The Ombudsman's final decision:
Summary: The Council delayed completing a financial assessment to confirm how much Mr C should pay towards his adult social care support. This meant when the charge was confirmed, and the Council sent a bill for the services, Mr C was surprised to find he owed over £3000. The Council has apologised for its delay, and confirmed Mr C can pay the arrears in instalments. This is appropriate action in response, and there is nothing further the Ombudsman can add.
- The complainant, who I will call Ms B, says due to the Council’s delay her father (Mr C) has received a bill for over £3000 for adult care services which he cannot afford to pay. Mr C says he did not know he might receive such a bill, and had he known he would not have accepted the services. Mr C, and his wife, are stressed about how they will pay this bill.
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- I considered:
- Information provided by Ms B and the Council.
- The Care Act 2014 and associated statutory guidance.
What I found
- Mr C was receiving rehabilitation in a care home, he then went home with a package of care support.
- 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 Mr C needs care support. The Council must then assess whether the person can pay anything towards that support. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14)
- Everyone whose needs the local authority meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning, with the final amount of the personal budget confirmed through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be an amount enough to meet the person’s care and support needs.
- The Council provided Mr C with an estimated personal budget of £135.38 per week. The Council provided this before the care package started, so Mr C had an indication of how much his care package cost. The Council explained its finance team would book a visit within the next four weeks and will tell you the actual personal budget and what you will have to pay towards it. The Council explained at that point it did not know how much Mr C may have to contribute, this would be confirmed after the financial assessment and any contribution Mr C had to pay would be backdated to the day the care services started.
- There are no timescales set in law or guidance about when the Council must complete the financial assessment. The Council’s policy is for its finance team to contact the person using the service, or their representative, within five working days of receiving the referral. The Council failed to meet this timescale and delayed by over four weeks to make the first contact to arrange the financial assessment. The Council has accepted this fault and apologised to Mr C.
- When the Council has the completed finance forms under its policy it then has ten working days to complete the assessment and send the outcome to the person using the service, or their representative. The Council failed to meet this timescale and delayed sending the outcome of the financial assessment by a week. The Council has accepted this fault and apologised to Mr C.
- Mr C received the outcome of the financial assessment four months after his care package had started. This timescale is partly caused by the time taken for Mr C to return the information for the Council to complete its financial assessment, and partly due to the Council’s delays. The Council told Mr C his total personal budget per week was £135.38 and he must pay the full amount.
- Ms B says this was a shock because people led them to believe the financial assessment would see they had no savings and not much income so they would not have to pay towards Mr C’s care. They had no idea the level of charges they were racking up and were surprised to receive a bill for over £3000. They are worried about how they will pay it, and that they may lose their house.
Was there fault causing injustice?
- I appreciate it is difficult to make a fully informed decision about what care support to receive when you do not know what the costs will be. The requirement of the Council is to provide you with an estimated personal budget and complete a financial assessment to determine the actual personal budget and how much, if anything, you must contribute. The Council has done this.
- The Council clearly told Mr C before his care package started, and during the process, that his contribution would be determined by financial assessment and any charges backdated to the start of the service. The Council told him his estimated personal budget, so he had an idea of what the maximum weekly cost was likely to be. Although Ms B says Mr C was led to believe there would be nothing to pay, I have seen no evidence of that.
- Ms B says Mr C has limited savings and income. However, the Council assessed Mr C could afford to pay up to £325.45 per week, so even with the £135.38 care charges Mr C still has disposable income. The Council has completed the financial assessment in line with law and guidance, so I cannot find fault in what it is asking Mr C to pay.
- There are no timescales in law or guidance regarding when the Council must complete the financial assessment. The Council has its own timescales which it missed, and for which it has apologised, which is appropriate action to acknowledge that fault.
- Ms B has provided the following guidance from the Department of Health “Under the Care Act, local authorities have powers to charge for care and support to cover the costs they incur when contracting for care. The local authority can, therefore levy charges from the date when it starts to incur costs to meet a person’s care and support needs. However, we would usually expect the local authority to work out how much the adult can afford to pay for their care and support before the local authority collects any money from them. An exception to this would be where a person refuses to co-operate with the financial assessment. We would expect a local authority to complete a financial assessment as quickly as possible to avoid people being faced with large and unexpected bills. Where any arrears of charges are due, people should be given a reasonable length of time in which to pay the money and should not be expected to pay it all off in one go.”
- The Council has complied with this. The Council can, and has, charged from the date the care services started. The Council has worked out what Mr C can afford to pay before it has asked for any payment from him. There are arrears of charges due, and the Council has confirmed it does not expect payment in one go and will agree a reasonable repayment plan.
- The issue to consider is whether there has been any unreasonable delay by the Council, and what the impact of that is. The Council accepts its process was delayed, and if not for that Mr C would have had the outcome of the financial assessment sooner. The timescale was also impacted as it took two months for Mr C to return the completed financial assessment forms, before which the Council could not complete the assessment.
- However, that delay does not mean the charges for Mr C’s care support are not rightly due. Mr C has had the benefit of the care support service and knew he may have to pay towards that. The impact is that a larger bill had accrued before Mr C knew how much he would have to pay, and it was a shock for Mr C to receive such a large bill. To acknowledge that the Council should apologise and offer to receive the arrears in instalments. The Council has already done this.
- I have completed my investigation on the basis the Council has already taken sufficient action to acknowledge the injustice caused by its delay. There is nothing further the Ombudsman can add.
Investigator's decision on behalf of the Ombudsman