Summary: the Council delayed in carrying out a financial assessment and then failed to take Ms X’s needs into consideration when it sent her forms to complete. The Council’s error in chasing a debt which was already paid caused additional stress and anxiety. The Council will now apologise to Ms X, carry out a thorough review of her disability-related expenses and offer a sum in recognition of the distress its actions have caused.

The complaint

1. Ms X complains that the Council did not complete a financial assessment for her care charges for 7 years and then began to charge her without warning, without providing the support she requested to complete forms properly. She says the Council also demanded repayment of over £700 she had already repaid, causing her considerable stress and anxiety. She says the Council is still not considering her disability-related expenses properly.

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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. I considered the information provided by Ms X and by the Council. I spoke to Ms X. Both Ms X and the Council had an opportunity to comment on a draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

5. 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.
6. 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.
7. 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. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.

What happened

8. Ms X began receiving care services from the Council in 2015 and her contribution was assessed as nil. Initially she received Direct Payments but from 2018 she began to use a Council-commissioned service instead. Ms X repaid an amount of £2771 she had received in Direct Payments for that time.
9. The Council did not review Ms X’s financial assessment until 2023. The Council says it sent out financial assessment forms in 2019 and in 2022 but Ms X did not return them. Ms X has dyslexia and regularly asks the Council for help and support with completing forms.
10. In January 2023 the Council wrote to Ms X setting out the charges she would have to pay. The Council says that its policy is to invoice the full cost when it does not receive a completed financial assessment form: however, it says as it had access to the benefits system it was able to draw figures from that to calculate Ms X's charges.
11. The Council calculated Ms X’s charges based on a higher ESA (Employment Support Allowance) than she was actually receiving and said her new charges would be £42 a week. Ms X says she spent months in correspondence with one officer who asked for evidence of benefit payments, energy bills etc which she provided. Then he told her she would have to complete a ‘change of circumstances’ form.
12. In June 2023 Ms X made a complaint. She said her anxiety was so great she had asked for the details of the officer’s manager and written to her, but she did not hear back. She said again that she had dyslexia and needed help with filling out forms.
13. The Council replied in August. It said that it had not received completed forms from her which was why it had sent out an invoice in January. It asked her again to complete an online form or said it could post a paper copy to her. It noted she had sent in some electricity bills but said it needed more. It also said it could see she was receiving less ESA than it had assumed and that would be considered. It apologised for the time taken to deal with her queries.
14. Ms X sent another email querying what charges would be raised and asking why another amount of over £700 was being applied. In October the Council responded and said her revised charges would be £16.46 from January to April, and £18.13 from April until the next review. It said the invoice for £752 was for an overpayment of Direct Payments which had been made in 2018.
15. In December an officer wrote to her again detailing what had been taken into account. She said the Council could not accept the evidence of gas bills Ms X had sent and asked her to submit them in a different format. She acknowledged that the Council had failed to follow up the repayment of the Direct Payments in 2018 and said she would place a credit on Ms X’s account for that amount as soon as possible. Again she apologised for the time taken to resolve the matter.
16. Ms X asked for her complaint to be investigated at Stage 2 of the Council’s processes in particular with respect to previous charges, and the amount of debt she was repaying which left her with insufficient to pay her assessed contribution.
17. The Council responded in May 2024. It said that not all expenditure could be taken into account and debt would not usually be considered, but the service agreed to discuss this with Ms X in case it could consider it. It asked her to get in touch if she required help with understanding and completing forms.
18. Ms X complained to the Ombudsman. She said she felt threatened and anxious by the charges imposed and was fearful that her care package would be cut if she complained.
19. The Council says that Ms X was billed a higher amount that necessary from January 2023 but says that she did not start payment until May 2023 and was reimbursed the extra amount in January 2024. It says her repayment of the overpaid Direct Payments in 2018 had not been entered onto the system at the time.
20. The Council says it can review Ms X’s gas charges once they are available but it understands she is currently disputing the charges with the supplier. It also says it is reviewing in detail the disability-related expenditure.

Analysis

21. The Council failed over a period of time to contact Ms X regularly about her financial assessment and to offer the appropriate support and assistance. Had it done so Ms X might have been charged the correct amount from the start and not had to endure considerable stress and anxiety over several months.
22. The Council notes that it reimbursed Ms X the higher charges she paid but that does not ameliorate the anxiety she felt at that time and the financial strain of paying higher charges than expected or warranted.
23. Ms X repeatedly asked for assistance in completing forms, but the Council continued to ask her to complete more without offering assistance until its final response letter in May 2024.
24. It is over a year since Ms X asked about her disability-related expenses – including, for example, the art classes which are recognised as a necessary part of her support, but which are not free, and yet no conclusion has yet been reached.

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Agreed action

25. Within one month of my final decision the Council will complete a comprehensive review of Ms X's disability-related expenses and apply them accordingly (back dating where appropriate);
26. Within one month of my final decision the Council will apologise to Ms X for its failure to assess her finances properly and for failing to provide the assistance and support it should have done;
27. Within one month of my final decision the Council will offer Ms X the sum of £500 in recognition of the stress and anxiety it has caused her.
28. The Council should provide us with evidence it has complied with the above actions.

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Final decision

29. I have completed this investigation. There was fault on the part of the Council in Ms X’s financial assessment which completion of the recommendations at paragraphs 25 – 27 will remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman