Summary: 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

The complaint

1. Ms Y complains on behalf of her father Mr X. She says the Council failed to make the funding arrangements for Mr X’s domiciliary care package care clear enough.

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The Ombudsman’s role and powers

2. 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)
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)

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How I considered this complaint

4. I have:

• considered the complaint
• made enquiries of the Council, and considered the responses
• taken account of relevant legislation
• offered Ms Y and the Council, and opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. The Care Act 2014 and the associated Care and Support Statutory Guidance (“the guidance”) set out the rules the Council must follow when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
6. The law states that people who have over the upper capital limit (currently £23,250) should pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.

What happened

7. Mr X has multiple myeloma and is undergoing chemotherapy. He lives at home with his wife.
8. Mr X was admitted to hospital in October 2020. Prior to which he had not received home care services.
9. Whilst Mr X was in hospital he was deemed eligible for ‘discharge to assess’. This allows patients to be discharged to a setting where their ongoing care needs can be properly assessed. Care packages are funded by the NHS for up to a maximum of 6 weeks to allow time for all relevant assessments to be completed.
10. Ms Y says that whilst Mr X was in hospital a social worker visited him and told him his care would be free of charge for six weeks, or until assessments had been completed. She says the family understood the care would be chargeable after this point.
11. Mr X was discharged home under an agreed ‘discharge to assess’ plan and received three domiciliary care visits a day.
12. The Council says finances and charging are discussed with service users during a needs assessment.
13. The Council completed an assessment of Mr X’s care needs on 7 November 2020. I have seen a copy of this document, under finances it records “Home to Assess pathway discussed and financial assessment for any ongoing care. [Mrs X] unsure if [Mr X] has over the threshold as he manages his own financial affairs”.
14. Mr X received a letter from the Council on12 November 2020 confirming his care arrangements. I have seen a copy of the letter. It confirms the NHS would fund Mr X’s care for a period of up to six weeks, it gave an end date, but said it could be earlier. The Council also provided Mr X with a copy of his care plan.
15. The Council reviewed Mr X’s needs on 20 November 2020. The review was conducted by telephone. Both Mr & Mrs X participated in the review. I have seen a copy of this document. It records them to be satisfied with the care provided, and that Mrs X wanted it to continue as it supported her in her caring role. The assessor recorded “Having discussed the current provision of care with [Mr and Mrs X], I have agreed to request the transfer from discharge to assess to care at home”.
16. The assessor also recorded that Mr X may require screening for NHS Continuing Health Care funding (CHC), and contact was made with the district nursing team. The district nursing team did not consider Mr X met the criteria for CHC funding at that time.
17. The Council’s records show an officer from social services spoke to Mrs X again on 25 November 2020, and that the officer explained her role and “…touched upon the subject of finances and [Mrs X] feels it will be a lot of money”.
18. The NHS ceased funding Mr X’s care on 26 November 2020. The Council wrote to Mr X on 26 November 2020, and included a “Care plan, fin99 fact sheet2,5 sent with pb letter…” I have had sight of the letter and the financial factsheet. The letter makes clear the cost of the care and invites Mr X to submit an application (financial assessment) for a reduction in care costs. The financial factsheet also explains the care is chargeable, subject to a financial assessment. Mr & Mrs X say they thought letter was for information only as it did not say the free care had ended. The Council says the letter was not an invoice for payment, which is why it was headed for information only.
19. Mr X did not complete the financial assessment form, so the Council charged him the full cost of the care.
20. The records show Mr X reduced his care visits because he was starting chemotherapy and he wanted to reduce the number of people visiting due to reduce the risk of any infections. The Council amended the charges accordingly.
21. Ms Y says the Council did not inform Mr X that the free care had ended early and that his care had become chargeable. She says the first they knew of this was when Mr X received a letter from the Council on 15 December 2020 informing him of the charges for his care. I have seen a copy of this letter. It sets out the charges and explained that Mr X could apply for a reduction in the charges, a second financial assessment form was attached
22. Ms Y contacted the Council on 22 December 2020 to query the charges and to say Mr & Mrs X understood the care would free of charge and funded by the NHS until 22 December 2020, or until an assessment had been completed. She said the family were not aware an assessment had been completed and that they expected the Council would write to Mr X to inform him the free care was ending and how much he was expected to contribute towards his care.
23. The records show Mrs X also contacted the Council on 23 December 2020. The charges were explained, and Mrs X was advised to complete the financial assessment form. Mrs X cancelled the care
24. Ms Y contacted the Council on 13 January 2021 to query the care charges again. The Council said the charges remained due and Mr X could still apply for a reduction in the charges, but he needed to complete a financial assessment. A third financial assessment form was sent via email.
25. Ms Y submitted a formal complaint to the Council on 27 January 2021. The Council responded in writing on 19 February 2021. I have seen a copy of this letter. It responds in detail to the issues raised and explains the charges. It says Mr X still had the option to apply for a reduction in the charges by completing a financial assessment form.
26. Mr X has not submitted a financial assessment form to the Council.

Analysis

27. The documents provided by the Council clearly show Mr and Mrs X were informed that the period of free NHS care could be up to six weeks, but it could end sooner. They were informed that following the cessation of the free care, any ongoing care would chargeable and subject to a financial assessment.
28. I am satisfied the information the Council provided made clear that Mr X’s care had become chargeable. During the review of Mr X’s needs on 20 November 2020, the assessing officer recorded she had informed Mr & Mrs X that Mr X’s care would be transferred from the ‘discharge to assess’ care (free NHS care) to care at home.
29. The Council wrote to Mr X on 26 November 2020 and included a financial assessment form, and a care plan with details of Mr X’s personal budget. The letter sets out the care costs and invites Mr X to submit a financial assessment form for a reduction in costs. It is fair to say, the Council would not request a financial assessment for care that had not become chargeable. Whilst the letter is headed ‘for information only’ this was to make clear it was not an invoice, but from plain reading, it is clear the care had become chargeable. The day previously Mrs X had a conversation with a council officer during which she referred to the cost of the care, and that she considered it a lot of money.
30. Ms Y says Mr X says he would have cancelled the care sooner if the charges had been made clear to him. I am satisfied the costs were made clear on 26 November 2020. Had Mr X completed the financial assessment form sent to him on 26 November 2020, he would have been notified if he were eligible for a reduction in costs.
31. I am satisfied the Council adequately explained the charges again in its letter to Mr X in December 2020, and in its complaint response letter to Ms Y in February 2021. A council officer also explained the charges during a telephone discussion with Mrs X on 23 December 2020.

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Final decision

32. 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.
33. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman