Summary: The Council was in error by failing to send out the financial assessment at the right time. The delay caused confusion and a large back-dated bill. The Council agrees to apologise, offer a payment in recognition of the distress caused by its actions and put in place a suitable instalment plan for the payment of the assessed contribution.

The complaint

1. Mrs X (as I shall call her) complains the Council did not tell her there would be a charge for her disabled son’s care package until long after the agreed activities began. She says as a result of the delay the family is faced with a large invoice which it does not believe should be payable.

Back to top

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)

Back to top

How I considered this complaint

4. I considered the information provided by Mrs X and by the Council. Both parties had the opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

Back to top

What I found

Relevant law and guidance

5. 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 places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the 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)
6. Where a council has decided to charge for care, 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 treat each person individually.
7. People receiving care and support other than in a care home need to keep 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)
8. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included.

What happened

9. Mrs X’s son Mr A is a disabled adult who lives at home with his family. He has autism and OCD. He receives a care package funded by the Council through Direct Payments and attends agreed placements which Mrs X provides transport for. He receives a PIP (Personal Independence Payment) mobility payment.
10. In February 2022 a social worker undertook a needs assessment of Mr A as he was moving on into adult care. The visit record shows they discussed suitable placements for Mr A. It concluded, “advised of fairer charge and top up system”.
11. Mr A began at his chosen placements in August 2022. On 4 November the Council wrote to Mr A with a financial assessment form to complete and return by 18 November. Mrs X says the form was not delivered to her until 10 November. She completed and returned the form by 18 November but complained about the delay in asking for the details.
12. On 14 December the Council wrote to Mr A with details of his assessed contribution towards the cost of his care, of £73.92 a week chargeable from the commencement of services, a back payment due of £1256.64.
13. Mrs X replied to the Council the same day. She asked why there had been no mention previously of a contribution towards the cost of care. She said it had taken over three months since the placements began to notify them of the charges. She said the Council had failed to consider in the assessment the amount Mr A would have to pay if his family was not providing accommodation and food for him. She said the Council was using a formulaic calculation which did not take account of his circumstances.
14. The account manager replied to the complaint in January 2023. She said there had been a ‘system error’ during the care needs assessment which failed to trigger the necessary financial assessment, and this was not picked up until October. She apologised for the delay and upheld this aspect of the complaint.
15. In respect of the financial assessment itself, she explained the calculation and what had been taken into account. She explained the Minimum Income Guarantee and said how this had been applied to Mr A. She said the PIP mobility allowance had been disregarded. She did not uphold this aspect of the complaint.
16. Finally she noted the social worker had mentioned the charging during the assessment in February. She said there was also information about assessed contributions in the Direct Payments agreement which Mrs X had signed. She did not uphold this part of the complaint.
17. The Council also considered a disability-related expenses claim for Mr A which Mrs X submitted, for fuel (for travel) and housing expenses. The claim was refused as Mr A had access to a mobility vehicle through his PIP mobility payment, and housing expenses were included in the MIG amount.
18. Mrs X complained to the Ombudsman. In addition to the complaints she had put to the Council, she also said it had failed to assess his disability-related expenses properly. She said despite having asked for assistance on the financial contribution process, none had been supplied.
19. The Council says “a letter is sent out as standard to all clients and further help can be requested as required. In respect of this case no further assistance had been requested and the documents were received in.”
20. The Council told us it had not previously seen the element of Mrs X’s complaint detailing the additional disability-related expenses and would consider these as part of a new DRE appeal. It subsequently wrote to Mrs X explaining it would not allow most of the expenses but would review the transport costs. Mrs X says the Council has agreed to review other elements of DRE.

Analysis

21. The Council acknowledges the error made in the delay sending out the financial assessment form. It has apologised but should go further to recognise the distress and confusion caused by that delay.
22. There is some evidence that information was made available about charging but in my view it could have been clearer. It should not have been a surprise to the family to receive the financial assessment forms.
23. I have not seen any evidence of fault in the way the Council carried out the assessment as it stands, which is in accordance with the regulations. It has reconsidered the disability-related expenses as part of a fresh appeal and continues to review the claimed transport and other costs.

Back to top

Agreed action

24. Within one month of my final decision the Council will offer a payment of £300 to Mrs X in recognition of the distress and confusion caused by the delay in undertaking the financial assessment. It will also agree a sensible instalment plan for the payment of the charges owing so far.
25. Within three months of my final decision the Council will review the way in which it presents information about charging and assessed contributions, and consider the provision of written information at an early stage or clear signposting to the relevant webpage.
26. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

27. I have completed this investigation on the basis there has been fault on the part of the Council which has caused injustice. That injustice can be remedied by the completion of the recommendations in paragraphs 24-25.

Back to top

Investigator's decision on behalf of the Ombudsman