Summary: There was fault as there was a delay in the financial assessment and the Council delayed informing Mr and Mrs B what Mr B’s financial contribution to the care package cost would be. The Council also failed to send Mr and Mrs B a copy of the assessment and care plan. The Council has already reduced its invoice so the financial injustice has been addressed. The Council has also agreed to apologise and to carry out a service improvement.

The complaint

1. Mrs B complains on behalf of her husband, Mr B. She says the Council failed to tell her how much Mr B would have to pay towards his care package at home and she says Mr B cannot afford to pay the contribution. She also says the family was forced to accept a care package that Mr B did not need and that they were told that Mr B would not be discharged from hospital if they did not accept the package.

Back to top

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)

Back to top

How I considered this complaint

4. I have discussed the complaint with Mrs B and I have considered the information that she and the Council have sent and the relevant law, guidance and policies.

Back to top

What I found

Law, guidance and policies

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Assessment and care plan

6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which sets out the costs to meet the needs.

Review of the care plan

7. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Financial assessment

8. Councils must carry out a financial assessment if they decide to charge for the care and support.

Timing of financial assessment

9. The law and CASS guidance do not specify a timescale for completing a financial assessment. The Act presumes the following order of events:
• The council carries out a needs assessment under section 9.
• The council makes a decision about the person’s eligibility under section 13.
• The council carries out a financial assessment under section 17.  At this point a council also has the duty to meet the person’s eligible needs, but this is subject to the requirement for the council to prepare a care and support plan, as follows.
• The council makes a care and support plan under section 25. This section presumes the council makes the plan before care services start and stipulates care and support plans must include a personal budget, which in turn must be based on the financial assessment.
10. The Ombudsman’s interpretation has therefore been that, in most circumstances, councils should complete financial assessments before they create care a plan and before care services begin. This should enable people to make informed decisions about the care and support they want, taking into account the financial impact. 

Assessment of income and minimum income guarantee

11. Because a person who receives care and support outside a care home will need to pay their daily living costs such as rent, food and utilities, the charging rules must ensure they have enough money to meet these costs. After charging, a person must be left with the minimum income guarantee which is set out in the regulations.
12. The purpose of the minimum income guarantee is to promote independence and social inclusion and ensure that they have sufficient funds to meet basic needs such as purchasing food, utility costs or insurance. This must be after any housing costs such as rent and council tax net of any benefits provided to support these costs – and after any disability related expenditure. 

Intermediate care and reablement

13. The council must provide intermediate care and reablement care free of charge for up to six weeks, even if the person is above the capital threshold.
14. Intermediate care services are provided to people, usually older people, after they have left hospital or when are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited time to assist a person to maintain or regain the ability to live independently.
15. Reablement is a particular type of intermediate care, which has a stronger focus on helping the person to regain skills and capabilities to reduce their needs, in particular through the use of therapy or minor adaptations. There is a tendency for the terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ to be used interchangeably.

What happened

16. Mr B is an older man who has a need for care and support. He and Mrs B live in an annex at the house of their daughter, Mrs C.
17. Mr B was admitted to hospital in February 2023 and was assessed by an occupational therapist on 13 March 2023. Mrs B and Mrs C had been providing all the care for Mr B but the OT noted that Mr B’s mobility had decreased and Mrs B’s ability to care for Mr B had decreased because she had her own medical and disability concerns. The OT said there was a risk of falls, injury, hospitalisation and carer breakdown without support.
18. The Council tried to deliver some equipment that Mr B needed but Mr and Mrs B declined the equipment as they said there was not enough space in the annex.
19. The Council received a referral on 29 March 2023 with a recommendation that Mr B should receive support by 2 care workers 4 times a day.
20. Mr B was reassessed on 4 April 2023. The assessment noted that Mr B needed a package of support as follows:
• Two care workers to attend for 30 minutes 4 times a day on 4 days a week.
• Two care workers to attend for 30 minutes 2 times a day for 3 days a week as Mr B was at the hospital all day during those 3 days.
21. So Mr B needed care and support for 11 hours a week by two care workers so 22 hours a week in total which cost £482.24 a week. The social worker rang Mrs B and told her that the Council’s Rapid Support Service (RSS) could start on 6 April 2023 if the equipment was in place. Mrs B said the equipment had not been delivered yet. (I presume a redelivery had been organised).
22. Mr B was discharged from hospital on 6 April 2023, but the RSS could not start until 9 April 2023. The Council was informed of the discharge on 7 April 2023.
23. The Council called Mrs B on 7 April 2023 to explain that the care package could not start until 9 April 2023. Mrs B said she could support Mr B with nutrition and medication. The Council said it would find a different agency to bridge the gap until 9 April 2023 to ensure Mr B’s needs were met. The Council’s in-house Community Response Team provided the support from 7 until 9 April 2023.
24. The Council officer spoke to Mrs B on 8 April 2023 and informed her that the Council’s Rapid Support Service would start on 9 April 2023. Mrs B said she had been very happy with the service so far. She said Mr B had taken to the support ‘like a duck to water’. The officer said there would be a review visit in a few weeks’ time, but if Mrs B had any concerns she should ring the Reablement service.
25. Mr B was readmitted to hospital the following day. He was discharged on 12 April 2023 and readmitted on 13 April 2023 and the service was stopped.
26. Mr B was reassessed on 24 April 2023 to see if his needs had changed. Mrs B told the social worker that 4 visits a day would be ‘enough support’. Mrs B said the hospital had told her that Mr B was now ‘end of life’. The family was waiting for a hospital bed to be delivered to the home. The social worker said Mr B needed the assistance of two carers to complete sit to stand transfer. He was unable to mobilise and needed to be transferred from his bed to his wheelchair.
27. The social worker discussed the finances. Mrs B said Mr B’s capital was below the threshold so he should be eligible for funding from the Council. The social worker explained that a financial assessment would be completed and a contribution would be required if Mr B needed long term care.
28. Mr B was discharged on 10 May 2023 and the Council restarted the support package.
29. The Council’s social worker reassessed Mr B’s needs for care and support on 1 June 2023 and the assessment concluded that Mr B was entitled to long term support. Mrs B had recently had a major medical emergency and had a fracture and surgery so they recognised that a support package would be beneficial for Mr and Mrs B.
30. The social worker explained the Council’s charging policy to Mr and Mrs B and made a referral to the Council’s financial assessment team to carry out the financial assessment.
31. Mr B signed the Council’s checklist and confirmed he had received the booklet ‘paying for care at home, paying for care at a care home’.
32. An officer on the Council’s financial assessment team contacted Mrs B on 2 June 2023 to make an appointment for the financial assessment.
33. The social worker contacted Mrs B on 9 June 2023 and informed her that the new agency would take over the care package and told her the hourly rate was £21.36 so this was the amount they would have to pay if the financial assessment concluded that they had to pay the full cost.
34. The agency took over the care package on 12 June 2023.
35. The financial assessment took place over the telephone on 28 June 2023. The finance officer calculated the contribution but this was subject to Mrs B sending the relevant bank statements. The officer informed Mrs B what the contribution was likely to be. Mrs B said she told the Council officer that they would not be able to afford this. Mrs B said the officer told her to wait and see what the final calculation would be. Mrs B sent the necessary documents to the Council.
36. The Council emailed Mrs B on 20 July 2023 and sent her a copy of the financial assessment. The Council informed Mrs B that Mr B would have to pay £252.27 per week towards his package of care which left him with a weekly net income of £264.80. The Council backdated the charges to 12 June 2023.
37. The Council sent an invoice to Mrs B on 15 September 2023. Mrs B contacted the Council and said they could not afford the package of care and she would stop the package. She said she had not been informed of the cost until she received the invoice.
38. Mrs B complained on 20 September 2023 and said:
• The family was told that Mr B would not be discharged from hospital unless there was a package of care in place.
• During the financial assessment, Mrs B explained to the officer that she and Mrs B lived in an annex and paid £650 to their daughter for outgoings, but she was told that the Council could not consider this in the assessment. This meant a ‘huge’ part of Mr B’s expenditure was not included which led to a ‘false calculation’ of Mr B’s disposable income.
• The finance officer gave them a ‘rough idea’ of what the cost may be and Mrs B told her that they would not be able to pay that contribution. The officer advised them to wait and see what the final calculation would be.
• A different care agency (the fourth agency) started to provide care around that time. The agency told them that they would not have to pay for the care until the financial assessment.
• They had now received an invoice for July and August and this was the first time they were informed what the contribution was.
• The Council said it sent her an email on 20 July 2023 informing her of the contribution, but she had not received that email.
39. The Council responded and said:
• The social worker explained to Mrs B on 24 March 2023 that, if a long-term service was required, it would be chargeable.
• The social worker reassessed Mr B on 1 June 2023 and Mr and Mrs B both agreed the proposed care plan. The social worker explained the charging policy and the customer checklist was signed.
• On 9 June 2023 a social worker informed Mr and Mrs B that a new care agency would start and informed them of the hourly rate. The financial assessment took place on 28 June 2023.
• During the assessment, Mrs B said they paid no rent or council tax. Mrs B said the payment of £650 was the couple’s contribution to the household bills. The Council explained that it would deduct rent as an expenditure in the financial assessment, but not the cost of the household bills as this was covered by the minimum income guarantee (MIG). If Mr and Mrs B paid rent and if they could provide evidence of a rental agreement and show that they paid the household bills separately, then the Council would consider this.
40. Mrs B added to her complaint and said:
• They had drafted a rental agreement between Mr and Mrs B and their daughter and started to record the payments in a rent book.
• They had been ‘dictated’ that Mr B needed help four times a day. They had been told that Mr B could not be discharged from hospital without a care package and that he would have to go to care home if they did not agree to the care package.
41. The Council responded and said:
• There had been significant involvement of health and social care professionals in assessing Mr B since his first hospital admission in February. A review of Mr B’s care needs took place on 1 June 2023. However, the Council had not sent the needs assessment and care plan to Mr B and it should have done so.
• It was the Council’s practice to advise the person of the contribution amount during the financial assessment and to confirm this in writing once all the supporting evidence had been received. The Council told Mrs B what the contribution cost would be on 28 June 2023 and the amount was confirmed in the email on 20 July 2023.
• There had been no fault in the Council’s actions but, as a measure of goodwill, the Council agreed to deduct Mr B’s half of £650 (£325 a month or £75 a week) from the outstanding invoice.
42. Mrs B received three invoices for the following time periods:
• 12 June to 13 August 2023. This was a period of 8 weeks, but the Council charged Mr B for 5 weeks only.
• 14 August to 10 September 2023 – 4 weeks.
• 11 September to 15 September – 1 week.
43. In total Mr B was charged for 10 weeks, but the care was provided for 13 weeks.

Council’s response to the Ombudsman

44. I asked the Council to send me the care plan for Mr B. It sent me Mr B’s reablement care plan dated 28 April 2023 which did not include a personal budget.
45. The Council made the following comments in response to the complaint:
• Mrs B told the officers on several occasions that she agreed with the support package provided. There was no evidence she ever told the Council that the support package was excessive until 15 September when the first invoice was received.
• The care workers sometimes did not stay for 30 minutes as sometimes the care had been provided already. The care package was due to be reviewed within 3 months of the start but Mrs B had cancelled the package so the review did not take place.

Further information

46. I have checked the care records for Mr B for the month of June 2023, just after the care package started and the last two weeks of September 2023, before the care package ended. I wanted to check how often no care was provided when the care workers attended. I noted the following:
• In June 2023, no care was provided on four occasions.
• In the last two weeks of September 2023, no care was provided on 14 occasions.

Analysis

Care plan

47. It is not for the Ombudsman to decide what Mr B’s care plan should have been. I can only consider whether there was any fault in the way the Council made the decision.
48. The Council carried out the relevant assessments in the months leading up to the provision of the care package. The assessments were carried out by the appropriate professionals including a social worker and an occupational therapist.
49. The social worker considered the needs and outcomes for Mr B as set out in the Care Act. They considered what Mr B was able and not able to achieve. Mr B’s disabilities were extensive and he needed two care workers for any transfers. The social worker and the occupational therapist also considered the care provided by Mrs B and her daughter, their ability to continue to provide the care and the effect that this had on them.
50. The social worker and the occupational therapist also considered the risks that Mr B, but also Mrs B and Mr B’s daughter would be exposed to if care was not provided by professional care workers. This was all good practice and I find no fault in that respect.
51. Mrs B said that the care plane was forced upon them and that they had been told that Mr B could not be discharged from hospital without a care package. The CASS Guidance says the care plan should be agreed with the person receiving the care or their representative. I have read through all the documents and communications and I note that the social worker and the occupational therapist included Mr and Mrs B in the discussions about the care plan. I could not find evidence, from the documents I read, that Mrs B disagreed with the proposed care plan or raised concerns. There were several references in the documents that Mr and Mrs B were happy with the plan and with the care that was provided.
52. It is true that there were some issues about the hospital discharge on 6 April 2023 as Mr and Mrs B were waiting for equipment and as the Council had said it could not start providing the care until 9 April 2023. However, those were separate problems which were resolved.
53. The long care plan was not put in place until 12 June 2023 after the Council reviewed Mr B’s needs on 1 June 2023 and decided that he needed long term care. Mr B had been receiving the care package for several weeks by then and, if Mrs B had objections to the care package, she could have raised them at this stage.
54. However, I agree there was some fault at this stage as the Council should have sent the assessment of needs and the care plan to Mrs B after it completed the review in June 2023 and failed to do so. It appears to me the Council did not complete a new care plan in June 2023 as the Council has only been able to send me the care plan from 28 April 2023, which was the earlier reablement care plan. I appreciate that there were no changes to this plan but, nevertheless the Council should have completed an updated care plan and should have included a personal budget in the plan. Its failure to do so was fault.
55. I have also looked at the actual care that was provided. I note that, in the first month that the agency attended, there were five times when Mr B did not require any care. So that suggests to me that the care was generally provided. I note that it was different during the last two weeks before the care package was stopped. There were more occasions, particularly on the days when Mr B received 4 calls a day, that the care was not needed.
56. I note the Council said it was due to review the care plan but this did not take place because Mrs B cancelled the care package before the 3 month review could take place. It would have been good practice the Council to review the care plan earlier, but I also note that Mr B had already been re-assessed 3 times in the previous months and that Mrs B had not raised concerns about the plan so there was no indication that a revision of the plan was urgently needed.

Financial assessment

57. I find no fault in the way the Council carried out the financial assessment. The Council took into account the appropriate income and disregarded the relevant income. The Council considered any disability related expenditure and deducted £43.32 on that basis. The Council’s charging policy said it would only charge 95% of the maximum it could charge and the Council reduced the contribution amount on that basis.
58. Mr and Mrs B told the finance officer that they paid no rent to their daughter but that they paid her £650 a month (£75 a week each) towards the household bills (gas, electricity and so on).
59. The Council therefore said the MIG of £163.65 a week should cover the cost of the bills so Mr B’s £75 a week was already accounted for in the MIG and would not be deducted again. I find no fault in that approach as it is the correct approach. Councils can consider housing costs such as rent or mortgage repayments but generally speaking, the household bills should be covered by the MIG.

Delay in financial assessment and cost information

60. As set out in paragraph 10, the Ombudsman expects councils to carry out the financial assessment before or at the same time as they prepare the care plan so that people have as much information as possible about the costs before agreeing the plan.
61. The Ombudsman knows that, in practice, many councils complete financial assessments after care planning and frequently after care services have started. In most cases, this would be fault and the Ombudsman will then decide what the injustice was.
62. In Mr B’s case, the Council provided reablement care until 12 June 2023 and so Mr B did not have to pay towards his care during that time. I find no fault in that respect.
63. The Council then re-assessed Mr B’s needs on 1 June 2023 and said he required long term care. The social worker provided Mr and Mrs B with the general information regarding charging and they were made aware that they would need to pay a contribution towards the cost of the care, but were not told the amount.
64. The social worker told Mrs B on 9 June 2023 what the cost would be if Mr B was self-funding and paying the full hourly rate.
65. The finance officer assessed Mr B’s finances on 28 June 2023 and informed Mrs B what the likely contribution was but the final figure could not be confirmed until the relevant evidence (bank statements) had been checked. Therefore, the Council provided quite a lot of information on 28 June 2023 to enable Mrs B to make an informed decision about care provision.
66. The Council then sent the financial assessment and informed Mrs B of the contribution on 20 July 2023. Therefore there is no fault in the Council’s actions in terms of charging from 20 July 2023. The Council had carried out the financial assessment, had informed Mrs B of the contribution amount and she was in a position to make a fully informed decision.
67. I appreciate that Mrs B says she did not receive the Council’s email from 20 July 2023 but the Council has provided evidence that the email was sent to the correct address. I do not know what went wrong in this instance but I cannot say there was fault in the Council’s actions from 20 July 2023 onwards.

Injustice

68. One the key factors in determining injustice is how much information the Council gave about the charges and when.
69. There was fault in the Council’s decision to charge Mr B before it carried out the financial assessment from 12 to 28 June 2023 as this was not in line with the CASS Guidance. And, as the final contribution amount was not confirmed until 20 July 2023, there was some further fault between 28 June and 20 July 2023. Mrs B had quite a lot of information already at that stage about what the likely cost would be, but she had not been given the full information yet.
70. So the fault and possible injustice is between 12 June 2023 and 20 July 2023, just over 5 weeks. Firstly, I note that the Council did not charge Mr B for the first 3 weeks that he received care from 12 June 2023 so any injustice for those weeks has already been addressed. Secondly the Council has agreed to exercise discretion and to reduce the debt by £75 a week as it has agreed to consider £75 as rent retrospectively as a gesture of goodwill. The Council has reduced the invoice by £750 (£75 x 10) which is the equivalent of a further 3 weeks’ contribution.
71. Therefore I am of the view that the injustice has been appropriately addressed by this offer and I do not recommend any further financial remedy. The Council has charged Mr B £1810.20 (roughly 7 weeks) out of a potential total invoice of £3279.51 (13 weeks).

Back to top

Agreed action

72. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise in writing to Mr and Mrs B for the fault.
• Remind relevant officers of the importance of sending a copy of the Care Act assessment and care plan to the person being assessed or their representative. The care plan should include the personal budget and the financial assessment should, generally speaking, be completed before the care plan is finalised.

Back to top

Final decision

73. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Investigator’s draft decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman