Summary: There was a delay completing Mr Y’s financial assessment for home care. This was fault causing avoidable distress and a large and unexpected first invoice. To remedy the injustice, the Council will reduce the invoice by £100 and agree an affordable repayment plan with Mr Y.

The complaint

1. Ms X complained for her father Mr Y that Staffordshire County Council (the Council) took too long to complete a financial assessment of Mr Y’s care costs. Mrs X also complained the Council did not take into account her mother’s income in the financial assessment.
2. Mrs X said had Mr Y known the amount he would be charged from the outset, he would not have agreed to the care package.

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The Ombudsman’s role and powers

3. 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)
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 considered:
• The complaint to us
• The Council’s response to the complaint
• Documents in the next section of this statement
6. I discussed the complaint with Mrs X.
7. Ms 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

Relevant law and policy

8. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
9. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)
10. Intermediate care is a structured programme of care provided for a limited time to help a person maintain or regain the ability to live independently. Intermediate care is free for up to six weeks or longer in some cases. Reablement is a type of intermediate care which helps the person regain skills and reduce their needs through providing services in the home. The terms reablement, rehabilitation and intermediate care are often used interchangeably. (Care and Support Statutory Guidance (CSSG) Paragraphs 2.12 to 14)
11. Councils may charge for home care (apart from intermediate care). They must be transparent so people know what they will be charged. There should be enough information available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3)
12. Guidance says only the income of the cared-for person can be taken into account in the financial assessment. A council has no power to assess couples according to their joint resources. Each person must be financially assessed individually. (Care and Support Statutory Guidance para 8.8 and Annex C, paragraph 5)
13. The Council’s charging policy says people will be given an indicative charge based on an indicative financial assessment which gives them early notice of their contribution towards the cost of care. This is so people can understand the financial implications of different types of care before their care and support plan is finalised. The policy has an exception for urgent cases, such as those being discharged from hospital – who do not get an indicative financial assessment.
14. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. The Coronavirus Act 2020 allowed councils to relax some of the duties in the Care Act 2020. These relaxations are called ‘easements’. The Council implemented some Care Act easements in April and May 2020, but these did not apply to charging and financial assessments and so the usual Care Act principles described above applied.

What happened

15. Mr Y received free reablement care for two weeks in March 2020 following a hospital admission.
16. A case note said a social worker discussed Mr Y’s ongoing care with his wife Mrs Y at the start of April and she agreed he would need four calls a day long-term. The social worker noted Mrs Y was unhappy about the backlog of financial assessments. There is no indication the social worker or any council officer made the family aware of how the Council calculated care charges. Another case note by the social worker said they discussed financial details, but no further explanation of what information/advice the social worker gave Mrs Y.
17. An assessment and care and support plan dated April 2020 described the care services the Council was going to fund to meet Mr Y’s care needs. The care and support plan had no personal budget for Mr Y and no information about his charge.
18. The finance team completed a financial assessment in July and calculated Mr Y’s contribution. The team sent Mr Y a letter with a breakdown and explanation of the charge. It also sent a backdated invoice.
19. Mrs X spoke to a finance officer at the end of July saying she was unhappy and had the impression her father would not be charged. The finance officer said she would not have given this impression. Mrs X said her father would not have agreed to so much care in the first place had they known about the charge. The finance officer apologised for the delay completing the financial assessment.
20. Mrs X complained to the Council about the issues she has raised with us. She said:
• She spoke to an officer who told her as Mr and Mrs Y were below the savings threshold, their charge would be low.
• They were shocked about the high charge which was unaffordable for her parents.
• It was unacceptable to backdate the charge to the start of April.
• Her mother was on a reduced pension and so her father’s income also supported her mother and the Council did not take this into account.
21. The Council apologised for the delay in carrying out a financial assessment, which it said was due to a backlog and by the team having to adapt to different ways of working during the COVID-19 pandemic.
22. Unhappy with the Council’s response to the complaint, Mrs X complained to us.

Was there fault and if so did this cause injustice?

23. The Council should have completed a prompt financial assessment and included the charge as part of Mr Y’s personal budget in his care and support plan. The delay was fault as it was not in line with section 26 of the Care Act 2014 and Care and Support Statutory Guidance which says councils need to be transparent so people know what they ‘will be charged.’ The use of the future tense indicates people should know their charge before starting to pay it.
24. I sympathise with the pressures on the finance team during the first lockdown. The Council could have chosen to implement easements in relation to financial assessments, but it did not and so the usual Care Act duties applied. The delay caused distress and a large invoice which would have been avoidable had the Council acted promptly.
25. There was no fault in the Council not taking into account Mrs Y’s income because statutory guidance says councils can only consider the resources of the cared-for person when calculating their charge.

Agreed action

26. The Council has already apologised for the delay. This is a partial remedy. To reflect the avoidable distress of receiving an unexpected large bill, the Council will, within one month of my final decision:
• Reduce the invoice by £100
• Agree an affordable repayment plan with Mr Y.

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Final decision

27. There was a delay completing Mr Y’s financial assessment for home care. This was fault causing avoidable distress and a large and unexpected first invoice. To remedy the injustice, the Council will reduce the invoice by £100 and agree an affordable repayment plan with Mr Y.
28. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman