Summary: Mrs X complained on behalf of husband, Mr X that there was a delay by the Council in completing a financial assessment which caused avoidable confusion, uncertainty and backdated charges. The Council was at fault because it allowed the financial assessment to drift, leading to delay in the final outcome. It has agreed to apologise to Mrs X, make a symbolic payment and offer an affordable repayment plan for the backdated charges.

The complaint

1. Mrs X complains the Council said her husband, Mr X, would not be charged for his care, but later charged him for it.
2. Mrs X said this has caused avoidable distress and backdated charges which they cannot afford to pay.

Back to top

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. 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

5. I considered Mrs X’s written complaint. I made enquiries of the Council and considered its response.
6. Mrs X and the Council now have the opportunity to comment on my draft decision. I considered their comments before reaching a final decision.

Back to top

What I found

Councils’ statutory duties

7. The Care Act 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 (Regulations) provide details of councils’ duties towards their residents with eligible social care needs and rules for charging for the services provided.
8. When exercising their social care functions councils must follow the Care and Support Statutory guidance (Statutory Guidance) issued by the Department of Health and Social Care, which is based on the Care Act 2014, unless they have very good reasons not to. They should also follow the Regulations.

Financial assessments

9. 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. This could be provided alongside a person’s care and support plan or separately, including via online means. (Care and Support statutory guidance paragraph 8.16)
10. Financial information and advice is fundamental to enabling people to make well -informed choices about how they pay for their care. The local authority service should include the following aspects of financial information and advice:

• understanding care charges
• ways to pay
• money management
• making informed financial decisions
• facilitating access to independent financial information and advice

11. Councils should ensure that information supplied is clear. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. Information and advice provided within the service should be accurate, up-to-date and consistent with other sources of information an advice. (Care and Support statutory guidance paragraphs 3.19 and 3.20)

Charging

12. When making decisions on charging local authorities should be clear and transparent so people know what they will be charged. Where a local authority has decided to charge it should explain in the financial assessment how the assessment has been carried out, what the charge will be and how often it will be made. The local authority should ensure this is provided in a manner that the person can easily understand, in line with its duties on providing information and advice. (Care and Support statutory guidance paragraph 8.2 & 8.16).

What happened

13. Mr X lived at home with his wife Mrs X. Mr X was receiving care and support at home.
14. In January 2023, Mrs X told the Council she was struggling with Mr X’s needs, and he needed to go into a care home. Mrs X expressed preference for a care home that Mr X had previously attended for respite. The care home was in another local authority’s area (Council B). The Council’s records stated “[Mrs X]… cannot make any decisions until she is aware of the costs she will need to contribute towards”
15. The Council sent Mrs X an email with a link to an online financial assessment for Mr X. The email also included a link to the Council’s website for adult social care which included details about charging, completing the financial assessment and an online care contribution estimator.
16. On 23 January, the Council completed a care and support assessment. It was agreed that Mr X would reside in short-term respite care at the care home whilst long-term support planning was being determined subject to the outcome of Mr X’s financial assessment. It was recorded that Mrs X was aware of how the funding worked and was prepared to support Mr X’s care with a third party top up, however she could not determine the amount until a financial assessment had been completed. Mr X moved to the care home on the same day.
17. On 30 January, Mrs X called the Council and said she had completed the financial assessment. The Council did not receive this and asked Mrs X to provide a reference number so that it could trace the assessment. Mrs X said she did not receive a reference number or email confirmation that the form had been successfully submitted.
18. The Council sent Mrs X another email with a link to the online assessment and a week later, it sent Mrs X a paper copy of the financial assessment by post.
19. In March, the Council completed another care and support needs assessment. It was recorded that Mrs X understood there may be a charge for any eligible services provided by the Council. Mr X became a permanent resident at the care home.
20. In mid-July the Council asked Mrs X to complete the outstanding financial assessment. Mrs X said she had already completed an assessment and had been advised that Mr X’s care would be fully funded. Mrs X said she did not have the funds to pay for Mr X’s care.
21. By August, the Council had still not received a completed financial assessment and contacted Mrs X. Mrs X said Mr X did not have the funds to contribute towards the cost of his care and she had been told his care would be fully funded. The Council sent Mrs X another financial assessment, and a copy of its care home funding booklet and charging policy.
22. Mrs X confirmed she had received the assessment form and booklet. Mrs X said she would not have agreed to the placement if she knew a financial contribution was required. Mrs X also expressed concerns about receiving a backdated bill.
23. The Council received a completed financial assessment form from Mrs X and wrote to Mr X in October. It said it had reviewed the assessment and Mr X was required to pay a contribution towards the cost of his care as follows:

• 20 January 2023 to 5 March 2023, at £169.39 per week;
• 6 March 2023 to 09 April 2023, at £188.17 per week; and
• From 10 April 2023, at £189.82 per week.

24. Mrs X complained to the Council. The Council said Mrs X was aware that a financial assessment would be required. It said it had already agreed to pay the additional amount above Council B’s banded rate for the cost of Mr X’s care and support.
25. The Council said there were no timescales in law or guidance regarding when it should complete the financial assessment and it was entitled to backdate the assessed contribution to the date that chargeable care and support services began in January 2023. The Council advised Mrs X to contact its finance team to discuss a payment plan.
26. The Council said it had not charged Mr X for the hours of care and support he received at home prior to moving into residential care the same week.
27. Mrs X complained to the Ombudsman and said the Council told her that Mr X’s care would be fully funded.

Analysis

28. When the Council assesses whether someone needs adult social care, it must then assess what, if anything, the person can afford to pay for that care. There is no set timescale for the completion of this financial assessment, but the implication in the statutory guidance is that it is done alongside the care needs assessment. As best practice, we would expect the Council to complete financial assessments within a month of the care needs assessment, although accept there may be reasons why this is not always in the person’s best interests.
29. Mrs X said the Council failed to inform them about a financial contribution. The records show Mrs X was aware that a financial assessment was required and told the Council she had submitted this in January. Mrs X would have been aware the financial assessment was being carried out for the specific reason of determining Mr X's contribution.
30. Though the Council was aware that it had not received a completed financial assessment for Mr X it took no action to address this between February and July. It allowed matters to drift which resulted in a significant delay in advising Mr and Mrs X of the actual charges. The delay is fault. Statutory guidance says councils should be clear and transparent so people know what they will have to pay. I recognise the Council had spoken to Mrs X about charges before this, however this communication did not confirm the actual amounts they would be charged. Furthermore, Mrs X did not realise the charges would be backdated and therefore it would have been a shock for her to hear this in September.
31. Mr X has received care since January 2023, and there is no evidence to suggest the Council told Mrs X that his care would be fully funded. Mrs X was aware that assessed charges may be due, regardless of the Council’s delay in advising them. However, the significant delay has caused Mrs X an injustice in the form of avoidable uncertainty and frustration about what the actual costs would be and the shock of backdated charges.

Back to top

Agreed action

32. Within one month of my final decision the Council has agreed to:
1. apologise to Mrs X;
2. pay Mrs X £200 for the injustice caused by the delay in informing her about the actual charges.
3. offer an affordable repayment plan to repay the backdated charges; and
4. remind staff that financial assessments should be completed in a timely manner.
33. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

34. The Council was a fault for allowing an ongoing financial assessment to drift, resulting in a delay to informing Mr and Mrs X about Mr X’s financial contribution towards his care. This caused uncertainty and frustration and the Council has agreed to a suitable remedy for this.

Back to top

Investigator's decision on behalf of the Ombudsman