Summary: Mrs B says the Council failed to provide her with advice or information about care options when the care provider increased her care costs, sent her an incorrect bill, wrongly closed her case and failed to explain why the large increase in costs was justified. The Council failed to provide Mrs B with alternatives when telling her about the increased care costs, delayed providing her with further information and sent her an incorrect invoice. An apology, payment to Mrs B and reminder to officers is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Mrs B, complained the Council:
• delayed transferring her to a full cost payer in 2022;
• initially closed her case which resulted in the care provider increasing the charge to reflect private rates for care;
• failed to provide her with any advice or information about care options when the costs increased;
• failed to explain why the large increase was justified and why the charge was higher than other care providers;
• failed to give her any advice about the quality of the alternative care providers it gave her details of; and
• sent her an incorrect bill which failed to take into account the 28 day notice period that applied.
2. Mrs B says as a result she has experienced unnecessary anxiety and is now paying more in care costs than other care providers charge.

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The Ombudsman’s role and powers

3. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a Council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. 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)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

7. I have investigated Mrs B’s concerns about what happened when the Council transferred her to a full cost payer. I have not investigated Mrs B’s concerns about the delay taking that action because I am satisfied that was resolved in May 2022 which is more than 12 months before the complaint to the Ombudsman. I see no reason why Mrs B could not have complained to the Ombudsman at the time and therefore I am not exercising the Ombudsman’s discretion to investigate that period.

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How I considered this complaint

8. As part of the investigation, I have:
• considered the complaint and Mrs B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
9. Mrs B and the organisation 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

The Care and Support Statutory Guidance (the statutory guidance

10. This says people with eligible needs and financial assets above the upper capital limit may ask the local authority to meet their needs.
11. Local authorities should take steps to make people aware they have the right to ask the local authority to meet their needs, in certain circumstances even when they have resources above the financial limits and would not be entitled to financial support with any charges. Local authorities should also offer support to people in meeting their own needs, including providing information and advice on different options, and may offer to arrange contracts with providers.
12. A local authority will be under a duty to meet a person’s eligible needs when requested to do so and their needs are to be met by care and support other than in a care home. However, where the person has resources above the financial limits the local authority may charge the person for the full cost of their care and support. In such circumstances, the person remains responsible for paying for the cost of their care and support, but the local authority takes on the responsibility for meeting those needs. This means that the local authority may for example provide or arrange care and support, or make a direct payment which may be a paper based exercise, or some combination of these.
13. The local authority must assure itself that whilst the person remains responsible for paying for their own care, they have sufficient assets for the arrangements that it puts in place to remain both affordable and sustainable.

What happened

14. Mrs B was receiving care from a care provider, arranged by the Council. In 2022 Mrs B inherited some money which meant she no longer qualified for Council funding as her capital exceeded the capital limit. That meant Mrs B had to pay for her own care. Mrs B contacted the Council about that. At that point the care provider was charging £22.49 per hour.
15. The Council terminated the care contract in July 2022. That prompted the care provider to write to Mrs B about the hourly charges for privately funded clients. That hourly charge exceeded the charge Mrs B previously paid. Mrs B contacted the Council and told it she wanted to continue to receive her invoices from the Council and for everything to continue as before. The Council contacted the care provider and put in place a new contract, backdated to July 2022.
16. In January 2023 the Council wrote to Mrs B to tell her the care provider had increased its charge from £20.81 per hour to £30.76 per hour. The Council said the change would take place after the minimum 28 days notice period and would be effective from that date.
17. Mrs B raised concerns about the increase in care costs and asked why the cost was so high. Mrs B asked whether other care providers charged a similar rate and asked for details of alternative options.
18. Mrs B’s MP also contacted the Council. When responding to Mrs B’s MP the Council said it would review Mrs B’s care package to see if there was an alternative provider.
19. In March 2023 Mrs B received an invoice for the period 30 January 2023-26 February 2023 at £30.76 per hour. Mrs B contacted the Council about that because this was during the 28 days notice period and should therefore have been charged at the lower rate. The Council sent an amended invoice.
20. Mrs B put in a complaint about how the increased cost had been handled. In response the Council said if Mrs B wanted it to do so it could get her some costings from other care providers. On 9 May Mrs B asked the Council to do that. The Council provided those details on 16 May and told Mrs B to contact it if she wanted the Council to arrange a change to an alternative provider.
21. Later in May Mrs B contacted the Council again for more information about the quality of care provided by the other care providers. Mrs B also asked for some further information about the increase in costs. Mrs B chased the Council on 31 July. On 2 August the Council wrote Mrs B to tell her care providers’ hourly rates varied across the district and the increase in this case followed a sustainability application to the Council.
22. On 11 August Mrs B asked the Council again to provide details of the quality of care for the alternative care providers. The Council wrote Mrs B on 21 September and suggested she visit CQC’s website.

Analysis

23. Mrs B says the Council closed her case when she inherited some money which meant the care provider put her on a private contract which increased her costs. Mrs B says it took time to sort that out and created unnecessary stress.
24. I can see from the documentary records the Council ended the contract with the care provider July 2022. Given the later communications it is clear there was a misunderstanding about whether Mrs B wanted to continue with a private contract with the care provider or remain with the care arranged by the Council. I do not have any evidence though to show where the misunderstanding lay. It is possible the Council misunderstood what Mrs B had asked for. However, it is also possible Mrs B did not make clear she wanted to remain with the Council handling the care arrangements. In those circumstances I cannot reach a safe conclusion about whether the confusion over the contract was due to fault by the Council.
25. Mrs B says the Council failed to give her any advice or information about alternative care options when the care provider increased its costs from £20.81 per hour to £30.76 per hour. The Council accepts it did not give Mrs B any advice or information about alternative care options at that point. Given this was a significant increase in cost I would have expected the Council to explore with Mrs B whether she felt able and willing to fund the increase in costs or whether she wanted to look at an alternative provider. Failure to do that is fault. I am also concerned the Council failed to provide Mrs B with that information until May 2023. That is despite the fact Mrs B asked for details of alternative providers in January 2023 and when responding to her MP in February 2023 the Council said it would review the care package to see whether there was an alternative provider. Delay doing that is fault.
26. I note though that despite Mrs B having details of alternative cheaper providers she has not moved from the care provider which now charges £30.76 per hour. In those circumstances I do not consider it likely, on the balance of probability, if the Council had discussed alternative options with Mrs B at the time she would have taken on a new provider.
27. In reaching that view I am aware Mrs B is concerned about the Council failing to provide her with information about the alternative care providers it gave her details of. I recognise Mrs B wanted the Council to give her some advice about the quality of the services provided by those other care providers. I understand why Mrs B would have wanted that. However, that is not the Council’s role. I am satisfied though the Council provided Mrs B with details of other providers and directed her to the CQC website for the latest inspection details. That is what I would expect the Council to do. There was, however, further delay directing Mrs B to the CQC website which is also fault.
28. I understand Mrs B’s concern about the increased cost and whether it is justified given it represents a significant increase on the charge originally in place. However, as I said earlier, it was open to Mrs B to seek a cheaper care provider had she wanted to do so. I am satisfied Mrs B has not done so despite having details of alternative cheaper care providers.
29. The Council was also at fault in this case for sending Mrs B an invoice for the period 30 January 2023-26 February 2023 at the increased rate when that period was part of the 28 days notice period when the lower rate still applied. That is fault, although I am satisfied it was later corrected by the Council.
30. So, I have found fault as there were delays providing Mrs B with details of alternative providers, in directing her to the CQC website and in sending her an incorrect invoice in March 2023. I am satisfied that caused Mrs B distress and left her in the position of not having sufficient information to make an informed decision about what to do between January and September 2023. Taking into account the fact Mrs B has not changed care providers since receiving information about alternatives from the Council I consider an apology and payment of £100 satisfactory remedy. I also recommended the Council ensure officers discuss with service users whether they want the Council to continue to arrange care when they move from a Council funded service to paying for care themselves. The Council has agreed to my recommendations.

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Agreed action

31. Within one month of my decision the Council should:
• apologise to Mrs B for the distress and upset she experienced due to the faults identified in this decision. The Council may want to refer to the Ombudsman’s updated guidance on remedies, which sets out the standards we expect apologies to meet;
• pay Mrs B £100;
• send a reminder to officers dealing with social care service users about the need to ensure a discussion takes place about how the service user wants their care to continue if they move from being funded by the Council to being a full cost payer.

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Final decision

32. I have completed my investigation and uphold the complaint.

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Investigator's decision on behalf of the Ombudsman