Summary: Mr X complains on behalf of Mr Y, about delays in completing Mr Y’s financial assessment and issuing invoices, incorrect care charging, and failure to explain Mr Y’s care costs. We find the Council at fault which caused Mr X avoidable uncertainty, frustration, and distress. The Council has instigated service improvements to prevent recurrence which is a partial remedy. It should also apologise to Mr X and make a symbolic payment to him to address the injustice caused.

The complaint

1. Mr X complains on behalf of his late father (Mr Y) that the Council:
1. Delayed issuing an invoice for Mr Y care costs due to a delayed financial assessment.
2. Subsequently issued an incorrect invoice.
3. Failed to explain how it calculated Mr Y’s final care charges.
2. Mr X says the Council’s actions caused him and his family uncertainty, distress and inconvenience trying to resolve the complaint.

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The Ombudsman’s role and powers

3. 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 future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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

5. During my investigation I spoke to Mr X to discuss his complaint and considered information he provided. I also made enquiries of the Council and considered its response.
6. Mr X and the Council had an opportunity to comment my draft decision. I considered their comments before making a final decision.

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What I found

Relevant law and guidance

7. The LGSCO’s Principles of Good Administrative Practice says we expect councils to act fairly and proportionately and to be open and accountable. This includes:
• Making timely decisions and explaining any delays;
• Explaining clearly the rationale for decisions and recording them;
• Stating the criteria for decision-making and giving reasons; and
• Keeping proper and appropriate records.
8. A council must provide local people with information and advice about care and support for adults and support for carers. (Care Act 2014, section 4)
9. Care and Support Statutory Guidance (CSSG) is statutory guidance which councils should normally follow. It says councils can charge people for care they provide and if there is a charge, this should follow national regulations on charging. I have summarised relevant paragraphs of CCSG below:
1. Care and support should put people in control of their care. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan. The plan must detail the needs to be met and how the needs will be met. (Paragraph 10.1 and 10.31)
2. Upon completion of the plan, the local authority must give a copy of the final plan which should be in a format that is accessible to the person for whom the plan is intended, any other person they request to receive a copy, and their independent advocate if they have one and the person agrees (Paragraph 10.87)
3. Councils must be transparent, so people know what they will be charged. There should be enough information available so they can understand any charge. (Paragraphs 8.2 and 8.3)
4. Where a local authority has decided to charge, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. It should explain how the assessment has been carried out, what the charge will be and how often it will be made, and if there is any fluctuation in charges, the reason. (Paragraph 8.16)

What happened

10. The available records show:
• In 2019, Mr X’s late father (‘Mr Y’) had home care visits. He was financially assessed and paid a weekly personal contribution towards his care costs.
• In November 2021, Mr Y had a financial assessment review. Mr X provided the Council with the completed forms and relevant information.
• Mr Y continued to receive care in 2022 but was not issued with a financial assessment outcome letter.
• In 2022, Mr Y’s health deteriorated, and he spent periods hospital and then in palliative care from April.
• In July 2022, the Council reviewed Mr Y’s care records and realised it had not completed his financial assessment. It decided to complete the process by obtaining outstanding information from Mr X and backdate Mr Y’s care charges.
• Mr Y passed away in late September 2022.
• The Council then contacted Mr X and his sister (Ms N) from November until early 2023 to obtain further information to complete Mr Y’s financial assessment.
11. In late January 2023, the Council issued Mr Y’s backdated care invoice.
12. Mr X emailed the Council and said:
• He had asked the Council to resolve the costs since 2021 He queried the reasons for the long delay in issuing the invoice.
• The invoice was incorrect as it included charges for periods Mr Y was in hospital.
• The Council’s errors were causing him and his sibling’s distress at an already difficult time.
13. In response the Council:
• Apologised for the delay in issuing the care invoice. It said this was due to a large backlog of cases needing financial assessment.
• Confirmed the periods when Mr Y was in care and hospitalised.
• Said it would correct the invoice.
14. The Council then issued a revised invoice for Mr Y’s care costs.

Mr X’s complaint

15. Mr X did not accept the revised invoice was accurate. He explained that he had lost confidence in the Council’s processes and complained about the issues he has raised with us.

The Council complaint responses

16. In its initial response the Council:
• Reassured Mr X the revised invoice was accurate. It said the previous invoice had been delayed and was incorrect because:
1. There was a backlog in financial assessments as it used to operate on a manual system. It was now updating its records to an electronic digital system.
2. The Council had reduced staff but higher workload during the assessment period. There was also a breakdown in communication between its care assessment and finance teams which meant it had not updated its records for periods when Mr Y was in hospital.
3. The accounts team erroneously included charges for periods when Mr Y had been in hospital and gone into palliative care. It apologised for the oversight. It also provided a statement with a breakdown of all costs and periods to confirm the invoice was accurate.
• Accepted Mr Y’s case had been poorly managed and caused Mr X and sibling’s distress. It apologised and said steps were being taken to prevent recurrence including reviewing its recording processes and recruiting further staff.
17. Mr X was not satisfied with the Council’s response and escalated his complaint.
18. In its final response, the Council reiterated its apology and upheld its initial position.
19. Unhappy with the Council’s response, Mr X approached the Ombudsman.

Council’s response to our enquiries

20. In response to our enquiries the Council:
• Provided records of Mr Y’s care charges and a breakdown of its calculations These records confirm the Council’s initial calculations were inaccurate. But its final revised invoice appears to be consistent with the care Mr Y received. Mr X also told me that he eventually also accepted the final invoice was correct, but it had caused him a lot of uncertainty, frustration and distress trying to resolve the situation.
• Provided internal emails which indicate it did not update Mr Y’s care and support plan with his financial circumstances at various stages between late 2021 and late 2022. This resulted in an inaccurate invoice being generated in January 2023, which was later corrected.
• Confirmed it had taken the following action since Mr X’s complaint:
1. Recruited further assessment staff and filled all vacancies to improve its capacity to deal with financial assessments.
2. Undertook an external review of its financial assessment process and was implementing a new system and providing staff training.
3. Introduced new performance monitoring measures for financial assessments and significantly reduced its financial assessments backlog.
4. Revised its processes to ensure support plans were updated and shared promptly across its relevant teams.
5. Introduced case audits so cases will be reviewed on a regular basis to identify any common themes and training and development needs within the teams.

Was there fault and did it cause injustice?

i) Mr X says the Council delayed issuing an invoice for Mr Y’s care costs due to a delayed financial assessment.

21. The evidence shows Mr X submitted Mr Y’s financial assessment form in November 2021. The Council was then required to undertake the assessment in line with the Care and Support Statutory Guidance (CSSG) set out at paragraphs 9 (c) and (d) (above). The Council should have completed its assessment and provided a written record to Mr Y, so he was clear about what he would be paying. The CSSG does not set a time limit for the assessment process, but our guidance and expectations would be for the Council to do so in a timely manner or keep the applicant informed of any unavoidable delays (Paragraph 7).
22. The evidence indicates the Council’s processing of Mr Y’s financial assessment was inconsistent with the guidance explained at paragraph 21 (above). I note the Council only became aware of Mr Y’s outstanding financial assessment in July 2022. It then completed the assessment between August 2022 and late January 2023 and then issued a backdated invoice for Mr Y’s care costs after he had passed away. I understand the Council has explained it was understaffed at the time, had higher workloads and there were errors in communications as a result. However, it still had a duty to ensure Mr Y was aware of his care costs and process his application without undue delay. Based on the evidence, I find the Council excessively delayed completing Mr Y’s financial assessment. The Council has also accepted this position and apologised to Mr X. The available records also do not show the Council informing Mr Y or Mr X about the reasons for the delay and this is poor communication and customer service. Its failure to update Mr Y’s care and support plan with relevant changes in his care circumstances was also inconsistent with its duties as set out at paragraph 9 (a) (above) and is fault. In totality, it meant Mr Y and Mr X who was helping him with his financial assessment, experienced avoidable uncertainty, and frustration about what the likely costs would be, reasons for the delay and Mr X eventually experienced further distress after being sent an initial incorrect invoice. This is injustice.

ii) Mr X says the Council subsequently issued an incorrect invoice

23. The Council accepts its initial invoice for Mr Y’s care costs was incorrect. The evidence says it was caused by a failure to update Mr Y’s care and support plans at various stages when his care circumstances changed. This included periods when he was admitted to hospital and later became fully funded upon starting palliative care. The Council’s failure to keep Mr Y’s records updated is fault and resulted in the Council issuing an incorrect invoice. Mr X then had to resolve the inaccuracies during a period of bereavement after Mr Y had passed away, this caused him further avoidable distress and frustration. This is further injustice.

iii) Mr X says the Council failed to explain how it calculated Mr Y’s care charges

24. The Council’s records show its corrected final invoice is consistent with the care Mr Y received. It takes account Mr Y’s hospital admissions and palliative care periods. Mr X also confirmed that he ultimately accepted the invoice was accurate but checking it caused him frustration and distress during a period of bereavement. I do not find fault in relation to this aspect of Mr X’s complaint. However, I sympathise with Mr X about any anxiety and distress he may have experience on receiving the new invoice given the other faults identified in this statement.
25. Normally where we find fault, we go on to recommend an organisation makes improvements to its service. However, in this case I have not made any such service improvements, as I am satisfied at this stage, that the Council has properly investigated the reasons for the financial assessment delays and instigated focused and appropriate measures to prevent recurrence as set out at paragraph 20 (above), this is welcomed by the Ombudsman.

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Agreed action

26. Within one month of my final decision, the Council has agreed to:
• Write to Mr X and apologise for the delay in completing Mr Y’s financial assessment, delays in issuing Mr Y’s care invoice and for issuing an incorrect initial invoice and any avoidable uncertainty, frustration and distress caused to him.
• Make a symbolic payment to Mr X of £200 in recognition of his avoidable uncertainty, frustration and distress.
27. The Council should provide us with evidence it has complied with the above actions.

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Final decision

28. I find fault which caused Mr X uncertainty, frustration, and distress. The Council has instigated suitable service improvements to prevent recurrence. However, it should also apologise and make a symbolic payment to Mr X to address the injustice caused.
29. I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman