Summary: We upheld Mr X’s complaints about not providing him with information on charging and about the assessment of his needs. The Council did not complete a needs assessment in line with the Care Act 2014 and did not give Mr X full written information about charges. This caused avoidable confusion and distress. The Council will apologise, reduce the invoice by £250 and take action described in this statement to minimise the risk of the same thing happening again.

The complaint

1. Mr X complained the Council:
1. Did not assign him a social worker;
2. Did not provide him with information about charging in writing so that he could understand it;
3. Did not assess him or provide equipment until seven weeks after his discharge from hospital; and
4. Issued invoices with mistakes.
2. Mr X says this caused avoidable confusion and distress. He wants the charge waived.

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The Ombudsman’s role and powers

3. Our service is free, but we use public money carefully. We do not start or continue an investigation if we decide:

• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organization.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. The Council and NHS have a joint health and social care team providing intermediate care (see paragraph 14) called the Community Independence Service (CIS) Home First which offers services at home to help people avoid unplanned hospital admissions. It provides short-term nursing, occupational therapy and physiotherapy to people with immediate health or functional needs who would otherwise need to be in hospital.
6. 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)
7. 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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What I investigated

8. I investigated complaints (a) to (c). I did not investigate (d) because Mr X said the Council issued credit notes after he explained the errors in its invoices. My view is the Council’s actions resolve his complaint, I have nothing further to add by investigating and there is no significant outstanding injustice to Mr X

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How I considered this complaint

9. I considered the complaint to us and the Council’s response as well as documents described later in this statement.
10. Mr 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

What should have happened

11. A council must carry out an assessment for any adult with an appearance of need for care and support (a needs assessment). The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. (Care Act 2014, section 9)
12. An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs. (Care and Support Statutory Guidance 2014, Paragraph 6.24)
13. A council has a power to meet urgent needs before completing a needs assessment or financial assessment. (Care Act 2014, section 19(3))
14. Intermediate care is a structured programme of care provided for a limited time to help a person maintain or regain the ability to live independently. It can be bed-based or community-based. Reablement is a type of intermediate care which has a focus on helping the person regain skills and reducing their needs through providing services in the home. (The terms reablement, rehabilitation and intermediate care are often used interchangeably.) (Care and Support Statutory Guidance (CSSG) Paragraphs 2.12 to 14)
15. Care and support funded by a council is chargeable unless it is intermediate or reablement care. People who have savings over £23,250 must pay the full cost.
16. Councils must be transparent so people know what they will be charged. There should be enough information available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3)
17. Service providers like councils, must not treat someone worse just because of one or more “protected characteristics” including a disability. The service provider is under a positive and proactive duty to look at removing or preventing obstacles to a disabled person accessing its services. If the adjustments are reasonable, it must make them. (Equality Act 2010, section 20)

What happened

18. Mr X is elderly and has hearing loss. The complaint is about the Council’s involvement with him during and after a hospital admission in May 2023 to treat a broken hip socket and wrist.
19. A social worker visited Mr X on the ward at the start of May to discuss a care package. The social worker’s case note said Mr X had high frequency hearing loss making it hard for him to hear female voices and so she used a mix of speech and writing to communicate with him. I have seen the handwritten notes that she used to communicate with Mr X. They indicate the social worker discussed a care package with Mr X with four calls a day. She wrote there was charge for care and he had over £24,000 in savings. Mr X was not able to bear his own weight and was set up at home in one room.
20. Mr X went home on 12 May. An occupational therapist (OT) from the CIS Home First team visited him on 13 May. They completed a medical history and assessed his ability to transfer. He was set up to live in one room temporarily while recovering after surgery, with a commode and a urine bottle. The OT noted Mr X was very hard of hearing and he needed assistance with washing, meal preparation, prompting for medication and assistance with food shopping. Mr X’s partner was due back from holiday within two weeks. He was finding it hard not to weight bear, although he was not supposed to. The OT provided Mr X with information about a pendant alarm for Mr X to use to call for help if he had a fall. The OT noted that they discussed rehabilitation, but Mr X was not ready for this until he could weight bear. The OT gave Mr X contact details for the rehabilitation team to refer himself.
21. For the first night, the NHS provided Mr X’s home care, then an agency commissioned by the Council took over.
22. The Council did not provide me with any evidence it sent Mr X an information leaflet about charging.
23. Mr X and his friend spoke to the finance team in the last week of May and told them Mr X did not want a visit from the finance team to complete the financial assessment. So the finance team sent him the financial assessment form in the post. Mr X’s friend spoke to the finance team again a week later and said Mr X didn’t want a financial assessment and he had savings over £23,250.
24. The social worker went to see Mr X at the fracture clinic on 8 June. Mr X told me he had asked to see the social worker. Mr X denied she told him about the charge for his care and said he was told care would be free – possibly by an NHS therapist. He said he would not have agreed to care if he had known how much it would cost. The social worker agreed to cancel Mr X’s care and did so after the visit.
25. At the end of June, another OT from the CIS team visited Mr X. His friend was present to assist with communication. Mr X said he was mobilising well with a stick and was only wanting bathing and toileting equipment to facilitate transfers. The OT ordered a bath board and toilet frame. She provided a home exercise programme for Mr X and they practiced indoor moving and using steps.
26. Mr X was unhappy with the charge for his care and with the service he had received and so complained to the Council.
27. The Council’s response to the complaint said:
• Reablement care was not appropriate because Mr X could not use his left arm and was considered not weight bearing. This means he had standard social care which is chargeable.
• The referral indicated Mr X was hard of hearing but could lip read and could respond if information was written down or with close speaking.
• A hospital social worker visited him on the ward at the start of May and wrote down the proposed care provision of four visits a day. She also advised about charges and provided a copy of a financial assessment form. He consented to the care discussed.
• He was discharged home with a temporary service commissioned by an NHS trust, which was free. This was provided for 24 hours until the Council commissioned care agency took over.
• A senior OT visited him at home the day after he was discharged and reviewed his mobility. They noted clear communication was possible with lip-reading.
• The same hospital social worker met him and his friend in June at the fracture clinic to discuss his wish to cancel care. He did not remember the discussion about charges and thought care was free.
• There was a further OT visit at the end of June and equipment was provided.
• The OT offered another visit in July, but this was declined and so he was discharged.
• The hospital social worker provided information about charging in writing. It was reasonable that the charge remained in place.
• He confirmed he had saving above £23,250. So he was charged full cost.
28. Unhappy with the Council’s response, Mr X complained to us.

Findings

The Council did not assign him a social worker

29. There is no legal entitlement to a social worker. So the failure to allocate Mr X a social worker was not fault.

The Council did not provide him with information about charging in writing so that he could understand it

30. The social worker identified Mr X’s communication needs and made adjustments by making written notes while she was speaking to Mr X. This was in line with the duty to make reasonable adjustments. On the evidence available, the social worker told Mr X he would need to pay for his care when they first met when Mr X was still in hospital. However, the social worker should have given Mr X the Council’s standard leaflet on charging for social care so he had full information about the charge and how this would be calculated. This was a failure to act in line with paragraphs 8.2 to 8.3 of Care and Support Statutory Guidance and was fault causing avoidable confusion and distress about the amount Mr X would have to pay.
31. The evidence indicates Mr X was told verbally about the savings limit for care by the finance team and this was when he first realised he would have to pay the full cost. He declined a visit from the finance team on 22 May and his friend said he had savings over £23,250 at the start of June. On a balance of probability, Mr X was aware he was required to pay for the full cost of his care on 22 May.

The Council did not provide or assess him for equipment until seven weeks after his discharge from hospital.

32. The law allows councils to provide urgent social care services before completing a needs assessment. Mr X’s case was urgent as he needed care and was ready to be discharged from hospital. There is no fault in the hospital social worker organising the care package before a needs assessment was done.
33. The CIS Home First Team is a health and social care team. It acts for the Council in providing services the Council is required to provide under the Care Act 2014. An OT from the CIS Home First Team assessed Mr X the day after he came home. At that time, he was not supposed to bear weight and so did not require equipment so there was no fault in not providing it. The OT completed a needs assessment. The needs assessment set out the care the OT considered Mr X required (assistance with washing, meal preparation, prompting for medication and assistance with food shopping.) The assessment did not describe Mr X’s desired outcomes or the impact on his wellbeing. This was not in line with Section 9 of the Care Act 2014 and was fault.
34. A second OT from the CIS Home First Team visited Mr X at the end of June. She assessed his mobility and provided guidance and ordered the equipment he requested. There was no discussion of the impact on Mr X’s wellbeing or his desired outcomes. The Council did not act in line with Section 9 of the Care Act 2014 or Paragraph 6.24 of Care and Support Statutory Guidance and this was fault.
35. Mr X had already cancelled care and so the injustice to him of not receiving a timely assessment that was in line with Section 9 of the Care Act 2014 is not clear.

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Agreed action

36. Within one month of my final decision, the Council will:
• Apologise to Mr X for not providing him with timely and appropriate written information about the charge for his care;
• Reduce the outstanding charge by £250 to reflect the avoidable distress and confusion;
• Remind social workers in the hospital team to give clients charging leaflets and to make a note of this on the case record; and
• Remind staff in the CIS Home First term to refer clients back to the Council for full Care Act social care needs assessments when clients require long-term care packages.
37. The Council should provide us with evidence it has complied with the above actions.

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Final decision

38. We uphold Mr X’s complaints about not providing him with information on charging and about the assessment of his needs. The Council did not complete a needs assessment in line with the Care Act 2014 and did not give him full written information about charges. This caused avoidable confusion and distress. The Council will apologise, reduce the invoice by £250 and take action described in this statement to minimise the risk of the same thing happening again.
39. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman