Summary: Ms X complained about how the Council charged for her care. The Council was at fault for delays during the assessment process after Ms X was discharged from hospital and failing to share important information about her care charges. The Council has agreed to remedy Ms X’s injustice.

The complaint

1. Ms X complained the Council charged for her for care which she thought was free and did not agree to pay for. She said the Council did not assess her finances correctly, it only looked at incomings not outgoings such as Disability Related Expenses.

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 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)

Back to top

How I considered this complaint

4. I considered Ms X’s complaint and spoke to her about it.
5. I also considered the Council’s response to Ms X and to my enquiries.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Legislation

7. In response to the Covid-19 outbreak, the NHS put in place special funding arrangements for hospital discharges and for hospital prevention. Initially this meant that people leaving hospital with additional care needs to those pre-admission would receive up to 6 weeks care paid for by the NHS. From July 2021, the NHS continued to fund this service but reduced the period to a maximum of 4 weeks.
8. For discharges under the Covid 19 pathway, the Council would normally provide a standard Covid 19 discharge letter. This letter advises “the NHS will pay for the social care and support needed by people leaving hospital, for up to a maximum period of four weeks or until a Social Care Assessment has been completed by Adult Social Care, whichever is sooner”.

What happened

9. Ms X lives alone. Pre-June 2022, she paid privately for a personal assistant to help her with cleaning, laundry, shopping, paperwork, finances and getting out into the community.

Discharge care and support charges

10. Ms X was admitted to hospital in June 2022. She was discharged home 6 weeks later with a care and support package delivered under the NHS Scheme 3 Covid 19 discharge pathway.
11. Ms X said she did not receive any information about care charges before she was discharged from hospital. In response to Ms X’s complaint, the Council acknowledged that there was no evidence that:
• it verbally explained the care charging.
• it provided Ms X with written information (Covid 19 discharge letter) about the discharge pathway and care charges.
• it provided Ms X with a copy of her care needs assessment.
12. In October 2022, the Council’s hospital team reviewed Ms X’s care scheme and transferred her to the neighbourhood support team. This should have taken place after 4 weeks. This amounted to a delay of 8 weeks. The Council said that it did not charge Ms X for care during this 12 week period as the Council was responsible for the delay in reviewing her scheme. From 3 October, the Council said Ms X became liable for a client contribution for care from this date onwards.

Financial assessment

13. At the end of September 2022, the Council referred Mrs X to the financial assessment team. This should have taken place in June when she was first admitted to hospital. This was delayed by 17 weeks. The Council completed a new financial assessment on 28 October 2022.

DRE Assessment

14. Shortly after receiving the financial assessment, Ms X provided information to support a review of her Disability Related Expenses (DRE). She requested that the Council consider her personal assistant as DRE. The Council completed the DRE assessment in March 2023. This did not respond to Ms X’s request.
15. Ms X complained and the Council investigated. It concluded in April 2023 that 7 hours of private personal assistant hours should be included in her care and support plan. Ms X’s personal assistant costs were backdated to 31 October 2022 which was when Ms X requested the DRE assessment.
16. In response to my enquiries, the Council reviewed Ms X’s case. It said it would have been appropriate to have applied the DRE review from the week commencing 3 October 2022, as it was the increase in care from this week that prompted Ms X to ask for a DRE assessment. The Council said it would credit £348.04 against Ms X’s outstanding balance.

My findings

17. The Council acknowledged that mistakes were made when handling Ms X’s care contributions. The Council was at fault for:
• Delaying the review of Ms X’s care and support plan after she left hospital.
• Delaying Ms X’s financial assessment.
• Delaying the review of Ms X’s care and support plan in January 2023.
• Failing to provide Ms X with information about care charges either verbally or in a written format when she was discharged from hospital.
• Failing to provide Ms X with a copy of her needs assessment.
• Failing to consider Ms X’s request to treat the cost of her personal assistant as Disability Related Expenditure (DRE).
18. Ms X initially suffered a financial injustice caused by the Council’s failure to back date her DRE to the point where her care needs increased (3 October 2022). The Council has acknowledged this and has agreed to credit Ms X’s account with the backdated DRE.
19. The delays in carrying out Mrs X’s review of her care and support plan after she was discharged from hospital benefitted Ms X financially. The NHS Scheme 3 Covid 19 pathway should only cover a maximum of 4 weeks after discharge or following reassessment. Ms X was not charged until 3 October when the Council carried out her care assessment rather than 11 August (4 weeks after discharge).
20. I recognise that the cumulation of all the delays and failure to provide information and a copy of her assessment caused Ms X avoidable distress. This distress included the uncertainty of what care and support she was entitled to and how much she needed to pay towards it. The Council has agreed to make Ms X a payment of £400 in recognition of this avoidable distress. This is in line with our approach to symbolic payments set out in our Guidance on Remedies.

Back to top

Agreed action

21. Within 4 weeks of my decision, the Council has agreed to:
1. Apologise to Ms X for the way it handled her care contributions following her discharge for hospital.
2. Pay Ms X £400 in recognition of the avoidable distress she suffered as a result of the Council’s fault.
3. Credit £348.04 against Ms X’s outstanding balance to account for the backdated DRE.
22. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

23. I have completed my investigation. I have found fault with the Council with the way it handled Ms X’s care contributions. This caused Ms X avoidable distress.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman