Summary: Mrs X complained about the Council’s decision to charge her mother, Mrs Y, for her care and support, after first saying there would be nothing to pay. We did not find the Council said Mrs Y would not have to pay for her care and support. However, we found the Council was at fault for not providing clear charging information in writing at the start, and for significant delays completing a financial assessment. But we found no fault in the way the Council completed Mrs Y’s financial assessment.

The complaint

1. Mrs X complained about the Council’s decision to charge her mother, Mrs Y, for her care and support, after first saying there would be nothing to pay. Mrs X said the Council did not give enough information about charging and the financial assessment process at the outset.
2. Mrs X also complained there was a delay with the financial assessment, meaning Mrs Y owed a significant sum in backdated charges.

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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 the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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)

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How I considered this complaint

6. As part of the investigation, I considered the complaint and the information Mrs X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. Mrs X and the Council now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.

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What I found

Charging for social care services

9. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
10. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
11. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
12. A financial assessment should be carried out over an appropriate and reasonable timescale. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process. (Care and Support Statutory Guidance, Paragraph 6.29)
13. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
14. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included.

Capital limits

15. The capital limits set the levels of capital (excluding any capital that has been disregarded) that a person can have while qualifying for financial support from their local authority.
16. The current upper capital limit is £23,250. The current lower capital limit is £14,250.
17. A person with assets above the upper capital limit is responsible for the full cost of their care. A person with assets between the capital limits will pay what they can afford from their income, plus a means-tested contribution from their assets. A person with assets below the lower capital limit will pay only what they can afford from their income.

What happened

18. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
19. Mrs X spoke with a social worker about Mrs Y’s care needs on 6 October 2022. Mrs X was due to leave hospital and could not manage her own personal care. The social worker offered reablement care, which would be free for up to six weeks. Mrs X did not feel this was suitable, due to Mrs Y’s age and health conditions. She said Mrs Y wanted to remain at home. She asked the social worker to visit Mrs X to complete an assessment and discuss different options.
20. The social worker met with Mrs X and Mrs Y on 13 October 2022 to assess Mrs Y’s needs. The social worker’s notes record they spoke about the financial threshold of £23,250. Mrs X said Mrs Y does not have any savings and was happy for the Council to do a financial assessment. The social worker also recorded they gave Mrs X paperwork about the financial assessment process and charging. Mrs X disputes this.
21. After the meeting, the social worker recorded Mrs Y needs support with personal care, meal preparation, and medication. They proposed Mrs Y should have a carer visit twice a day, morning and evening. A manager agreed. The social worker then made a referral to the Council’s financial assessment team on 18 October 2022.
22. A care provider, sourced by the Council, agreed to care for Mrs Y in November 2022.
23. The Council wrote to Mrs Y on 18 November 2022. It confirmed her personal budget was £284.54 per week. It said, following her financial assessment, she may need to pay a part of this cost. It said it would tell her about this separately.
24. The Council’s financial assessment team wrote to Mrs Y on 5 June 2022. It apologised for the delay and explained the assessment process. It said it could confirm the weekly amount Mrs Y would have to pay once it completed her assessment.
25. Mrs X asked the Council for an information pack so she could give details of Mrs Y’s finances. She returned the financial assessment forms in July 2022.
26. The Council wrote to Mrs Y with the result of its financial assessment on 3 August 2022. It calculated Mrs Y must contribute £102.22 per week towards the cost of her care from 22 November 2022, and then £114.27 per week from 10 April 2023 going forward. This meant Mrs Y had to pay charges backdated to the time her care package started.
27. On 11 September 2023, Mrs X asked to make a complaint or appeal against Mrs Y’s financial assessment. Mrs X said:
• There were several appointments with the Council, and each time it told her Mrs Y would not have to pay for her care, as she had no savings or income. This was repeated by the care provider.
• She went through Mrs Y’s finances with a social worker on 13 October 2022 and they said Mrs Y would not have to pay.
• She thought the financial assessment took place at home, so she was surprised when someone from the Council’s financial assessment team contacted her.
• Charging Mrs Y would cause her financial hardship.
28. The Council’s financial assessment team agreed to review Mrs Y’s financial assessment. It asked Mrs X to send details of Mrs Y’s DRE, which she did.
29. The Council sent a revised financial assessment for Mrs Y on 26 September 2022. It reduced her charge to £63.05 from 22 November 2022, and to £75.10 from 10 April 2023 going forward. Mrs Y still had to pay backdated charges.
30. Mrs X thanked the Council for the revised assessment, but argued it misinformed her at the start and she wanted to appeal. She said Mrs Y should not have to pay backdated charges because the situation arose through no fault of her own.
31. The Council’s first complaint response, dated 13 November 2023, said a social worker gave information about personal contributions and financial assessments when discussing Mrs Y’s need for long term care.
32. In the Council’s final complaint response, dated 29 November 2023, it said a social worker told Mrs X that Mrs Y needed a financial assessment for her support, which Mrs X agreed. It said it found no evidence anyone told Mrs X that Mrs Y would not need to pay for ongoing care. It apologised it took several months to arrange a financial assessment.
33. Mrs X remained dissatisfied and brought her complaint to the Ombudsman in December 2023.
34. Sadly, Mrs Y died in early 2024 and the Council closed her care package. The total outstanding care charges are £4,619.04.

My investigation

35. The Council told me Mrs Y left hospital through the supported discharge pathway, which is a non-chargeable interim care service. A social worker discussed reablement care, which Mrs X declined. They also discussed the Council’s charging policy and means testing. As Mrs Y’s assets were below the financial threshold, Mrs X agreed for the Council to undertake a financial assessment to identify what charges would be due towards the cost of Mrs Y’s care.
36. The Council said there is no evidence it told Mrs X or Mrs Y that long term care would be free.
37. The Council provided me with copies of letters the adult social care and financial assessment teams sent to Mrs X or Mrs Y. It told me its standard practice is to send information leaflets to customers before the financial assessment referral. However, the Council has no record of what leaflets, if any, it sent in this case.

Analysis

38. Mrs X said the social worker told her Mrs Y would not have to pay for her care. However, the only evidence of this comes from Mrs X’s own recollection, and in her emails to the Council when challenging the financial assessment. I reviewed the Council’s case notes and its correspondence with Mrs X and Mrs Y. I have not seen evidence from the Council’s records that it said Mrs Y would have nothing to pay.
39. Where there is conflicting evidence about what happened, we make findings based on the balance of probabilities, or what we think is more likely to have happened.
40. On balance, I find it is more likely the Council did not tell Mrs X that Mrs Y would have nothing to pay.
41. The social worker recorded they discussed the financial threshold with Mrs X, and she agreed to a financial assessment. The social worker then referred Mrs Y for an assessment. There would be no need for the Council to complete a financial assessment if it had already established Mrs Y would not have to pay for her care and support.
42. A form completed by the social worker states they gave Mrs X information leaflets about charging, which was standard practice. However, the Council has no record of this and cannot show it sent the leaflets. It also gave no indication about what Mrs Y’s contribution might be. The Council was therefore at fault for not providing clear information in writing about charging at the outset.
43. However, when the Council wrote to Mrs Y in November 2023, it put her on notice she may have to pay care charges, depending on the result of the financial assessment.
44. It took the Council’s financial assessment team over seven months to contact Mrs X to start Mrs Y’s financial assessment. The statutory guidance says councils should carry out a financial assessment over an ‘appropriate and reasonable’ timeframe. Seven months is a significant delay and was fault by the Council.
45. When the Council completed Mrs Y’s financial assessment it correctly disregarded the money in her bank account, as it was below the threshold. It included the MIG and allowed some household expenses. It also allowed some DRE after Mrs X supplied further information. This reduced Mrs Y’s contribution and ensured she retained more of her income. There was no fault in the Council’s financial assessments.
46. In summary, I did not find the Council told Mrs X there would be no charges for Mrs Y’s care. I also found no fault in the way the Council completed Mrs Y’s financial assessments. However, the Council cannot show it sent written information about fees at the outset, and it gave no accurate idea about what fees to expect. It also significantly delayed starting the financial assessment.

Injustice

47. While the Council should have given clearer information about charging at the start, I did not find it said Mrs Y’s care would be free of charge.
48. By the time the Council completed Mrs Y’s financial assessment, her care package had been in place for over eight months. It was therefore distressing for Mrs X and Mrs Y to receive a large bill in backdated charges. That is their injustice.
49. However, there was no fault in the financial assessments themselves. The Council was entitled to charge Mrs Y, and she received the care. I therefore cannot ask the Council to waive the charges.

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Agreed action

50. Within four weeks of my final decision, the Council will apologise to Mrs X for not providing clear written information about charging at the start of the assessment process. It should also apologise for its delays starting Mrs Y’s financial assessment, and for the distress Mrs X and Mrs Y suffered when they received a large bill for backdated care charges.
51. Within eight weeks of my final decision, the Council will:
• Give staff refresher training or guidance on giving clear information about charging for adult social care. It should remind staff that verbal advice should be confirmed in writing.
• Review its adult social care financial assessment practice to identify any systemic issues leading to delays and consider ways to reduce wait times.
52. The Council should provide us with evidence it has complied with the above actions.

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Final decision

53. I completed my investigation. I did not find the Council said Mrs Y would not have to pay for her care and support. However, I found the Council was at fault for not providing clear charging information in writing at the start, and for significant delays completing a financial assessment. But I found no fault in the way the Council completed Mrs Y’s financial assessment.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman