Summary: Mr X complained the Council failed to accurately charge Mrs Y for her home care and delayed in issuing refunds. The Care Provider, acting on behalf of the Council, was at fault for failing to tell it about a period when Mrs Y did not receive care. This caused Mrs Y unnecessary frustration. The Council also failed to invoice according to its schedule. This did not cause Mrs Y an injustice. The Council will apologise and remind its staff they must issue invoices in accordance with its schedule.

The complaint

1. Mr X complained the Council failed to accurately charge his mother, Mrs Y, for her home care. He also says the Council delayed in issuing refunds. Mr X says this caused Mrs Y unnecessary distress and frustration.

Back to top

The Ombudsman’s role and powers

2. 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)
3. 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)

Back to top

How I considered this complaint

4. I have considered:
• all the information Mr X provided and discussed the complaint with him;
• the Council’s comments about the complaint and the supporting documents it provided; and
• the Ombudsman's guidance on remedies.
5. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

What happened

6. Mrs Y receives daily care at home from MKC Care and response (the Care Provider), which is owned by the Council. She has four visits per day. Originally, the Council invoiced every four weeks. The Council says this meant it often had to adjust people’s invoices after it sent them.
7. In February 2020, the Council began using a new charging system. It now invoices on a repeating cycle of four weeks, four weeks and five weeks. The Council says it drafts invoices based on the care it assumes the person will receive in a billing period. If a person does not receive care for some reason, including a hospital visit, the care provider should tell the Council before the end of the billing period. The Council then adjusts the invoice. The Council's invoicing schedule shows it should send the invoice to the person at least one week after the billing period ends.
8. I have reviewed the dates the Council invoiced for Mrs Y’s care from February 2020 to the end of the year. It did not send any of its invoices after the end of the billing periods. Most were around a week before.
9. In late February, Mr X contacted the Council to say Mrs Y had been in hospital from December 2019 to early January 2020 but had been charged for her care. In late March 2020, Mrs Y complained to the Council as she had not received a refund yet.
10. The Council responded two weeks later to say Mrs Y’s care provider had delayed in telling it she had gone into hospital, so it had not known she did not receive care on those days. It had issued her a credit note the previous week.
11. Mrs Y complained again in mid-April 2020. She said she had also been in hospital in late January and the Council had charged her for that period as well. The Council issued a second credit note in late April.
12. Mrs Y complained again in late September 2020. She said she had been in hospital twice in August but the Council had again charged her for those periods. The Council responded to Mrs Y to apologise and say it had taken action to review how care providers tell it when someone does not receive their expected care. In response to my enquiries, the Council said it changed the format of a report on its system so information from care providers was clearer and received quicker. Five days after Mrs Y’s complaint, the Council confirmed it would reduce the amount she owed by what she had overpaid.
13. The Council says following Mrs Y’s complaint, it identified and fixed an error in its invoicing system. It is considering making invoicing more automated to make it faster to record when someone does not receive their expected care. The Council also said that due to the COVID-19 pandemic, it decided to pay all care providers for the care they were expected to provide in a period. This was to ensure they could continue supporting vulnerable people. However, it meant some care providers did not tell the Council about changes to the care they provided. It relied on people receiving care to tell it when they did not have the care they paid for.
14. In his complaint to the Ombudsman, Mr X said the Council only refunded eleven days’ worth of care, when Mrs Y was in hospital for twelve and a half days in August 2020. I have reviewed the Care Provider’s records. Mrs Y missed and paid for care worth £558.50. The Council refunded £495.44.
15. Following my enquiries, the Council has refunded Mrs Y £72.07. This is the difference between the amount it initially refunded and the amount Mrs Y paid plus the cost of one short visit. The Council says this is because on one day Mrs Y received one of her four expected visits. It nonetheless decided to refund the cost of all four visits.

Findings

16. We hold the Council responsible for acts and omissions of the Care Provider. This is because the Care Provider was acting on its behalf.
17. Care providers should tell the Council if a person does not receive their expected care package. They should do this by the end of the billing period. When Mrs Y went into hospital in December 2019 and January 2020 the Care Provider did not tell the Council. This was prior to the COVID-19 pandemic. The Council was not aware of Mrs Y’s hospital stay until Mr X contacted it at the end of following month. This poor communication from the Care Provider was fault. It caused Mrs Y unnecessary frustration and meant she had to go to time and trouble to pursue a refund.
18. Mr X told the Council about Mrs Y’s hospital visits at the end of February. It arranged a credit note in early April, one week after Mrs Y made a complaint about the issue. Although there was some delay in the Council responding to Mr X’s contact, I do not consider it sufficient to make a finding of fault.
19. Mrs Y again stayed in hospital in August 2020. The Council says during the COVID-19 pandemic some care providers stopped telling it about changes to someone’s expected care. Given the unprecedented demand on care providers during the pandemic, I do not consider the Care Provider was at fault for not telling the Council about Mrs Y’s hospital stay in August 2020. Nonetheless, I welcome the efforts the Council has made to improve its systems following Mrs Y’s complaint. Once it became aware of Mrs Y’s hospital stay, the Council promptly arranged a credit note. There was no undue delay so it was not at fault.
20. However, the Council was at fault for failing to properly refund Mrs Y for the care she missed in August 2020. It refunded her £63.06 less than it should have. It has now made a refund payment of £72.07. I consider this suitably remedies the financial injustice the fault caused Mrs Y. However, she also experienced undue frustration as a result of the Council's fault and I have made a recommendation in paragraph 24 to reflect this.
21. The Council says its new system means it sends invoices at least one week after the end of the invoice period. This should give care providers time to tell the Council if they do not provide care for some reason. Records show the Council sent Mrs Y invoices before the end of the billing period from February 2020 to the end of the year. This was fault. However, it did not cause Mrs Y personal injustice because even if the Council had invoiced correctly, the Care Provider did not tell it Mrs Y had not received some care. It would have still invoiced for the full amount.

Back to top

Agreed action

22. Within one month of the date of my final decision, the Council will:
• apologise to Mrs Y for the time and trouble and frustration caused by the Care Provider’s failure to tell it she had not received her expected care and its failure to properly refund her for care she did not receive.
23. The Council has already made some suitable service improvements to its invoicing systems. However, I am still concerned the fault I have identified may cause Mrs Y or other people injustice in the future, so I have made a recommendation to prevent that occurring.
24. Within three months of the date of my final decision, the Council will remind its staff they must issue invoices in accordance with its schedule.

Back to top

Final decision

25. I have completed my investigation. I have found fault leading to personal injustice. I have made recommendations to remedy that injustice and prevent reoccurrence of the fault.

Back to top

Investigator's decision on behalf of the Ombudsman