Summary: The Council acknowledges it delayed for some time in issuing an invoice to Mr X for Mrs X’s care due to an error in its system; however, there is ample evidence the Council had explained charges would be made. The Council has offered a payment plan and will also offer the sum of £500 in recognition of the distress caused by its errors.

The complaint

1. Mrs A (as I shall call her) complains the Council delayed in issuing a large invoice for her mother’s care charges.

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

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What I found

Relevant law and guidance

5. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
6. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
7. If no suitable accommodation is available at the amount identified in the personal budget, the council must arrange care in a more expensive setting and adjust the budget to ensure it meets the person’s needs. In such circumstances, the council must not ask anyone to pay a ‘top-up’ fee. A top-up fee is the difference between the personal budget and the cost of a home.
8. The Council issues a leaflet “Paying to live in residential or nursing home care”. It says, “Once all the financial information has been gathered and the financial assessment has been completed, the Financial Administration team will calculate the assessed client contribution and will notify you of the client contribution. They will also issue an invoice to cover the period from the start of placement until the date the assessed charge is calculated. The invoice for this period is payable to the Council. From the period after the invoice has been issued the assessed contribution must be paid directly to the care home provider, separately from the top up fee mentioned elsewhere in this document.”

What happened

9. Mrs X was discharged from hospital to a care home in December 2020. The placement was initially made on a temporary basis while assessments could be undertaken and it was funded by the NHS to enable Mrs X’s hospital discharge.
10. In January 2021 Mrs X’s social worker spoke to Mrs A to confirm the placement would be made permanent. He explained that although the cost of the placement was higher than the Council would usually pay, as there was no other suitable provider in the area the Council would fully fund the care fees except for Mrs A’s own contribution. In February the social worker spoke to Mrs A to discuss signing the contract. The case recording shows he noted he “told her that although Walsall Council will be funding the placement her mum will be required to pay a contribution from her income. I told her that from her income, her mum will be allowed to keep a personal allowance of £24.90 and the rest will go towards her residential stay contribution.” In an email to Mrs A he confirmed, “In a nutshell, all your mother’s income will go towards contributing for her stay at (the care home) and she will only be allowed to keep a weekly personal allowance of £24.90.”
11. By December Mrs X’s needs had increased and the Council discussed a change of placement with Mrs A. The case recording shows that a further copy of the Council’s information leaflet about pay for care was sent to Mrs A. Mrs A was transferred to another home on 22 December. Emails from the social worker in February and March to Mrs A asked for her to complete relevant forms so the Council could pay the new home.
12. The case recording shows that an invoice for £6488.70 was raised on 1 June 2022 for Mrs X’s care from 3 February 2021 to 5 June 2022. The case recording adds “Home to collect from 06/06/22”.
13. On 29 June Mrs A contacted the Council as the family had received the invoice. She said during the whole time Mrs X had been in care she had been asking if there was anything to pay and Mr X was shocked to be sent such a large invoice.

The complaint

14. Mrs A complained to the Council in July 2022. She said she had been told repeatedly that there would be nothing to pay for her mother’s care. She said the delay of a year in invoicing the family was unacceptable and the debt should be cancelled.
15. A service manager responded in October. She did not uphold the first complaint. She said the case recording showed clearly that different social workers had explained to Mrs A that Mrs X would have to contribute towards the placement and had sent her explanatory leaflets about the charges.
16. The service manager apologized for the long delay in issuing the invoice. She said the placement had been recorded as a ‘short stay placement’ rather than a permanent placement until March 2022, which was why no invoices had been sent.
17. The service manager said the Council would not waive the charges as there was evidence the family had been given information there would be an assessment and a contribution would have to be made by Mrs X. She said however that the Council could offer a payment plan.
18. Mrs A did not receive the complaint response and contacted the Council again on 14 January: the Council emailed a further copy of the response on 23 January.
19. Mrs A complained again in March 2023. She said the Council had not resolved her concerns. She said Mr X had still not received a formal financial assessment to show how the contribution had been calculated.
20. The Council responded. It said it had nothing more to add except to send a copy of the financial assessment. Mrs A complained to the Ombudsman.

Analysis

21. The Council was at fault in the way it delayed in issuing invoices to Mr X for Mrs X’s care. The delay meant the arrival of a large invoice was a considerable shock to Mr X who believed there was nothing to pay. In my view the Council should acknowledge that distress further than with an apology.
22. There is evidence however that successive social workers explained to Mrs A that Mrs X would have to contribute towards the cost of her care. The email of 5 February 2021 was explicit that Mrs X would contribute all her income except for the personal expenses allowance. So I do not agree with the argument that social workers told Mrs A there would be nothing to pay.

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Agreed action

23. The Council has acknowledged there was an error in its system and offered to put in place a payment plan to make the accrued debt easier to manage. There is no reason why the Council should waive the charges, but the implementation of a payment plan would ease the burden of the large debt for Mr X. Within one month of my final decision the Council will discuss such a plan with Mrs A and Mr X.
24. Within one month of my final decision the Council will offer Mr X the sum of £500 in recognition that its delay in issuing an invoice caused distress.
25. Within one month of my final decision the Council will identify why there was an error in the classification of the placement and how that can be prevented from recurring.
26. The Council should provide us with evidence it has complied with the above actions.

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Final decision

27. I have completed this investigation. I find there was fault on the part of the Council causing injustice to Mr and Mrs X, which will be remedied by completion of the recommendations in paragraphs 23 – 25.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman