Summary: The Council failed to ensure Miss Y received accurate invoices for domiciliary care services from a care agency commissioned by the Council. The Council delayed in acting on numerous complaints about this.

The complaint

1. Mr X complains there are frequent and numerous errors in the invoices generated by the Council for Miss Y domiciliary care services.

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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 significant injustice, or that could cause injustice to others in the future 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 have:

• considered the complaint and discussed it with Mr X;
• considered the correspondence between Mr X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mr X and the Council the opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s powers to charge. The Council also has its own policies.
6. The Guidance sets out the overarching principles which underpin charging for adult social care services. These are (among others):

• Ensure that people are not charged more than it is reasonably practicable for them to pay.
• Charging should be clear and transparent, so people know what they will be charged.

7. The Council’s policy explains it operates a “…charging system that is lawful, fair, equitable and transparent. National guidance and best practice are complied with at all times”.

What happened

8. Miss Y is in her nineties. She lives in her own home and receives domiciliary care services from a care agency, arranged by the Council. Miss Y pays the full cost of her care.
9. Mr X, who is in his seventies, is an informal carer for Miss Y and supports her to managing her finances, including checking/paying the invoices for her care.
10. Mr X says over the last five years there have been frequent and numerous errors in the invoices generated by the Council for care services. This usually relates to visits that have been cancelled in advance.
11. Mr X says he gives the care agency the required two days’ notice to cancel home care visits, he says although the carers do not attend on these days, the visits are still included on the invoice. He says where Miss Y is unable to give the required notice, she fully expects to pay for missed visits.
12. Mr X has been raising this issue with the Council for the last five years and says this has taken considerable effort and a significant amount of his time. He feels strongly that invoices should be accurate. He says the Council blames the care agency and visa-versa. He says the Council does amend the bills when he highlights the errors, but it does not explain the amendments, so he is unable to reconcile the bills and confirm if the amount requested is correct.
13. Mr X says since he submitted a complaint to this office, Miss Y received a five-week bill, three of the weeks were incorrect by ½ hr, and one week by 1 hour.
14. After numerous informal complaints to the Council and the care agency, Mr X submitted a formal complaint to the Council. He received a final response email on 30 March 2023. The author of the email explains that the Council’s finance team are aware of his concerns and had contacted him twice to discuss the matter and explain how its invoicing system works. The author said Mr X’s concerns about the care agency had been passed to the Council’s contract management team and the team would follow-up the concerns directly with the care agency.

The Council’s response to my enquiries.

15. In response to my enquiries, the Council acknowledged the issues Mr X raises and says it is “…taking the necessary action with the care company to ensure any inaccuracies are remedied and that there is accurate billing going forward from the care provider. This has included a review of the care provider’s arrangements and processes for billing, with agreed actions for improvements to their processes”. It provided no details of the agreed actions or a timeline for implementation.
16. It says invoices submitted by care agencies to the Council should be true and correct in accordance with the contractual agreement. The Council does not require cancelled visits to be recorded. It says where queries/concerns are raised invoices are checked “…against data from providers’ electronic home care monitoring systems/ care delivery records and the care agency is required to amend invoices as necessary”.
17. In this case, the Council says it has met with the care agency to investigate the invoicing issues, following which it issued the care agency with a formal breach of contract letter along with actions required to remedy the breaches.
18. The Council says the care agency has since contacted its system supplier and obtained advice and training in using the system. The Council says the care agency has undertaken its own internal audit to check the accuracy of historical invoicing. The care agency submitted reports to the Council for review. The Council says a follow-up meeting has been arranged to review progress.
19. The Council says its procurement team are “…piloting a digital electronic home care monitoring database that will give oversight of actual care delivery against commissioned hours and rota’d hours. This will support the monitoring and checking of invoices against care delivered and enables the Council to identify missed and late visits”.

Analysis

20. 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.
21. Whilst the Ombudsman welcomes the Council’s acknowledgement of failings in the invoicing system of the care agency, and its commitment to resolve the issue, it should have acted much sooner. The anomalies occurred over several years, which Mr X has tried in vain to address, with the care agency and the Council. Mr X has kept diligent records on behalf of Miss Y, and his persistent reports of incorrect accounting should have alerted the Council to a systemic problem with the care agency’s recording system. It is more probable than not, that other service users have been similarly affected. The Council is at fault here.
22. The delay caused Miss Y uncertainty and it is only through Mr X’s persistence and diligence that she has not suffered a greater injustice.
23. Mr X who is himself, a senior citizen, has suffered injustice. He has been put to significant time and trouble over a prolonged period, correcting invoices and raising the issue with the care agency and the Council. He should not have had to do so.
24. The Council’s apology to Mr X is not sufficient redress for the injustice caused.

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Agreed action

25. The Council should within four weeks of the final decision:

• apologise to Mrs Y, pay £100 for distress and act to prevent recurrence:
• apologise to Mr X and pay £250 for the time and trouble he has been put to pursuing this complaint with the Council and this office;
• provide a copy of the action agreed between the Council and the care agency, referred to in paragraph 17 & 18, and a timeline for completion for the action;
• submit the notes of the follow-up meeting referred to in paragraph 18 and any ongoing action plan.

26. Within three months:

• confirm if/how many other service users have been similarly affected and the action taken to remedy any injustice caused.

27. The Council should provide us with evidence it has complied with the above actions.

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Final decision

28. The Council failed to ensure Miss Y received accurate invoices for domiciliary care services from a care agency commissioned by the Council. The Council delayed in acting on numerous complaints about this.
29. The recommendations above are a suitable way to settle the complaint.
30. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman