Summary: Mr X complained about the Council’s failure to tell him he had to make a financial contribution towards the cost of his care at home. He also complained about being charged for care he did not receive. We have found the Council to be at fault because it sent bills to the wrong address and overcharged him by over £1000. This caused significant distress. To remedy this injustice, the Council has agreed to apologise, cancel the outstanding invoice and carry out a review of the Care Provider’s charging practices.

The complaint

1. Mr X complains the Council failed to tell him he had to pay for home care because letters were sent to the wrong address. As a result, he received an unexpected invoice that he cannot afford to pay. This has caused considerable distress and led to him cancelling the care package.
2. Mr X also complains that he was charged for care that he did not receive.
3. Mr X is represented by his partner, Ms P, in making this complaint.

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The Ombudsman’s role and powers

4. 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)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
6. If we are satisfied with an organisation’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 Ms P and reviewed the information she provided.
8. I made enquiries with the Council and reviewed the relevant law.
9. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Relevant law and guidance

10. Care and Support Statutory Guidance (CSSG) is statutory guidance which councils should normally follow. CSSG says councils can charge people for care they arrange 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.
11. 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.”

What happened

12. In August 2020, Mr X was discharged from hospital with a package of home care. He was assessed as needing two care calls of 45 minutes each, seven days a week. This was initially funded by the health service. Mr X was told he may have to pay a contribution towards this care in future.
13. When the health funding came to an end, the Council took over responsibility for commissioning the care package. It did so by contracting with the private sector care company, Ornate Health Care Limited (the Care Provider). Mr X was asked by the Council to complete a financial assessment form. This would determine what, if anything, he had to pay. Mr X returned this form to the Council in October 2020.
14. Mr X did not hear anything about paying for his care until August 2021, when he received a phone call from the Council telling him he owed over £3000.
15. This came as a tremendous shock to Mr X. He assumed that as he had not been told what he had to pay, that it was free. He had spoken to his social worker several times since the care started and he was not told he had to pay or there was money owed. He was so distressed about having to pay this debt, he cancelled his care package because he says he cannot afford to pay for this as well as the large debt. This has left him struggling to cope with daily living.
16. Ms P, on Mr X’s behalf, complained to the Council. She was told the relevant letters and invoices had been sent by mistake to his previous address. The Council apologised but said the money still had to be paid. It said the couple were aware the care package may not be free and so they had some responsibility to make enquiries about the matter.
17. Once she became aware how much the care package had cost, Ms P was concerned Mr X had been charged for care that he had not received. She says many of the visits were much shorter than they should have been.
18. The Council said Mr X should contact the care provider directly to query the duration of daily care calls.
19. Dissatisfied with this outcome, Mr X brought his complaint to the Ombudsman.

The Council’s response to the Ombudsman’s enquiries

• Invoices were sent to the wrong address because of human error. The Council has since made improvements to its systems to make them more robust. To acknowledge this distress, the Council offered a goodwill payment of £300.
• Mr X signed a declaration in October 2020 confirming the charging regime had been explained and agreed to pay the maximum contribution if required.
• Mr X was offered the opportunity to pay by installments.
• An audit of the relevant time sheets confirmed Mr X had been overcharged for the care he received. He was billed for 65 hours of care that was not provided The amount owed by Mr X has been reduced by approximately £1000.
• The case highlighted some issues with communication between the Council and the Care Provider that would be addressed.

Analysis

20. I will address the two areas of complaint below.

Charging for care

21. The Council was entitled to charge for care Mr X received but needed to properly assess his finances and inform Mr X of the outcome of the assessment. There was no fault in how the Council carried out the assessment and I am satisfied Mr X was told about the possibility a contribution would be required. This was recorded in the Council’s case notes. What happened afterwards was fault.
22. The Council did not make Mr X aware of the outcome of the assessment or the fees that would apply to his care. Paragraph 11.3 of CSSG says councils should provide a personal budget to include the person’s assessed charge and this should be available before care and support begins. This did not happen here.
23. The Council also missed several opportunities to alert him about the debt when he was contacted by his social worker about his care arrangements. I disagree with the Council’s position that Mr X should have chased up the outcome of the assessment. Mr X would have been unaware that, as a rule, social workers do not deal with chasing unpaid invoices. It is entirely understandable why he would have expected the social worker to tell him if there was a problem.
24. The failure to do so caused Mr X severe distress and uncertainty when he received a large, unexpected bill for ten months of care. It is understandable why Mr X felt he had no choice to cancel his care package because he was worried about being able to pay for this, as well as the large debt. Mr X has an assessed need for daily support, and he has struggled to manage without this. He would not be in this position had the Council done things right.
25. I do not consider the Council’s proposed remedy of £300 is sufficient, particularly as there was further fault by the Care Provider, and I made alternative recommendations. The Council has agreed with my recommendations.

The amount Mr X was charged

26. In response to the Ombudsman’s enquiries, the Council carried out an audit of the hours worked by carers and those billed by the Care Provider. This identified many occasions when carers had not attended for the length of time Mr X had been charged for.
27. Recipients of care services should not have to question what they have been asked to pay is correct. Providers should have systems in place to ensure clients are only charged for the care they receive. This is fault.
28. While the Council has now reduced the total amount owed by Mr X, this does not acknowledge the additional distress, time and trouble caused to him by being overcharged by such a significant amount.

Injustice and remedy

29. I do not consider the Council’s good will payment of £300 is sufficient to recognise the distress and uncertainty caused to Mr X by both the failure to notify Mr X about the assessment and being overcharged.
30. We do not normally recommend councils should cancel invoices entirely where the complainant has had the benefit of a service. But in this case, I consider it is appropriate to do so for the following reasons:

• Mr X had no reason to believe a debt had accrued for a significant period of time. He says he already lived on a tight budget and this money has already been spent. He should not have to suffer further worry about his finances because of Council fault.
• Mr X has been without care for several months. While I accept it was his choice to cancel his care, he would not have been put in this position had the Council acted properly.
• Mr X was invoiced for 65 hours of care that he did not receive. This is a significant amount and raises concerns about the Care Provider’s systems and practices. My remedy acknowledges Mr X’s understandable loss of confidence in the Care Provider because he was overcharged by such a large amount.

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Agreed action

31. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although part of the remedy below relates to fault by the Care Provider, I made recommendations to the Council only.
32. The Council has agreed with my recommendations to take the following action within four weeks from the date of my final decision:
1. Apologise to Mr X and Mr P.
2. Cancel the outstanding invoice.
3. Contact Mr X to discuss whether he would like care support to be reinstated.
4. Carry out a review of the Care Provider’s billing practices (this may take the form of an audit of a sample of random cases) to ensure other service users are being charged correctly. The Council should provide the Ombudsman with a short report confirming the outcome of this review.

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Final decision

33. I have completed to my investigation. I found the Council to be at fault and the Council agreed to my recommendations to remedy the injustice to him.

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Investigator's decision on behalf of the Ombudsman