Summary: Mr X complained about how the Council communicated with him about the costs of care for his late wife Mrs X. Mr X said he received a large, unexpected bill which caused him a great deal of stress and the Council did not answer his questions about this. We find fault with how the Council communicated with Mr X and ask it to apologise, waive the fees, and review its process.

The complaint

1. Mr X complains about the way the Council has communicated with him about the costs of care for his late wife, Mrs X. Mr X says he was never made aware of the outcome of Mrs X’s financial assessments and did not know charges were accruing until he received a bill for her care. Mr X says this has caused him a great deal of stress and he has been unable to get answers about the charges from the Council.

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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. 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 spoke to Mr X about this complaint and considered the information he provided.
5. I asked the Council for the information I needed to consider Mr X’s complaint and I reviewed all the information it provided. This included:
• Emails between the Council and Mr X
• Notes of relevant calls between the Council and Mr X
• A chronology of events from January 2020 up until November 2021
• Mrs X’s financial assessment summaries
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

7. Care and Support Statutory Guidance (CSSG) is statutory guidance which councils should normally follow. CSSG says councils can charge people for care they arrange and fund in a care home by applying national regulations on charging. Councils work out a person’s charge by carrying out a financial assessment. The adult or their representative completes a questionnaire giving details of their finances and evidence of income and capital. The council uses this information to work out how much it should be charging based on the charging regulations. Most of an adult’s income is taken into account in the financial assessment and if they have capital of over £23,500, then they pay the full cost of their care.
8. CSSG sets out the council’s requirement to provide an adult who it has assessed for care and support with a personal budget. Paragraph 11.3 says a personal budget “means, before care and support planning begins, there is an estimate of how much money is available to meet a person’s needs with the final personal budget having clear information about the total amount including the proportion the local authority will pay and what amount the person will pay.”

Principles of Good Administrative Practice

9. Our Principles of Good Administrative Practice sets out what we expect to see from Councils when dealing with complaints and queries.
10. We expect councils to deal with people helpfully, promptly, and sensitively, taking account of their personal circumstances.

What happened

11. Mrs X had dementia and Mr X held power of attorney for managing her finances. Mrs X collapsed at home and was admitted to hospital at the start of 2020.
12. While Mrs X was in hospital, the Council’s Adult Social Care department discussed the possibility she would receive a package of care at home with Mr X. However, Mrs X could not return home, so discussions moved to finding an acceptable residential care home.
13. As Mr X and the Council could not identify an appropriate care home locally, it was agreed the Council would provide funding for Mrs X to receive care in another county. Mrs X moved into a care home in a different county in March.
14. The Council confirmed it would continue to provide funding for Mrs X’s care at least until it had completed a financial assessment.
15. A financial assessment took place for Mrs X in September, but Mr X was not notified of the outcome of this.
16. Mr X called the Council at the start of November to explain he had been told Mrs X was eligible for Funded Nursing Care (a payment by the NHS for nursing services in a care home). The Council agreed to look into what was happening and it began another financial assessment for Mrs X. However, the Council says it did not complete this until March 2021.There are no records of any updates to Mr X.
17. The charging team wrote to Mr X in March 2021 to explain it needed more information to complete the financial assessment and asked for details of Mrs X’s income and expenditure. Mr X was told a weekly contribution of £148.85 would be applied to Mrs X’s care until the assessment could be completed. Mr X supplied the information promptly.
18. The charging team wrote to Mr X at the end of March to explain Mrs X’s care would now cost £192. Mr X contacted the charging team to question how it had calculated the charge and a member of staff explained he would get an invoice.
19. At the start of April Mr X received a bill of £5,700.78 for Mrs X’s care between September 2020 and March 2021.
20. Mr X contacted the charging team to question the bill as he had not been expecting it. At that stage the charging team put forward different ways for Mr X to pay the bill.
21. Mr X complained to the Council in July. He explained he had been going through a very stressful time as his daughter was also experiencing health issues. Mr X told the Council he had made it clear from the outset cost would be an issue for him but had never been told how much the fees would be or when they would apply. Mr X said he had been passed around different members of staff throughout this time and he felt he was being put under pressure to pay which was causing a great deal of distress.
22. The Council says the issue of the outstanding charges was escalated to the relevant team manager. However, it says there is no record Mr X ever received a response.
23. The Council responded to Mr X’s complaint in August. It acknowledged he had been passed to many different staff members but explained this is because the Adult Social Care department is large with different duties handled by different teams. The Council agreed there was confusion around the payment of care home fees and said someone from its charging team would be in touch.
24. Mr X made multiple attempts to contact the charging team over the next two months but could not speak to the relevant manager.
25. Mr X complained to us in October 2021.
26. The Council reviewed Mr X’s complaint and wrote to us saying it did not communicate appropriately with Mr X or answer the questions he had which would have caused him considerable distress and uncertainty. The Council apologised and offered to waive the full fee of £7,651.77.
27. The Council also said it would undertake a review to identify where it can improve its process regarding care home fees.

Analysis

28. The Council is entitled to charge for care Mrs X received but would need to properly assess her finances and inform Mr X of the outcome of the assessments. The Council has confirmed it did not make Mr X aware of the outcomes of the assessments or the fees that would apply to Mrs X’s care. This is fault because there was a failure to inform Mr X of the assessed charge for Mrs X before her care began. This was not in line with paragraph 11.3 of CSSG which says councils should provide a personal budget to include the person’s assessed charge and this should be available before care and support begins.
29. This caused Mr X severe distress and uncertainty as he received a large, unexpected bill for seven months of care. This is injustice.
30. The Council is also at fault for the way it communicated with Mr X throughout the process. Mr X had to spend a lot of time trying to chase answers and was often promised contact that did not happen. The Council ought to have been aware this was already a stressful time for Mr X. The Council should have ensured it responded to him promptly to avoid adding to that stress. I consider the Council’s customer service was not in line with our expected standards as set out in our 2018 Principles summarised in paragraph 10.
31. In recognition of its fault, the Council has already agreed to waive fees of £7,651.77. I think this remedy is sufficient in recognising the distress and uncertainty caused to Mr X.

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Agreed action

32. To remedy the injustice set out above, I recommend the Council:
33. Within one month:
• Apologises for its failure to keep Mr X properly updated about the financial assessments and for the poor communication throughout.
• Write to Mr X to confirm it has waived the £7,651.77 outstanding care bill.
34. Within three months:
• Complete its learning event to identify improvements to processes in relation to care home fees and provide the Ombudsman with a written summary of the outcome
35. The Council has agreed to the recommendations above.

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Final decision

36. I find fault with the Council for failing to communicate properly with Mr X and for failing to keep him updated on the financial assessments. To remedy the outstanding injustice, I make the recommendations set out above.

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Investigator's decision on behalf of the Ombudsman