Summary: Ms D complained the Council delayed completing the financial assessment for her mother, Ms X, and failed to explain how much her care would cost. She said had Ms X known the cost of the care package; she would not have accepted it. This has caused her emotional and financial distress. The Council is at fault for failing to provide clear written information about the charging process and delay in the financial assessment process.

The complaint

1. Ms D complained the Council delayed completing the financial assessment for her mother, Ms X, and failed to explain how much it would cost. Ms X said had her mother known the cost of the care package; she would not have accepted it. This has caused her emotional and financial distress. Ms D would like the Council to waive her mother’s fees.

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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)

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How I considered this complaint

4. As part of the investigation I have considered the complaint and the information provided by Ms X and Ms D.
5. I have made enquiries of the Council and considered its response along with relevant law and guidance.
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.

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What I have and have not investigated

7. I have only investigated the timeliness of the financial assessment and correspondence about the same. I have not investigated how the Council has calculated the financial assessment.

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What I found

Charging for social care services

8. 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.
9. 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)
10. 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. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
11. 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 carried out and keep the person informed throughout the assessment process. (Care and Support Statutory Guidance, Paragraph 6.29)
12. 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)

The Council’s policies and procedures

13. The Councils website explains the financial assessment process. It says the amount someone pays is based on what the Council assesses they can reasonably afford to pay.
14. The Council will ask a welfare benefits adviser to assess an individual’s finances. This will help it work out how much someone should pay towards the cost of support. If they have more than £23,250 in savings and investments (not including the value of their main or only home), they will have to pay the full cost. For most people, the amount they pay will be a contribution towards the full cost of care.
15. The amount someone contributes is based on their weekly income and any capital (if less than £23,250 in savings or investments). To work out the amount, the Council adds together the persons weekly income, such as pensions and state benefits (but not money someone earns). It takes a weekly charge on capital at a rate of £1.00 a week for every £250 (or part of £250) of savings over £14,250 but less than £23,250. This does not include the value of someone’s main or only home. Then the Council takes away allowances to cover the persons day-to-day living expenses (the 'minimum income guarantee'), property-related household expenses and agreed disability-related expenses. The final figure is what the individual must contribute.

What happened

16. I have summarised below the key events; this is not intended to be a detailed account.
17. Ms X was admitted to hospital in 2021.
18. Ms X returned home in the middle of August 2021. Ms X received care under the Councils reablement scheme. This was free for the first six weeks.
19. Around the same time, the Council telephoned Ms D to discuss ongoing care. The Council Officer said there ‘may be a charge if long term services are required…’
20. In the middle of September, the Council visited Ms X and completed a care act assessment. It said Ms X required longer term support after the reablement plan ended. At the meeting, the Council advised Ms X it would need to complete a financial assessment to identify what contribution Ms X would need to make towards her care. Following this meeting, the Council drafted a support plan and referred Ms X for financial assessment.
21. Ms D said her mother did not receive any written correspondence following this meeting to confirm what was said at the meeting, or leaflets explaining the process. Neither did she receive any updates about the financial assessment.
22. The Council wrote to Ms X in October and November 2021, and April and May 2023, confirming her personal budget. It said following her financial assessment, she may have to pay towards her care. It said it would tell her about this separately.
23. The Council sent Ms X an ‘Agreement to Pay for Care’ which she signed in late March 2023. This set out the following: ‘I understand that I will have to pay towards the cost of any social care provided through the County Council. Any payment I have to make will be based on an assessment of how much money I have.’ It also confirms receipt of booklets explaining how the assessment is done and how charges are decided and states the individual confirms they have been told any charges may be back dated to the start of the services received.
24. In mid-July, the Council wrote to Ms X about the financial assessment. The letter explains how the financial assessment is calculated and explains the threshold. It asks for information from Ms X to begin its calculations.
25. In early August, the Council wrote again to Ms X and asked for the supporting documents and a statement of financial circumstances.
26. There followed several emails between the Council and Ms D. Ms D said the correspondence from the Council was threatening and not helpful. She expressed concern that Ms X could not afford to pay for the care as she has a low income. She said Ms X may have to cancel the care package.
27. At the beginning of September, Ms D sent the supporting evidence. The Council responded with questions and explained there was a document missing. In a later email, Ms D said Ms X could not answer the questions for the financial assessment and was overwhelmed by the process.
28. In October, the Council sent Ms X an invoice for her care to date. This totalled around £4,300.
29. Upon receipt of the invoice, Ms X cancelled all her care. Ms D told me her mother could not afford to pay for the care. Ms D was now caring for her mother.
30. At the end of November, the Council reassessed Ms X’s client contribution. It reduced the weekly contributions significantly. The total outstanding invoice is now around £2,400. Ms X has not made any payments.

The complaint

31. Ms X complained to the Council in early October 2023.
32. The Council responded in late November. In its stage one response, the Council ‘…acknowledged that despite our receiving a request to assess your contribution from adult services on 15 September 21, we did not in fact contact you until 12 July 2023.’ It explained it had not been able to process assessments as quickly as it would like because of unexpected demands.
33. The letter referred to two occasions (August and September 2021) when the Council told Ms X there would be a financial assessment to calculate her contribution towards her care. It also explained there had been an error in the financial assessment and it would do a new assessment.
34. In its stage two complaint response, the Council reiterated its earlier response and apologised for the stress and anxiety caused. It declined Ms X’s request to waive her contributions towards care.

Analysis

35. When the Council assessed Ms X for what care she needed, it told her verbally there would be a financial assessment. Ms X and Ms D were both aware that Ms X was expected to pay something towards the care she received. The Council also wrote to Ms X about her personal budget, which put her on notice she may have to pay care charges, depending on the result of the financial assessment.
36. Following the meeting in September 2021, I would expect the Council to write to Ms X to confirm what was said, explain the next stages of the financial assessment and provide a timeline. The Council provided nothing in writing. It did not send a letter with any details or provide any generic information or leaflet. This is fault.
37. Ms X and Ms D did not hear anything further about the financial assessment until March 2023 when the Council sent Ms X an agreement to pay form. This is roughly 18 months after the care started. The assessment process started properly in July 2023 when the Council wrote to Ms X. The statutory guidance says a financial assessment should be completed in an ‘appropriate and reasonable’ time. 18 months is a significant delay, this is fault.
38. In response to my enquiries, the Council said it did not tell Ms X how long the financial assessment would take or how long any delay would be. The Council did not provide updates or communicate with Ms X about the financial assessment for around 18 months. Following the statutory guidance, we expect the Council to keep individuals updated. The Council failed to keep Ms X updated, this is fault.
39. It is important councils give enough information about paying for care at an early stage. This is to enable informed decision making. Where the council cannot complete a prompt financial assessment it should still give suitable written general information about the likelihood of needing to make a contribution towards care costs. I asked the Council if it told Ms X how much the charges were likely to be. It explained it does not provide customers an ‘estimate’ of charges but does tell them a charge may be payable. While I do not expect the Council to provide an ‘estimate’, I do expect it to provide general information about how much the care might cost as an indication so customers can budget accordingly. The Council did not do this, this is fault.
40. This was especially important in Ms X’s case as she later found out she could not afford to pay for the care. As soon as she knew how much the care was costing, Ms X cancelled it and her daughter started to provide the care. The Councils failure to provide Ms X with information about how much the care was likely to cost in advance and failing to provide a financial assessment within a reasonable time, meant Ms X lost the opportunity to make an informed decision about whether she could afford to pay for care. As she cancelled the care and made alternative arrangements as soon as she received the invoice, it is likely she would not have accepted the care originally had she known the costs. Ms X now has an invoice of around £2,400 which she cannot pay. This has caused her distress financially. It has also caused her emotional distress as she is worried about how she is going to repay the debt. This is her injustice.

Action already taken by the Council

41. Following a recent Ombudsman investigation, the Council has provided refresher training / guidance about giving clear information about charging for adult social care and reminded staff that verbal advice should be confirmed in writing. The Council has also reviewed its financial assessment practice to identify any systematic issues leading to delays and considered ways to reduce wait times. I do not need to make any further service improvement recommendations.

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Agreed action

42. Within four weeks of my final decision, the Council agreed to apologise to Ms X and pay her £1,000 for the significant emotional and financial distress caused by the Councils failing to provide clear written information about charging and for the delay carrying out the financial assessment.
43. The Council should offer to set up a payment plan to enable Ms X to pay the outstanding balance for care fees.
44. The Council should provide us with evidence it has complied with the above actions.

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Final decision

45. I have completed my investigation. The Council is at fault for failing to provide clear written charging information and significant delay in carrying out the financial assessment.

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Investigator's decision on behalf of the Ombudsman