Summary: Mr C complained the appeal to consider Ms B’s disability related expenditure did not properly address itself to the relevant issues. As a result she did not receive all the allowance she should. There was fault in the Council’s consideration of the appeal. It will calculate the amount of the payments Ms B should have received and make any payment to her estate.

The complaint

1. Mr C made the complaint on behalf of Ms B who died during the investigation. Mr C complained the appeal to consider Ms B’s disability related expenditure did not properly address itself to the relevant issues. As a result he said Ms B did not receive all the allowance she should.

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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 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

4. I considered the complaint and documents provided by Mr C and spoke to him. I asked the Council to comment on the complaint and provide information. I sent a draft of this statement to Mr C and the Council and considered their comments.

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What I found

What should happen

5. The Care and Support Statutory Guidance (the guidance) says when carrying out a care assessment local authorities must consider all the adult’s care and support needs, regardless of any support provided by a carer. Where the adult has a carer, information on the care they are providing can be captured during assessment but must not influence the eligibility determination. After the eligibility determination has been reached, if the needs are eligible or the local authority otherwise intends to meet them, the care which a carer is providing can be taken into account during the care and support planning stage. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. This ensures the entirety of the adult’s needs are identified and the local authority can respond appropriately if the carer feels unable or unwilling to carry out some or all of the caring they were previously providing.
6. North East Lincolnshire Council’s charging and financial assessment for adult care and support services (the Council’s policy) says it will undertake a financial assessment to decide how much an adult can contribute towards the cost of their care and support. It says where the adult is in receipt of a qualifying benefit the Council will also consider disability related expenditure.
7. The Council’s policy says the definition of disability related expenditure in the statutory guidance is:
• needs not met by the Council;
• reasonable additional costs directly related to a person's disability or necessitated by their disability.
8. The Council’s policy says when considering what to allow as disability related expenditure it will use the adult's care plan as a starting point. It says the Council has largely adopted the approach set out by the National Association of Financial Assessment Officers in developing an approach to disability related expenditure. The Council says with regard to the following common expenses it anticipates that reasonable additional costs directly related to the person's disability can be met within the following limits:
• social activities up to a maximum of £50 per week
• gardening up to a maximum of £15 per week
• window cleaning up to a maximum of once per month
9. It says higher claims in those areas must be accompanied by clear rationale as to why this is justified and that will be submitted to the appeal panel. It says there is no intention to fetter discretion or set arbitrary limits but rather to ensure all appropriate matters have been taken into account before apparently costlier claims are endorsed.
10. It says the Council will generally not allow disability related expenditure where there is reasonable alternative available at lesser cost (where the lesser cost would be allowed) or where costs could be met by other agencies such as the NHS.
11. The Council’s policy says it will consider disability related expenditure allowances outside of its policy where individual circumstances may warrant a departure from it and this will be decided by the appeal panel.
12. The Council’s policy sets out what it will consider for various potential areas of disability related expenditure. That includes comparing fuel bills to the areas average fuel bills, private domestic help, laundry/washing powder, a clothing allowance, social activities and petrol costs. The Council’s policy says for laundry/washing powder the Council will award £3.92 per week where the care plan has identified an incontinence problem requiring more than four loads per week. For petrol the policy says a maximum of £12.50 per week is allowable for essential trips and anything above that can be presented to the appeals panel.

What happened

13. Ms B had partial paralysis and other medical conditions due to a stroke. She lived in a fully adapted living area on the ground floor of Mr C’s house. The Council provided Ms B with carers as well as a direct payment for one-to-one support for a personal assistant to take her out into the community, one hour support each day to enable Mr C to have a break from his caring role and four weeks residential respite care per year
14. Mr C complained to us about how the Council had treated Ms B’s laundry and petrol costs. We upheld the complaint and asked the Council to consider a further appeal. This complaint concerned the way that appeal was conducted.

Analysis

Laundry cost

15. The Council allowed the normal amount in accordance with its policy for the laundry costs Ms B incurred. It said it would only be if she needed to claim more that receipts would need to be produced and then only a representative number of receipts sufficient for the Council to calculate the costs normally incurred. I do not consider there was any fault in this approach.

Petrol costs

16. The Council reconsidered this point following my enquiries about the complaint and then again following Mr C’s comments on a draft of this statement. It accepted that Ms B’s daily trips out were a recognised need. Following Mr C’s comments it accepted the frequency and nature of the trips as he set out. That was four days a week in the car and three local trips in the milder weather and in the winter (November to February) one day a week as a local trip and six in the car.
17. The Council has now properly considered this point. However, it did not properly address itself to the key points at the appeal in February 2022. It referred to Ms B being able to have the necessary stimulation in the house but following the input from the social worker it accepted that Ms B did need to go out every day. That should have happened at the appeal. As I understand it Ms B was taken out daily so those costs were incurred. In our previous investigation we found fault in the Council’s consideration of how Ms B’s disability related expenditure should be considered. The Council should therefore calculate the entitlement backdated to January 2019, and make any payment to Ms B’s estate.

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Agreed action

18. The Council will, within eight weeks, calculate the entitlement and make any payment to the estate as outlined above. It should provide us with evidence it has done so.

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Final decision

19. There was fault in the Council’s consideration of the appeal.

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Investigator's decision on behalf of the Ombudsman