Summary: Mr X complained that the Council wrongly assessed him as being liable to pay a contribution towards the costs of his care and support. He says he cannot afford to make the payment and needs the money to pay for medication that is not available on the NHS. We found no fault in the way the Council completed the financial assessment. So, there are no grounds to criticise its decision that Mr X should contribute towards the cost of his care.

The complaint

1. Mr X complains that the Council has wrongly assessed him as being liable to pay a contribution towards the costs of his care and support. He says he cannot afford to make the payment as he needs the money to pay for medication that is not available on the NHS.
2. Mr X also complains that he is receiving inadequate support from his care provider because they do not work weekends or bank holidays.

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What I have investigated

3. I have investigated Mr X’s complaint that the Council has wrongly assessed his contribution towards the costs of his care and support.

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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. 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

6. I have considered all the information provided by Mr X together with that provided by the Council.
7. I have also considered the Care and Support (Charging and Assessment of Resources) Regulations 2014.
8. 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

Legal and administrative background

9. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
10. Where a council has decided to charge, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the costs it incurs to meet a person’s assessed eligible needs.
11. People receiving care and support other than in a care home need to retain a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014 )

Key facts

12. Mr X has autism and has identified support needs under the Care Act 2014 for support with accessing the community and maintaining his tenancy and home. He receives 12 hours of support per week commissioned via a direct payment and uses these hours for support with shopping and social activities.
13. In May 2022 the Council became aware that Mr X was now receiving the health allowance element of Universal Credit so his income had increased. This increase had taken place some time previously, but the Council had not been aware of it. In light of this information, the Council arranged a financial assessment review for 26 May 2022.
14. Because of the increased benefit Mr X was receiving, the Council calculated he should pay a contribution of £23.34 per week towards the cost of his care and support from 23 May 2022. He had previously been making a nil contribution. This was explained to Mr X at the review meeting. His support worker was also present. Mr X was unhappy with the Council’s decision. He complained to the Council, but his complaint was not upheld.

Analysis

15. The Council has provided a copy of Mr X’s financial assessment. The Council has included Mr X’s income of £159.04 per week and from this it has deducted an allowance of £135.70 resulting in a weekly contribution of £23.34.
16. Government guidance is that current rates for the minimum income guarantee are £94.15 for a single person aged 25 or over but less than pensionable age and £41.55 for the health allowance. These make a total of £135.70. So, I am satisfied the Council has deducted the correct amount.
17. Mr X says he was awarded the health allowance element of Universal Credit so he could pay for medication that is not available on the NHS. However, the health allowance is awarded to people who have a health condition or disability that prevents them from working or limits the amount of work they can do. It is not awarded to pay for items such as medication but, rather, is based on the fact that the person has a health condition or disability that affects their ability to work. The Council is entitled to take the increase in Mr X’s Universal Credit payment into account when calculating how much he should contribute towards the cost of his care and support.
18. The Council was entitled to backdate Mr X’s contribution to the date he first received the health allowance element of Universal Credit. However, it exercised discretion to start the payment from 23 May 2022 for Mr X’s benefit.

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Final decision

19. I do not uphold Mr X’s complaint.
20. I have completed my investigation on the basis that I am satisfied with the Council’s actions.

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Parts of the complaint that I did not investigate

21. I have not investigated Mr X’s complaint that he is receiving inadequate support from his care provider. From our enquiries we have established that this complaint is currently being considered by the Council through its complaints procedure. The law says that, before investigating a complaint, we must normally be satisfied that the complainant has made a formal complaint to the Council and that it has been given an opportunity to consider it and reply. As Mr X has not yet completed the Council’s complaints procedure, we will not investigate this matter.

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Investigator's decision on behalf of the Ombudsman