Summary: The Council has correctly completed financial assessments of what Ms B should pay towards her adult social care support. The reason it concludes Ms B must now pay is because her Disability Related Expenditure has reduced, which means there is surplus income she can put towards her care costs. This can be reviewed if Ms B provides evidence to the Council of her Disability Related Expenditure.

The complaint

1. The complainant, who I will call Ms B, says the Council started charging her a contribution towards her care support, when previously she has not had to pay anything. Ms B says nothing regarding her financial circumstances has changed, so she does not understand why she now must pay. Ms B thinks the Council might be calculating it wrongly and including a benefit she does not receive.
2. Ms B recognises her circumstances are not the norm; with medical help she has weaned off pharmaceutical medication and uses natural products to manage her symptoms. These organic foods and products cost more than the average; she says this is an extra expense she incurs as a direct result of her disability. Ms B says her Doctor has provided a supporting letter, but the Council has asked for more detail. She does not understand why the letter is not sufficient, and it costs her £25 each time she must ask her Doctor to write.
3. Ms B finds it difficult being asked to prove things because of her history; she feels she is not believed. Ms B is finding the situation very stressful, especially receiving monthly invoices with no recognition there is an ongoing dispute. She would like the Council to accept she is an honest person; nothing has changed, and she should not have to pay.

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The Ombudsman’s role and powers

4. 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)
5. 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

6. I considered:
• Information provided by Ms B, including during a telephone conversation.
• Information provided by the Council in response to my enquiries.
• The Care Act 2014 and supporting guidance regarding charging for care services.
• The Department of Health & Social Care local authority circular ‘Social care – charging for care and support’ published January 2019.
7. Ms B 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

8. Councils have a duty under the Care Act to assess those that come to its attention that might need help meeting their care needs. The Council has assessed Ms B needs care support. The Council must then assess whether the person can pay anything towards that support. The Council must review care needs assessments and financial assessments at least every year.
9. The Council will provide a ‘personal budget’ which is the amount Ms B needs to meet her care needs. Instead of directly arranging Ms B’s care support for her, the Council gives her ‘direct payments.’ This means the Council pays her personal budget into a dedicated bank account, and Ms B has choice and control about how to spend it to meet the needs on the support plan the Council has produced.
10. Ms B lives alone. Ms B spends her direct payments to employ a personal assistant to support her in meeting her care support needs.
11. The Council should audit the direct payment account at least once a year, to check the person is only spending the money on meeting the assessed care needs. The person using the service should keep receipts to evidence their spending. If there is a lot of money left in the account, it might indicate the person does not need the full personal budget and trigger a review.
12. In December 2019, the Council completed a financial assessment and decided Ms B could pay £19.48 per week towards her care support. Ms B was surprised, because in all previous financial assessments the Council concluded she did not have to pay.
13. There are rules the Council must follow when completing financial assessments. Ms B’s income is a state pension and a benefit called Disability Living Allowance (DLA). The Council can consider the care part of the DLA but not the mobility part. The Council has done this correctly.
14. If the person has more money coming in than going out, then they may be asked to contribute to their care costs. The Council must ensure it leaves Ms B with the ‘Minimum Income Guarantee’ set by Government. In Ms B’s case this amount is currently £189.00. The Council shows this as a weekly allowance on Ms B’s financial assessment.
15. The Council will look at whether the person must spend money on things because of their disability or illness. For example, someone may spend more money on washing clothes and bedding if they are incontinent. This extra expense as a direct result of disability or illness is called Disability Related Expenditure (DRE). If you pay towards your care, the amount you pay may be reduced to make allowance for DRE.
16. The difference between Ms B’s previous assessment and the most recent ones are the amount the Council has allowed as DRE and it is because of this the Council has assessed Ms B can now contribute to her care costs.
17. Ms B says she faces extra costs because of her illness. Ms B used to take medication that did not agree with her, she now manages her illness through diet and organic products used in the home. Items such as local honey help her allergies, though cost more than mass produced honey and she must buy honey in larger quantity than the average household.
18. The Council has accepted this and allowed certain products as DRE. The Council asks Ms B to provide a Doctor’s letter to support that she needs certain products, and what it is those products do to help her illness. Ms B must pay £25 for the Doctor’s letter, but the Council includes that cost as DRE.
19. The difference between the 2018 and 2019 assessment, is in 2019 the Council no longer allowed the following items as DRE:
• Salt lamp
• Vinegar for cleaning
• Lavender oil
• Bracelet
• Glasses
• Gloves
• Gluten free bread
20. The Council allowed goji berries as DRE in December 2019, which was not listed as DRE the previous year.
21. Because the Council removed the items bullet pointed above from Ms B’s spending, it meant she had more disposable income available which could now be put towards her care costs.
22. The Council explains the salt lamp, bracelet, glasses, and gloves were all one-off purchases and were not repeated in the December 2019 assessment. Ms B provided no evidence of purchasing vinegar for cleaning, lavender oil, or gluten free bread in the December 2019 assessment, so the Council made no allowances for these.
23. The Council has now contacted Ms B about her December 2020 financial assessment. The Council has assessed she can pay £39.49 per week, so her weekly charge has gone up by £20.
24. The reason for the increase is again because of DRE. The Council has only made an allowance for local honey. The Council has seen the evidence of Ms B’s spending on this, and the Doctor’s letter clearly says this is needed for her illness. The Council said in its letter to Ms B it is happy to review this based on evidence with receipts and a Doctor’s note.

Was there fault causing injustice?

25. The Council has correctly completed the financial assessments in accordance with the law and statutory guidance. The reason it has assessed Ms B can now pay towards her care support is because it has included less DRE. So, the assessment shows Ms B has disposable income that she did not have in previous years.
26. Ms B says her circumstances have not changed, her illness, and the products she requires remains the same. Ms B explains she feels she is not believed as she must prove everything and provide receipts. Ms B feels stressed and that people think her disabilities are not real.
27. While this is a very real feeling for Ms B, the Council must ask for evidence of her spending. This is the same as everyone else at financial assessment. It is not a case of not believing those using services, but the Council is accountable to the wider public for the money it spends and must be able to evidence it has spent it correctly.
28. I appreciate it might seem frustrating to those using care services that each year they must prove the same issues, but that is not fault of the Council. It is the process that must be followed to properly account for the spending of public funds. Plus, things can change each year, as can be seen in this case where Ms B had some one-off purchases that were considered one year. If Ms B was assessed as paying at that point, those one-off purchases would have reduced the amount she would contribute that year. Also, medically things can change for people and that might impact on their DRE spending.
29. The Council is right to ask Ms B to evidence her DRE spending in the form of receipts. To highlight and explain why her purchases are DRE. And to ask for the evidence from her Doctor to support why those items are needed as a direct result of her illness or disability.
30. I can find no fault in what the Council has done in this case. If Ms B has further evidence of DRE spending, she should provide it to the Council for consideration. Ms B will also need a note from her Doctor explaining medically why those items are needed. Although Ms B must pay for the Doctor’s letter, the Council allows that cost as DRE.
31. Ms B is finding it stressful to prove the spending on DRE items. Ms B is trying to source support from an advocate but is struggling in the current circumstances. The Council might consider how it can support people to evidence their DRE spending, and whether it is able to signpost people to, or provide, an advocate to help people in this process. It is possible that vulnerable people could be paying more than they should simply because they struggle to prove their spending.
32. Ms B says she has contacted the Council about a repayment plan but had no response. The Council should agree a reasonable repayment plan with Ms B for the money she owes towards her care support.

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Final decision

33. I have completed my investigation on the basis there is no fault by the Council.

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Investigator's decision on behalf of the Ombudsman