Summary: Ms X complained the Council delayed completing a financial assessment for her father and delayed issuing an invoice for his care. The Council was at fault. This caused Ms X undue distress. The Council should pay Ms X £300 in recognition of that distress, issue staff reminders and amend the information about paying for care in its leaflet on adult social care.

The complaint

1. Ms X complained the Council delayed completing a financial assessment for her late father, Mr Y, and delayed issuing an invoice for his care. She said the Council’s actions caused her significant distress and she should not have to pay Mr X’s outstanding care fees.

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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:
• all the information Ms X provided and discussed the complaint with her;
• the Council’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman's guidance on remedies.
5. Ms 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

Relevant law and guidance

Charging for care and support

6. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”.
7. 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. The financial assessment considers both the income and the capital the person has.
8. The Guidance says councils must “provide information to help people understand what they may have to pay, when and why and how it relates to people’s individual circumstances. This must include the charging framework for care and support, how contributions are calculated (for both assets and income) and the means tested support available, top ups and how care and support choices may affect costs”.
9. The Council has a leaflet titled ‘Information about Adult Social Care in Staffordshire’. It includes a section on paying for care, which notes “most people will have to pay something for their ongoing care and support. Many people have to pay the full cost”. It says the Council will carry out a financial assessment to decide how much a person has to contribute towards their care and that any fees will be backdated to the date the care started. The leaflet links to the Council’s website for more information on paying for care. The Council told me staff should share the leaflet at the beginning of the care process.

What happened

10. In February 2021, before Mr Y moved into a nursing home, the Council wrote to Ms X and asked her to complete a financial assessment form for Mr Y. The form stated Mr Y would have to pay a “nominal“ amount towards his care. It explained that once the Council had completed a financial assessment, it would ask Mr Y to pay the difference between what he should have been paying and the nominal amount, backdated to the date he started living in the nursing home.
11. Ms X completed the financial assessment form and returned it to the Council in late March 2021.
12. Mr Y moved into a nursing home in early April 2021.
13. Shortly after the move, the Council emailed Ms X to say “as I previously discussed with you, your father will need to pay a cost towards his care…the statutory contribution is £152.50 per week until the financial assessment has been completed which will then determine his total cost per week”. Ms X began making the weekly payment on behalf of Mr Y.
14. The Council completed the financial assessment in late May 2022 and says it sent a notification letter to Ms X. The letter stated Mr Y’s weekly contribution to his care costs would be just under £400 per week from April 2021. Ms X says she did not receive that letter.
15. In December 2022, the Council sent Ms X an invoice for Mr Y’s care that month. It still showed the indicative weekly amount. The Council told me this was because staff had not yet updated Mr Y’s case with the outcome of the financial assessment.
16. Mr Y died in January 2023. In early February, the Council wrote to Ms X to confirm the amount Mr Y needed to contribute towards his care in the nursing home. It said the difference between the amount Mr X should have paid per week and the nominal amount of £152.50 that he had been paying meant he now owed around £22,000. The Council said it would take the money via direct debit in early March 2023. The Council did not take payment and Ms X has not paid off any of the outstanding fees.
17. Ms X complained to the Council. In its response, the Council said it had delayed assessing Mr Y’s finances and issuing an invoice, but it was satisfied it had given Ms X information about the financial assessment process and had told her Mr Y’s accurate weekly cost in its late May 2022 letter. It said it sincerely apologised for the delays, which it said were due to unprecedented demand on its services. The Council said it had brought new members of staff in to cope with that demand.
18. The Council told me it hired new staff in June 2022 and again in October 2022. It said the demand on its financial assessment team had continued to increase so it had reviewed its processes to improve how it dealt with assessment requests. This included that it is in the process of creating a telephone financial assessment service which people could book at the same time as their needs assessment. It also said it had changed how it recorded financial assessments to decrease the amount of time between completing an assessment and sending an invoice for any outstanding amount.
19. I asked the Council about other people currently waiting for a financial assessment. It told me 1000 people are waiting for an assessment outcome. If people have submitted all the information necessary they currently wait, on average, three months for an assessment outcome.

My findings

20. The Council gave Ms X some initial information about how Mr Y would be expected to pay towards his care when it asked her to complete the financial assessment form, and again shortly after Mr Y moved into the nursing home. From that information, Ms X knew Mr Y would need to pay at least 152.50 per week towards his care, that the actual weekly amount would likely be higher and Mr Y would need to pay the difference in the care costs once the Council had finished its financial assessment. However, there is no record the Council shared the more comprehensive information the statutory guidance says it should. The Council has a leaflet which it is meant to share with people at an early stage. It did not do this and in addition, the leaflet does not contain all the information it should. This was fault.
21. The Council took thirteen months to complete Mr Y’s financial assessment, which it did in May 2022. This was a significant delay and was fault. The Council sent an invoice in December 2022 using the original weekly cost, which was incorrect and also amounts to fault. The fault occurred because staff had not yet updated Mr Y’s case with his financial assessment outcome.
22. Ms X says she did not receive the letter the Council sent in May 2022, which set out Mr Y’s new weekly contribution. Regardless, the Council took eight months after May 2022 to issue an invoice for the shortfall between the nominal contribution and the assessed contribution. This further delay was fault.
23. I am satisfied that in hiring more staff and changing its processes, the Council is taking sufficient action to improve the time it takes to do financial assessments. This is evidenced by the fact that the current wait time for an assessment outcome is three months. I am also satisfied the Council has taken appropriate steps to address the delay that occurred when staff did not update Mr Y’s case with the assessment outcome.
24. The Council’s February 2023 invoice stated Mr Y owed around £22,000 for his care and this sum would be taken by direct debit in early March. For such a large sum of money, the Council should have considered whether to offer Ms X a payment plan so she could pay in instalments. Its failure to do so was fault but it did not cause Ms X an injustice. This is because Ms X told me she would not have accepted a payment plan and does not think she should have to pay the outstanding fees.
25. Without the Council’s faults, Mr Y would still have been required to pay his contribution to his care costs. However, the faults set out in paragraphs 19-21 meant Ms X did not have an accurate idea of what Mr Y would pay towards his care and meant she experienced the shock of receiving a very large bill. This caused her significant avoidable distress. The Council has made a sincere apology to Ms X, which I welcome, but it should also make a symbolic payment in recognition of her injustice. I have made a recommendation to that effect below.

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Agreed action

26. Within one month of the date of my final decision, the Council will take the following actions.
1. Pay Ms X £300 in recognition of the distress she experienced due to the faults set out in paragraphs 20-22.
2. Remind staff they must share the Council’s leaflet on adult social care at the start of their involvement with a person for whom the Council is arranging care for the first time.
3. Remind staff they should consider whether to offer a person paying for care a payment plan where the Council’s delay in carrying out a financial assessment will result in it sending a large invoice.
27. Within three months the Council will review its leaflet about adult social care to ensure it explains a person should expect to pay most of their income towards their care. The Council will also review its leaflet so it sets out the average cost of common types of care. For example, the average weekly cost of living in a nursing home or a care home and the average hourly cost to receive care at home in the day, on the weekend or at night.
28. The Council should provide us with evidence it has complied with the above actions.

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Final decision

29. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman