Summary: Mr X complained the Council did not properly discuss his care package with him, delayed contacting him about his financial assessment, sent letters to the wrong address and failed to discuss with him how he could address the arrears which accrued. The Council was at fault when it failed to clarify consent with Mr X, did not keep him updated about his hospital discharge and sent his financial information to the wrong address. There was no fault in the way it calculated his contribution to his care charges. The Council properly investigated Mr X’s complaint and has taken action to address the faults it identified. It has agreed to apologise to Mr X and pay him £250 to acknowledge the distress sand frustration caused by the faults.

The complaint

1. Mr X complained the Council did not properly discuss his care package with him, delayed contacting him about his financial assessment, sent letters to the wrong address and failed to discuss with him how he could address the arrears which accrued. This has caused him distress and frustration.

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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. 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)
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 have considered the information provided by Mr X and the Council’s response to our initial enquiries. I have considered the relevant law and guidance.
6. I gave Mr X and the Council the opportunity to comment on a draft of this decision and considered any comments I received in reaching a final decision.

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What I found

Assessment and Charging

7. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved. Where local authorities have determined that a person has any eligible needs, they must meet these needs.
8. The Care Act 2014 sets out the legal framework for charging. Councils can make charges for care and support services they provide or arrange. They must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014. Charges may only cover the cost the council incurs.
9. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25% (also known as the minimum income guarantee). The Council can take a person’s capital and savings into account subject to certain conditions. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)
10. NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.

Discharge to assess funding

11. In March and April 2020, the government allocated additional funding for NHS and social care discharge support. The aim of the funding (which I refer to as discharge to assess funding) was to free up NHS capacity via the rapid discharge of patients out of hospital. This was to help support the NHS during the COVID-19 pandemic.

What happened

12. Mr X has a number of physical health conditions. After a stroke in December 2020, Mr X fell causing damage to his knees. This left him unable to stand without support or to move about independently. Mr X is hard of hearing and prefers not to speak on the telephone.
13. In February 2021, the Council completed an assessment of Mr X’s needs whilst he was in hospital through discussion with hospital staff and Mr X’s daughter in law. It recommended a package of care of four visits a day by two carers to assist with moving him from room to room, personal care, toileting and preparing meals. The Occupational Therapist also recommended equipment to assist him at home.
14. The Council spoke to Mr X’s daughter in law mid-February and explained Mr X’s care would initially be funded from discharge to assess funding. A review would take place around two to three weeks later at which point a CHC checklist would be completed to see if Mr X qualified for NHS CHC funding. If not a financial assessment would be completed to identify what contribution would be required towards the cost of his care package.
15. The Council had difficulty finding a care provider to meet Mr X’s care needs so a week later it suggested a temporary stay in an intermediate care facility. Mr X agreed to this until a care package could be sourced. However later that day the Council identified a care provider and the hospital updated Mr X he would be going home with a package of care. The Council spoke to Mr X’ s son and told him the care package would be funded initially through the discharge to assess funding. Mr X was discharged home the next day with a care package of four calls per day.
16. The Council carried out a review of Mr X’s care needs on 11 March 2021. It wrote to Mr X on 26 March, sending him a copy of the support plan which Mr X signed and returned. It also sent Mr X a copy of the financial assessment form for completion, a direct debit mandate and a ’guide to paying for care and support’.
17. Mr X completed the form on 1 April and returned it to the Council.
18. Mr X’s son contacted the Council a week later to ask about his contribution. It signposted him to the finance team. At the end of April the finance team confirmed it had received the completed form.
19. The Council assessed Mr X’s financial contribution. It took into account his income and savings. It disregarded an amount in line with government guidance and allowed some disability related expenditure.
20. Mr X’s son contacted the Council in early June as they still had not received the outcome of the financial assessment. The social worker spoke to the finance team who confirmed it had posted the assessment in mid-May but had sent it to the address of a deceased relative of Mr X. The social worker apologised and amended the system.
21. Mr X complained to the Council he had not received any contact about the cost of his care or any visit to discuss the care he needed. He said he returned the financial assessment from in early April but had no further communication from the finance department. He was unhappy the Council had sent him a direct debit mandate to complete without advising him about the cost of his care and had sent his financial assessment to his late relative’s address. In mid-June a Council officer visited Mr X to discuss his complaint.
22. The social worker visited Mr X in late June to complete a needs assessment and the CHC checklist. It proposed an increased package of care to include two community access visits per week. Mr X agreed to the increased support which has yet to start. It was later confirmed Mr X was not eligible for CHC funding. The Council officer dealing with the complaint met with Mr X again in late June.
23. The Council responded to Mr X’s complaint in August 2021. It apologised for the breakdown in communication. It explained officers had not been able to visit hospitals during the COVID-19 pandemic, so assessments were completed electronically. It said the assessments were completed with family members but Mr X was not contacted to ask who he would like to be involved in decisions about his care. It said Mr X’s son and daughter in law told staff to consult with them in the first instance and the officer believed they were acting on his behalf with his full knowledge and agreement. It apologised for not establishing his consent to speak to family members and for not encouraging his active participation in the decisions being made. The Council said it had reminded staff to confirm with the adult whether they wished for a family member to represent them in decisions about their care.
24. The Council said discharge to assess funding was discussed with a family member and Mr X had signed the financial contribution form. It concluded Mr X should have been kept informed of the process and it should have been explained to him in more detail.
25. It explained there was a seven day delay in his discharge when it could not find a care provider. It had therefore recommended a short residential stay but later that day found a care provider to meet his needs. It apologised that it was the hospital not the social worker that advised him of this change.
26. It apologised for sending letters to the address of a late relative. It said the electronic case file showed a link to that address and the letters were sent there due to human error. It had reported the error to its Information Governance Team. It said it had offered on several occasions to visit the address to try and retrieve the letters but this was refused by him and his family. It understood Mr X’s son had visited the property and obtained the letters. It apologised for the distress and inconvenience caused and said additional training would be provided to members of the finance team. It understood Mr X had changed his bank account details to ensure his financial security. It said it had not charged Mr X for his client contribution for the period to 1 June 2021 when he was not aware of his financial contribution.
27. The Council explained Mr X would need to pay his care contribution which was assessed based on government guidelines. It also offered Mr X £50 to reimburse the expenses incurred in retrieving the letters incorrectly sent to the wrong address.
28. Mr X spoke to a Council officer in August 2021 and clarified the family had already got the letter back so had not needed the Council to do so. He was unhappy as the care contribution had built up again and he wanted to discuss the contribution and the amount he had to pay. The Council officer advised it was not negotiable but based on government figures.
29. Mr X remained unhappy and complained to us. Mr X said the Council did not offer on several occasions to visit the house and retrieve the letter. He said when they did offer, his son had already been and done so. Mr X said he had not received a written apology and considered his care contributions were too high.
30. Mr X says he met with the Council in late October 2021 and has made arrangements for a payment plan to clear the arrears.

Findings

31. Due to restrictions imposed by the COVID-19 pandemic, the Council carried out assessments electronically rather than face to face when Mr X was in hospital. That was not fault. The Council considered Mr X’s needs based on input from the hospital and relatives and introduced an appropriate care package to meet his needs. However, it failed to ensure Mr X was fully involved in the discussions and kept up to date with what was happening when he left hospital. That was fault and caused Mr X some frustration and anxiety. The Council has already taken action to prevent recurrence of this fault.
32. Although Mr X had to stay in hospital a week longer than necessary while the Council sought a care package, this was not fault. The evidence shows the Council was actively pursuing a care package. It contacted a number of care providers and also considered the possibility of a short term stay to enable Mr X to be discharged from hospital. However, the Council was at fault for not keeping him fully up to date with what was happening.
33. Mr X’s care package was initially funded through the discharge to assess funding. After it reviewed the care package the Council sent Mr X information about charging for care and a copy of his support plan which he signed and returned. The Council had also previously spoken to Mr X’s son and daughter in law to advise Mr X would require a financial assessment if he was not eligible for CHC funding. The Council was not at fault for charging Mr X for his care.
34. The Ombudsman is not an appeal body. We cannot question a council’s decisions if there is no fault in the way the decisions are reached.
35. The Council calculated Mr X’s contribution to his care charges in line with the relevant statutory guidance and regulations. It took into account Mr X’s disability related expenditure and left Mrs X with an amount in line with the minimum income guarantee set by the government. There was no fault in the way the Council carried out Mr X’s financial assessment and calculated his contribution to his care charges.
36. The Council sent the outcome of Mr X’s financial assessment to the wrong address. This was fault. Mr X has retrieved the letter, the Council has already apologised for this and offered to pay £50 to reimburse the expenses incurred in retrieving the letter. It has also provided additional training to staff. There is nothing else I could achieve by investigating this further.
37. The Council properly investigated Mr X’’s complaint. It acknowledged its faults and set out the actions it had taken to prevent a recurrence. It acknowledged Mr X was not aware of his financial contribution until June 2021 and so did not charge him his client contribution prior to this date. This was appropriate. However, the Council has not offered a remedy for the frustration and distress caused to Mr X by the Council’s faults.

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Agreed action

38. Within one month of the final decision the Council has agreed to write to Mr X to apologise and to pay him £250 to acknowledge the distress and frustration caused to him by the Council’s faults.

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Final decision

39. I have completed my investigation. There was evidence of fault causing injustice which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman