked for help towards the day care services. Mrs X said she would not be able to manage without the service.
16. In the notes of the call the social worker discussed:
• the possibility of financial support for Mr X’s assessed eligible needs so he could continue to attend the day centre.
• using a direct payment package of care to give Mr and Mrs X flexibility in using the funds. The social worker said she would complete a support plan for Mr X and request a budget.
17. The social worker told Mrs X there would be a financial assessment and a ‘contribution will apply towards the services ‘. The social worker noted Mr X received Attendance Allowance and used this to purchase day care services and pay for transport. But the funds were now not enough to cover day care costs due to an increase in fees. The notes say Mrs X understood and was happy for the financial assessment.
18. The social worker called Mrs X again to check she had received the information about the direct payment and wanted to go ahead with the budget for the package of care. Mrs X confirmed she received the information and wanted to go ahead. The social worker later confirmed the direct payment for the package was £148 a week to cover Mr X’s attendance at the day centre for four days.
19. The social worker confirmed the care package would start on 1 July 2019 and she would arrange a home visit to complete the direct payment forms.
20. The social worker carried out the home visit on 26 June 2019. The notes of the visit say Mrs X confirmed again receiving the fact sheets and CFS leaflet. The social worker explained setting up a direct payment, confirmed there would be a financial assessment and if any contribution it would be backdated to 1 July 2019. The social worker explained if there was any contribution Mrs X needed to pay it directly into the direct payment account. Mrs X signed the direct payment agreement form and prepaid card agreement as she would be managing the account.
21. Mr X’s care package started on 1 July 2019 and the Council sent Mrs X a prepaid card for the direct payment budget. A social worker contacted Mrs X in August 2019 for an evaluation of the service so far. Mrs X said she was happy with the direct payment and flexibility. The social worker advised she was no longer the assigned social worker and would be transferring Mr X’s case to the review system. The social worker reminded Mrs X there would be a financial assessment and the contribution would apply from the date the care started. Mrs X said she understood and happy for the care to be transferred to the review system.
22. The social worker sent Mrs X a copy of the support plan. This assessed Mr X’s eligible needs and agreed to help to support for social isolation so Mr X could continue to attend the day centre. The support plan refers to the Final Personal Budget and if a financial assessment has been done it will be detailed on the form.
23. On Mr X’s support plan this was left blank. The notes on the support plan say if it is blank then it is likely the financial assessment has not yet been completed and the person would be notified by letter how much the contribution will be once completed. It also says the assessed contribution would be included in the final personal budget from the date the support starts.
24. The Council sent Mr X a letter on 28 August 2019 about needing to do a financial assessment to determine how much he needed to pay towards the costs of the care and support he received. The Council said an officer would visit to complete the assessment and listed the information Mr X needed to have ready.
25. The officer visited on 5 September 2019. The officer wrote to Mr X with the outcome of the financial assessment. This showed Mr X needed to contribute £166.38 a week towards his care and it exceeded the amount of direct payment being provided by the Council. The officer told Mrs X the direct payment agreement would cease and a social worker in contact with her to discuss the options for Mr X going forward. Mr X now needed to fund his care and support services.
26. A social worker contacted Mrs X to explain the financial assessment carried out and Mr X’s contribution to his care and support needs. The social worker said the Council would cancel the direct payment agreement. Mrs X was unhappy with the information. Mrs X said she did not understand and was anxious and worried. The social worker offered to arrange a review so she could explain matters to Mrs X more clearly.
27. Mrs X complained to the Council in October 2019 she received an invoice for £1628 for Mr X’s care and support back to July 2019. Mrs X said they could not afford the bill and Mr X’s mental health would deteriorate if he could no longer go to the day centre. Mrs X complained it had taken the Council three months to tell her she needed to contribute.
28. The Council responded and explained the financial team is alerted to the need to carry out a financial assessment once the service agreement for the direct payment package is put into the system. The Council says it took one month for it to be input in Mr X’s case. The case was allocated to a financial officer, but he was on leave. The officer arranged a home visit at the earliest opportunity. So, the time delay from the start of the care package until the financial assessment was two months.
29. The Council says the financial assessment showed Mr X’s income meant he needed pay for his eligible care and support needs. The Council apologised to Mrs X for the delay in putting Mr X’s case on the internal system and allocating to an adviser, and any inconvenience caused. But Mr and Mrs X were told from the start of discussions on the care package there would be a financial assessment and charge for the service. The Council says it provided Mr and Mrs X with information and leaflets explaining this. The Council told Mr and Mrs X they could repay the invoice in instalments in recognition of the financial concerns they raised.

My assessment

30. The documents provided by the Council clearly show Mr and Mrs X were advised there would be a financial assessment for the services they wanted to use to help Mr X attend the day care centre. Mr and Mrs X were also advised there would be a charge for the services and a likely contribution. Mrs X is documented as saying she understood this. The Council also provided leaflets explaining about a person having to pay for their eligible care and support needs subject to a financial assessment.
31. The support plan sent to Mrs X had a blank section in the personal budget details. The form explained this was likely because the financial assessment had not yet been carried out. So, I do not consider there is any fault by the Council. It gave clear information to Mr and Mrs X about the need for a financial assessment and that there may be a possible charge for the service.
32. The Council accepts it delayed by one month to input Mr X’s case into its system and allocate it to a finance officer. However once allocated to the finance officer the documents show the case was progressed without delay.
33. It is unfortunate there was delay of one month at the start of the process however I do not consider this is significant enough to pursue the matter further. In addition, Mr and Mrs X were advised there would be a financial assessment carried out and it was likely they would need to contribute towards the costs of Mr X’s care and support package. They were also told that if they had to contribute then it would be backdated to the start of the package in July 2019. So, I consider the Council made Mr and Mrs X aware of the possibility of costs and that these may be backdated.
34. The Council acknowledged Mrs X’s concerns about the invoice and being asked to pay a backdated amount and it has offered to allow Mrs X to pay this in instalments. This is suitable action for the Council to take.

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Final decision

35. I am completing my investigation. I have found no evidence of fault by the Council in the way it dealt with the financial charges for Mr X’s domiciliary care package.

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Investigator's decision on behalf of the Ombudsman