Summary: Mrs X complained the Council took too long to complete a financial assessment for her husband’s care. She stated the delay meant her husband commissioned care he could not afford, and they have accrued debt for his care costs, which they would otherwise have avoided. We found fault by the Council for delay in completing Mr X’s financial assessment and, on the balance of probabilities, that he commissioned care he would otherwise have avoided. The Council agreed to apologise to Mrs X and reduce the outstanding invoice for Mr X’s care costs.

The complaint

1. Mrs X complained the Council took too long to complete a financial assessment for her husband’s care. She stated that because of the delay her husband commissioned care which he could not afford and they have accrued debt for his care fees, which they would otherwise have avoided.
2. Mrs X stated this has caused her distress, uncertainty and financial hardship.

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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. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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

6. As part of my investigation I have:
• discussed the complaint with Mrs X and considered her complaint;
• made enquiries of the Council and considered its response;
• considered the relevant legislation and guidance;
• considered the Ombudsman’s guidance on remedies; and
• set out my initial thoughts on the complaint in a draft decision statement and invited Mrs X and the Council to comment. I considered Mrs X’s comments in response.

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That I found

Charging for care and support

7. The Care Act 2014 (sections 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. 
8. Where the person has capital above the upper capital limit of £23,250 the person will need to pay the costs of their care in full. Otherwise, the council will carry out a financial assessment to determine how much they should contribute to the cost of their care. The financial assessment considers both the income and the capital the person has.

NHS Continuing Healthcare Funding

9. NHS Continuing Healthcare funding is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.

Key events

10. What follows is a chronology of key events. It does not show everything that has happened.
11. Mrs X’s husband, Mr X, lived at home. He had care and support needs met by two carers helping him three times a day. Mr X received CHC funding to pay for his care.
12. In March 2023 the Council told Mrs X that Mr X may no longer receive CHC funding. A case file note shows Mr X told the Council he had savings under the upper capital limit.
13. In April the NHS decided to withdraw Mr X’s CHC funding. It said that Mr X still needed three daily visits with two carers attending each visit. It said an Occupational Health Assessment should be completed in a few weeks to see if Mr X’s care package could be reduced.
14. In May Mr X’s CHC funding ended. A review of his care found Mr X still needed three visits each day with two carers at each visit. The Council commissioned a package of care for Mr X which it paid for because it believed Mr X did not have savings above the upper capital limit.
15. Also in May the Council received a referral for its Financial Assessment Team to complete a financial assessment to find out if Mr X needed to pay towards the cost of his care.
16. In June Mr X’s social worker reviewed his care package. The review found Mr X’s care needs and provision did not need changing.
17. In October a finance officer began a financial assessment for Mr X. The financial assessment found Mr X had personal savings over the upper capital limit. The Council told Mr X he would need to pay for his care.
18. In November Mr and Mrs X cancelled his care package because they could not afford to pay for care. The Council asked Mr and Mrs X to think about their decision because of the impact on Mrs X as Mr X’s carer. They did not change their decision.
19. The Council also sent an OT to visit Mr and Mrs X to discuss reducing Mr X’s care so a care package could be reinstated. Afterwards Mr X paid for a reduced care package consisting of one visit a day attended by two carers.
20. Following its decision that Mr X would need to pay towards his care, the Council issued him with an invoice for £15,050 for the care provided to him between May 2023 and October 2023.
21. Unhappy Mrs X complained to the Council. She said the Council took too long to complete a financial assessment for Mr X. She said Mr X was unaware that he would need to pay for his care until the assessment was decided. If it had been completed sooner, they would have reduced his care package, as they did in November 2023.
22. The Council replied. It said that Mr X advised the Council that he managed his own finances, and he had capacity to do so. It said he told officers in May 2023 that he did not have savings above the upper capital limit and so, the outstanding bill for his care was not the responsibility of the Council. It also said Mr X received the care that he was assessed as requiring. It did not uphold Mrs X’s complaint.
23. Unhappy Mrs X complained to the Ombudsman. In response to our enquiries the Council said:
• its financial assessment team was under resourced in May 2023 with a backlog of 900 cases. Therefore it did not complete Mr X’s assessment until October 2023. It has hired more staff and restructured the department which has significantly reduced the backlog of cases awaiting assessment.
• it accepted Mr X had to wait an unacceptable time for his financial assessment to be completed.
24. Mr X died before our investigation began.

Finding

25. The Council took six months to complete Mr X’s financial assessment. This is a significant delay and is fault.
26. I am satisfied the Council has acted to improve the time it takes to complete financial assessments. Therefore I do not consider it is necessary for me to make a service improvement recommendation now.
27. Mrs X says that because of the delay Mr X commissioned care when he would not have done so. Mr X reduced his care package once the Council completed his financial assessment. Therefore I do not have reason to doubt Mr X would have reduced his care package earlier if the financial assessment had been completed sooner.
28. I note the Council arranged an OT visit after it decided Mr X’s financial assessment to advise Mr and Mrs X about how to best reduce the care package. I consider it is likely the Council would have offered such a visit earlier if the financial assessment had been completed sooner.
29. It was also recommended in April 2023 that an OT assessment be completed for Mr X to see if his care needs could be reduced. No evidence has been provided to show an assessment took place and so, it is unclear if Mr X’s care needs could have been reduced sooner. I recognise a review by Mr X’s social worker in June 2023 did not recommend any changes to his care package. However I do not consider the review can act as a substitute for the recommended OT assessment.
30. I recognise Mr and Mrs X did not tell the Council that he had savings above the upper capital limit in April 2023. If they had done so the Council would have likely advised them that he would need to pay for his care costs at this time. However Mr and Mrs X declared the savings when asked to complete an assessment form in October 2023. Therefore it seems likely the confusion around the savings held by Mr X would have been clarified earlier, had the financial assessment been completed sooner.
31. For the reasons discussed I consider that, on the balance of probabilities, Mr X would have reduced his care package earlier had the Council completed the financial assessment sooner. Therefore I consider Mr and Mrs X have been financially disadvantaged because of the fault I have identified.

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Agreed action

32. Within one month of my final decision the Council should:
• apologise to Mrs X for the identified fault.
• reduce the outstanding invoice for Mr X’s care costs by £5000 in recognition of the fault and injustice discussed in paragraphs 25-31. This payment takes into account that Mr and Mrs X benefited from having the care he received between May 2023 and October 2023 but that he would likely have reduced his care package earlier if the financial assessment had been completed sooner.
33. The Council should provide us with evidence it has complied with the above actions.

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Final decision

34. I have completed my investigation. I find the Council at fault, and this caused injustice. The Council has agreed to apologise and make a payment to Mrs X.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman