Summary: Miss X complained the Council incorrectly charged her for care that she understood would be free. The Council was at fault for failing to provide financial information to Miss X about her package of care when she left hospital. That meant she could not make an informed decision about the care she agreed to receive. The Council also delayed in responding to Miss X about her charging query and delayed in reviewing her care needs. That caused Miss X avoidable distress and uncertainty and meant she paid for an increased package of care longer than necessary. The Council has agreed not to charge Miss X for the additional visits it put in place and apologise for any avoidable distress caused.

The complaint

1. Miss X complained the Council has incorrectly charged her for care that she understood would be free. She also said the Council said it would not charge her more than £200 a month for her care and support. She said it has charged her more than what was agreed.
2. She said the Council’s charges have meant she is unable to afford to pay her bills or for food.

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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. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
5. 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. We can consider whether the council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
6. 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

7. I discussed the complaint with Miss X.
8. I made enquiries of the Council and considered its response.
9. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
10. I referred to the Care and Support Statutory Guidance (the Guidance).

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What I found

Charging for adult social care

11. Councils must assess anybody in their area who appears in need of care services. Following an assessment, the council must decide which needs are eligible for their support. If the council provides support, it must produce a written support plan. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person. Councils must assess a person’s finances to decide what contribution he or she should make to the cost of their care.
12. The Guidance states that councils must provide information to help people understand what they must pay. They should also consider a person’s need for this financial information and advice throughout the assessment, care and support planning and review process.

Discharge to assess under COVID-19

13. From 19 March 2020, there was a requirement to free up hospital beds for the anticipated wave of COVID-19 admissions. Government guidance at that time directed rapid discharge of all patients who were clinically ready to leave hospital, either home or to another place of care.
14. Where patients were discharged under this government guidance the NHS fully funded the cost of new or extended out-of-hospital health and social care packages. The Government later amended the guidance to limit the funding of support to six-weeks.

What happened

15. The Council completed a care needs assessment for Miss X in November 2020. It assessed her as needing support with tasks such as washing dishes, preparing her evening meals and with her finances. She also struggled to access her bathroom. During the assessment the Council explained it may charge her for care and support.
16. The Council assessed Miss X as needing one 30-minute visit a day. The aim of the support was to promote Miss X’s independence and help her find ways of completing tasks safely. It also referred her for an Occupational Therapist assessment to look at modifications to her bathroom, and to a community worker for support with her finances. The package of care started mid- December.
17. Miss X completed a financial assessment form. The Council wrote to her at the start of January 2021. It said the maximum she would have to contribute to her care was £110 a week. However, if her care cost less than that she would not need to contribute the full amount.
18. Following that, Miss X spoke to the Council because she thought her assessed contribution was too high. The Council reviewed its financial assessment. It wrote to her on 12 January 2021 with a revised assessment stating her maximum contribution was £89.93 a week. However, the cost of Miss X’s care was lower than this.
19. At the start of February 2021, Miss X began to refuse her carer’s support. The care provider told the Council they were concerned she was refusing care because she could not afford it. The Council contacted Miss X. It discussed whether she wanted more support. Miss X said she was happy with the support she was receiving.
20. Miss X’s mental health began to deteriorate. On 8 February she was taken to Accident and Emergency where she stayed overnight. The case records indicate that financial worries contributed to the decline in her mental health.
21. Whilst in hospital, the Council spoke to Miss X about increasing her care package to two visits a day. Miss X agreed to this, but the records do not show the Council discussed with Miss X the potential financial implications of increasing her care package to ensure she understood that her contribution may increase. Miss X says the Council told her she would not have to pay for the first six weeks of the additional support.
22. The Council visited Miss X at home the next day and reviewed her support plan. The reviewed plan said the increased visit was to support Miss X to manage her home environment, prepare meals and remind her to take her medication. There is no record that the Council discussed the financial implication of the increased care package at this visit.
23. Miss X contacted the Council on 21 February and said she no longer wanted support from the care provider. Over the next week, the care provider had regular contact with the Council as Miss X was refusing their care visits. It told the Council the carers rarely provided support on visits.
24. Miss X contacted the Council’s out of hours service on 27 February after she received an invoice for her care. She said her first invoice was for £202, but the new invoice was for £235. She said she did not want care as it had caused her distress and she could not afford it. The out of hours service said it could not cancel her care, but a social worker would contact her at the start of the next week.
25. A social worker spoke to Miss X further on 1 March. It said it would speak to its financial services for more information about the increase in charges before cancelling the package of care. Miss X agreed to this.
26. Miss X contacted the Council further on 23 March. She said she had tried to contact the Council several times about the care charges, but it had not responded. She contacted it further the next day stating she was told the additional morning call was free for six weeks as it was put in after she left hospital.
27. Around this time the care provider contacted the Council about the suitability of domiciliary care for Miss X. It said it was not completing support tasks when it visited Miss X.
28. The Council reviewed Miss X’s care charges on 1 April. It said that although she stayed overnight at hospital she was not admitted to a ward and therefore not eligible for her care to be paid for through the COVID-19 discharge to assess funding.
29. Miss X contacted the Council further in April and said she wanted to stop the package of care. She continued to refuse visits.
30. The Council tried to contact Miss X by telephone mid- April to discuss her care contributions but was unsuccessful.
31. Following a conversation with the care provider and Miss X, the Council cancelled Miss X’s care package on 21 April. It reassessed Miss X’s care needs and decided she did not have eligible needs as she was independent in all daily tasks.
32. At the end of April, the Council emailed Miss X stating she was not eligible for free reablement care. It said it would write to her further explaining that decision.
33. Miss X subsequently complained to the Council about it charging her for the additional care she received after leaving hospital.
34. The Council wrote to Miss X at the start of May. It said that between December 2020 to February 2021 her package of care cost less that her maximum assessed contribution. Therefore, she contributed £58.90 a week to her package of care. It said after the Council increased her visits to twice daily, the cost of her care was more than her assessed maximum weekly contribution, therefore it charged her the maximum contribution of £83.93 a week. The Council said she was not eligible for free care when she left hospital as she was not admitted to a hospital ward.
35. Miss X continued to contact the Council about its decision and provide further evidence about her stay in hospital. The Council wrote to her in June. It said because she was not admitted onto a ward, she was not eligible for funding towards her care. It said it could arrange a payment plan for her to repay the invoices in instalments.

My findings

36. The Council wrote to Miss X in January 2021 with the outcome of her financial assessment. That confirmed her maximum assessed contribution was £89.93 a week.
37. She initially contributed £58.90 a week because she only received 3.5 hours of care. Her first invoice was for twelve hours of support and costed £202. That invoice did not cover the full four-week invoicing period as her care package started mid-way through December 2020. Her second invoice was for £235 because it was for a full month’s support (fourteen hours). When the number of care hours increased, so did her contribution. The Council was not at fault.
38. Miss X told me the Council said her maximum contribution to the cost of her care would be no more than £200 a month. I have seen no evidence the Council said that to Miss X. It wrote to Miss X with its financial assessment setting out her maximum contribution. The Council was not at fault.
39. Miss X said the Council told her she would not have to pay for the first six weeks of additional support after her discharge from hospital. As I was not there, I cannot confirm who said what to Miss X. However, I have seen no evidence the Council told Miss X this or discussed how the additional support would be paid for.
40. The Guidance states the importance of considering a person’s needs for financial information so they can make informed decisions about their care. Miss X had been admitted to hospital because of her mental health and the care provider had told the Council it was concerned finances were a factor in her refusing care support. The Council should have discussed with her the financial implications of increasing her care package. Failure by the Council to provide Miss X the appropriate financial information was fault. That caused Miss X a significant injustice. It means she could not make an informed decision of whether she wanted the additional visit or not.
41. I cannot know whether Miss X would have agreed to the increased care, had she known she would have to pay more to receive it. However, given that Miss X had contacted the Council about wishing to cancel her care, specifically because of its cost, I am satisfied based on the balance of probabilities, Miss X would have most likely declined the additional support visit if she knew she were expected to pay for it.
42. Miss X contacted the Council about wanting to stop her care on 21 February. She contacted it further on 1 March about the cost of her care. In this call she agreed to keep her care until the Council confirmed how much it would cost. Although the Council struggled to contact her by telephone in April, it did not send a written explanation about the charges until May. That was two months after Miss X asked for the information. That delay was fault. That caused Miss X avoidable distress and frustration.
43. Despite Miss X asking the Council to cancel her care from 21 February, the Council failed to review her care and support needs until the end of April. The Council’s contact with the care provider shows Miss X regularly refused care and that Miss X was independent with her personal care. The care provider also questioned Miss X’s suitability for domiciliary care in March. The Council should have reviewed Miss X’s care and support needs sooner. Failure to do so was fault. That meant Miss X was paying for care for longer than she needed or wanted it, which caused her avoidable distress, uncertainty and financial loss

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Agreed action

44. Within one month of my final decision the Council has agreed to:
• Amend and reissue its invoices to Miss X so she is not charged for the additional care and support visits in place from 10 February to the end of her care package.
• Write to Miss X and apologise for failing to the avoidable uncertainty and distress caused by it failing to explain the care charges when her package of care increased and for delays in responding to her query about the additional care charge.

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Final decision

45. The Council failed to explain Miss X would need to pay for additional care visits when she left hospital and delayed in responding to her charging query. The Council has agreed to apologise for any avoidable distress that caused and not charge Miss X for the additional visits. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman