Summary: Mr X complained the Council did not properly explain what he would have to pay for care he received following discharge from hospital. We found there were some missed opportunities and the Council made errors when initially completing the financial assessment. We recommended an apology and a modest payment to Mr X to reflect the impact these issues had. We found overall Mr X was advised there would be care charges and the care costs were payable.

The complaint

1. Mr X complains that the Council did not tell him he would need to pay for care he received following a discharge from hospital or send financial assessment forms to him. When the Council told him the financial contribution payable for the care, he cancelled it as he found it unaffordable. Mr X complains he would not have incurred the care costs if the Council had explained the charges and properly dealt with the financial assessment at an earlier stage.

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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)
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I spoke to Mr X and considered the information he provided. I asked the Council for information and considered its response to the complaint.
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments I received before making a final decision.

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What I found

Care Act 2014

7. 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)
8. 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).
9. When a financial assessment cannot be completed, or cannot be completed adequately because someone has not provided information or engaged with the process, the Local Authority is permitted under the Care Act to conclude that the individual has sufficient financial resources to pay for the full cost of the services provided to them.

Intermediate Care/Reablement

10. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider whether to continue to provide them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Short-Term Intervention Team (STIT)

11. This is a Council team providing short-term reablement care for people to regain independence who may need help following a fall, an illness or after a stay in hospital. The care provided is free for six weeks.
12. If someone still needs care after six weeks, an assessment of needs is carried out to determine what ongoing care is required. A financial assessment is then conducted to determine whether someone has to contribute towards the cost of the required care.

What Happened

13. Mr X was discharged from hospital in April 2023. On discharge the National Health Service (NHS) arranged for and funded a package of care. This transferred to the Council on 5 May 2023. Care was provided by the Council’s Short-Term Intervention Team (STIT).
14. On 6 May the Council provided information to Mr X about charges for his care and agreed Mr X’s mother would help him complete a financial assessment which would be needed to determine if Mr X needed to contribute to his care costs. It put this in writing on 11 May. The letter explained why a financial assessment was needed and explained that it was not compulsory. However, it stated if someone chose not to have a financial assessment they would need to pay the full cost of their care.
15. Mr X says he did not receive any forms. The Council provided evidence that it had sent a letter to Mr X on 12 May sending financial assessment forms. It says it did not receive anything back.
16. In mid-June Mr X’s social worker asked for a light-touch financial assessment when they noted no financial assessment had been completed. It seems this was not carried out.
17. The SITT team provided free care for just over six weeks. It became chargeable on 17 June 2023.
18. On 28 June the Council determined Mr X would be self-funding his care because it had not received a response to the financial assessment forms it sent him. At the end of June it sent a letter to Mr X confirming this was the decision it had made and it explained the reason.
19. In July 2023 Mr X told his social worker that he had not received the financial assessment forms. As a result, the social worker attempted to raise this with the financial assessment team. Unfortunately, the relevant team did not receive the contact.
20. Mr X says he received an invoice in July for around £75 but believed this was a penalty for missing care appointments without giving notice when he was away at a family function. The Council sent monthly invoices from July onwards.
21. The Council records indicate an invoice was sent in late August. I understand Mr X did not receive this.
22. In September 2023 the Council sent an invoice to Mr X for his care fees. As he was considered to be self-funding, the full charge was £147 per week. When he received this Mr X questioned the charges. A light-touch financial assessment was carried out as a result. This was based on Department for Work and Pensions (DWP) records. This determined, Mr X’s contribution should be £97.72 per week.
23. Mr X provided details of his finances and a further review was conducted in October 2023. This confirmed the correct contribution based on Mr X’s financial position was £97.72 per week. The breakdown sent to Mr X shows that the Council took account of the minimum income guarantee required by the Care Act.
24. Mr X decided on 1 November to cancel the care as it was unaffordable. He stated he intended to appeal about the cost. He had received chargeable care between June 2023 and November 2023 when it was cancelled.
25. When reviewing Mr X’s case in mid-November, the Council recognised it had made an error. The Council recognised it had not included the enhanced disability premium Mr X was entitled to. When it took this into account, Mr X’s weekly contribution reduced from £97.72 to £75.37 per week.
26. In January 2024 Mr X received a further invoice, showing the cost of the care up to the date he cancelled it. I understand Mr X had paid invoices up to August 2023. The invoice reflected his revised contribution of £75.37 per week, backdated to that point.
27. Mr X complained that if he had known the contribution he was expected to pay sooner, he would not have continued with the care when it became chargeable.

Was there fault by the Council

28. The Council correctly advised Mr X there would be charges for care in May 2023, after it took over responsibility for providing Mr X’s care. Although Mr X says it was not received, there is evidence the Council did send information to Mr X and explained a financial assessment needed to be done. It sent the required forms to Mr X. So, I have not found there was a failure to send the required forms.
29. In principle, the Council was entitled to determine at the end of June that Mr X would have to pay the full cost of his care. This is because Mr X did not provide information that enabled the financial assessment to be done. The Council provided evidence that it wrote to Mr X at the end of June and explained this decision. So, Mr X also had the opportunity to provide information at that point and to query the full care costs that were set out.
30. However, there was some fault by the Council. The Council missed opportunities in June and July to address the lack of a financial assessment when social workers identified it had not taken place. The social workers requested a light-touch assessment on two occasions. These requests were seemingly missed through miscommunication.
31. While the Council could have carried out a financial assessment sooner if these opportunities were not missed, I found that the errors were not solely responsible for the delay in the assessment. This is because the main cause of the initial delay in doing the financial assessment was the lack of response from Mr X to the Council’s correspondence in May and in June about the financial assessment and charges. As Mr X had been told there would be charges, I found the missed opportunities to act on the social worker’s observations did not cause significant injustice to Mr X.
32. There was some further fault by the Council. When the Council did calculate Mr X’s contribution, it was too high because the Council made an error. This error affected the assessment it did in September and the error was repeated in October 2023. This was corrected in mid-November. However, by this time Mr X had decided the care was unaffordable and he cancelled it. Given Mr X’s concerns about the cost, the errors added to a stressful situation for Mr X. The error by the Council meant that Mr X was not able to make an informed decision because the correct contribution was not confirmed until mid-November.
33. I have recommended the Council apologises and makes a payment to Mr X to recognise the impact of the errors it made. However, I do not consider the issues we identified meant that Mr X incurred care costs that would otherwise have been avoided. I say this because the Council had indicated Mr X’s care would be chargeable at the outset and it has evidenced the forms were sent to Mr X. It also evidenced that it had told him at the end of June that the full cost of his care was payable. It was open to Mr X to challenge the costs at this early stage. Mr X continued to receive the care throughout and has had the benefit of the care.
34. I understand from Mr X that he is concerned about repaying the care costs that have accrued. We have also asked the Council to offer a payment plan so Mr X can repay the outstanding costs in an affordable way over a reasonable period.

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Agreed action

35. Within four weeks of the final decision:
36. The Council agreed to apologise to Mr X for the issues we have identified with communication and for the errors made in the initial financial assessments. The apology should adhere to our guidance on making effective apologies. This can be found on our website, within our Guidance on Remedy here.
37. To recognise the errors made by the council are likely to have resulted in additional stress and concern and caused some uncertainty to Mr X the Council agreed to pay him £200.
38. The Council agreed to offer Mr X a payment plan to enable him to repay the outstanding care costs over a reasonable period, taking account of Mr X’s ability to afford repayments.
39. The Council should provide us with evidence it has complied with the above actions.

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Final decision

40. There was fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman