Summary: Ms Y complained the Council failed to provide her and Mrs X with information about possible charges for Mrs X’s care at home, leading to a debt causing distress. We found evidence of some fault in the way the Council administered these matters, but these faults did not cause injustice to Mrs X or Ms Y. So, we have completed our investigation.

The complaint

1. Mrs X was Ms Y’s mother-in-law. Ms Y complained that:
• The family was told that a care package had to be in place in order for Mrs X to be safely discharged from hospital, but not that Mrs X would have to pay for this
• They were told (in person), and again on a later telephone call, that funding was in place for her care
• They did not receive invoices for six months
• If they had been told the care was not funded, they would have reduced the frequency of care visits from four to two per day, immediately
• Mrs X’s case went to panel in October 2023; a personal budget letter should have been sent out after this
• The family was not advised that Mrs X may have been eligible for Continuing Healthcare (CHC) funding.
2. Because of the alleged faults, the family says it has suffered a financial impact and emotional distress. They want the backdated invoices for care costs to be cancelled.

Back to top

The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. 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)
5. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)

Back to top

How I considered this complaint

6. I spoke to Ms Y and considered the information she provided with her complaint. I considered information from the Council and the supporting documents it provided along with the relevant law and guidance.
7. Ms Y and the Council had an opportunity to comment on a draft version of this decision. I considered the comments received before making a final decision.

Back to top

What I found

Law, guidance and policies

8. 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.

Intermediate care and reablement

9. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

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 continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Needs assessment and care plan

11. 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.

Charging for social care services: the power to charge

12. 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)

Financial assessment

13. 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.

Timing of financial assessment

14. 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.
15. 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. 

The Council’s Charging Policy

16. The Council produces a leaflet for service users, relatives, and carers entitled Non-Residential Charging for Adults. The version relevant to this complaint was dated 2023 to 2024. It explains that the Council will need to carry out a financial assessment to establish a person’s liability towards their care fees. It includes:

“Non-residential services include most services provided to an adult who lives in their own home. For example, a homecare service provided by an agency”.

“How do you know my financial position? Once you have had a discussion about your needs and eligibility your Care Assessor, where relevant, will refer you for a financial assessment. We will ask you, or your financial representative, to complete a ‘financial assessment form’ to provide us with full details of your financial position including your income and capital.

What happens if I refuse a financial assessment? You do not have to give us information about your financial circumstances. However, if we are unable to assess your financial position, then you will be asked to pay the full cost towards your services.”

“If your savings and investments are more than £23,250, then you will be charged the full cost of the service plus administration fees.”

Continuing Healthcare (CHC)

17. NHS CHC 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.
18. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman

What happened in this case

19. What follows is a chronology of key events. It does not contain all the information I reviewed during my investigation.

Events of 2023

20. Mrs X was admitted to hospital in August 2023. On 12 September, Mrs X was assessed by an Occupational Therapist (OT) on the ward. They made a referral to social care which said that a package of care at home, to include four visits per day, was required for Mrs X to be safely discharged.
21. Mrs X was discharged and care calls commenced on 14 September.
22. A referral for a full financial assessment was made by the first Care Assessor on 15 September.
23. Also on that day, the Council emailed Mrs X’s daughter, Ms Z, attaching an Adult Social Care Financial Assessment form and explaining “the form needs to be completed, signed and returned back to us as soon as possible.”
24. Attached to that email was a letter that included:

“I am writing about the social care services Mrs [X] may be eligible for. Please find enclosed a Financial Assessment Form that you need to complete. We use this to work out how much they must pay towards their services. The savings limit is £23,250. If they have more than this, they will have to pay the full amount for services plus administration charges.

[…]

Any contribution towards services applies from the date services commenced so it is important to send the form and any evidence to us as soon as possible. You should return the form by 29/09/2023. If we do not receive this in time, Mrs [X] will have to pay the full cost for services until financial evidence is provided.”

25. The Council’s leaflets, Non-Residential Charging for Adults and About Administration Charges, were attached to the email.
26. Ms Z called the first Care Assessor on 18 September. She asked for the package of care to be reduced to two visits per day. She asked that male carers not be sent to her mum. She asked about the financial assessment form, and the Council’s finance department re-sent the relevant documents that day.
27. Mrs X had a further hospital admission between 23 September and 5 October. On discharge, care visits were increased back to four times per day.
28. On 11 October, the Council sent Ms Z a reminder letter that the financial assessment form needed to be completed. It gave a revised deadline of 25 October and advised “if you don't return the form I will not be able to assess [Mrs X’s] circumstances and they may have to pay the full cost of their care”.
29. The first Care Assessor completed a Strength Based Assessment for Mrs X on 14 October. This concluded:

“We will arrange for a Care Act eligibility assessment for you. This will determine and summarise your needs and eligibility under the Care Act

We will also arrange for a financial assessment to determine what, if any, financial contribution you will need to make towards any required care and support.”

30. The first Care Assessor shared the Interim Services letter with the family. This stated that “Wokingham Borough Council will invoice you approximately every 4 weeks in arrears if a charge applies.” 
31. The first Care Assessor visited Mrs X at home on 19 October and completed a Care Act Assessment with her. This included that no reablement service had been provided because there was “no reablement potential”. The “summary of needs” in the assessment, reflected in the Care Plan, included the Care Assessor’s professional opinion that the package of care put in place by the hospital should continue to prevent further admissions. She noted that Mrs X’s family was in agreement with this.
32. Mrs X’s case was considered by the Council’s Self-Directed Support Overview Panel on 31 October. The Panel agreed Mrs X had eligible care needs and that these could be met via a package of domiciliary care consisting of one carer visiting four times per day. The cost of this package was noted as being £18,150 per annum. The submission considered by the Panel included that CHC was not applicable because Mrs X’s needs did not meet the threshold. The outcome of this Panel meeting was not shared with the family.
33. The first Care Assessor emailed Ms Z on 27 November to ask how the family felt about the support that was in place for Mrs X. She noted that the financial assessment form had not been completed, and asked when this would be done. The email concluded “If not completed there is a risk your mother will be charged full cost for services.”
34. The Hospital Liaison Team wrote to Mrs X on 30 November to explain that her care would now be overseen by the Ongoing Care Team. This letter was not about how Mrs X’s care would be funded.
35. Ms Z phoned the Council on 8 December and spoke to a member of the administration team. Ms Z said that her sister had been told, during the first Care Assessor’s visit of 19 October, that care would be funded. She asked whether that funding would carry on, or whether there would be a charge. The administrator said “if it’s been approved it should carry on”.

Events of 2024

36. The family requested a reduction in care visits from four to three per day. This change was made on 5 January 2024.
37. A second Care Assessor reviewed Mrs X’s Care Plan on 23 February 2024. During this review it was noted that the family had confirmed Mrs X had savings above the limit of £23,250 and would therefore be required to fund her own care. The review also noted that the family had requested a CHC checklist be completed.
38. The second Care Assessor emailed Ms Y and Ms Z on 27 February to confirm that Mrs X would need to fund her own package of care from 20 September 2023 onwards. She also referred Mrs X to the Council’s CHC Team to complete the CHC checklist, as Mrs X’s health was deteriorating quickly.
39. Council care ceased on 29 February. On 5 March, the Council issued invoices for the costs of Mrs X’s care from 20 September 2023.
40. A member of the Council’s CHC Team visited Mrs X on 6 March and completed the CHC checklist. This was positive, so Mrs X’s case was then referred to the local Integrated Care Board (ICB) for a full CHC assessment called a Decision Support Tool (DST). Mrs X was placed in residential care in a different ICB area so the DST was not progressed by the first ICB.
41. Ms Y complained in March, and the Council responded in April. Ms Y escalated her complaint, and the Council provided a stage 2 response on 3 June.
42. Mrs X died on 8 June 2024.

My analysis

43. Below, I consider each of Ms Y’s complaints in turn.

The family was not told Mrs X would have to pay for her care

44. Ms Y complained that Mrs X’s family was told that a care package had to be in place, but not that Mrs X would have to pay for this.
45. I cannot comment on the actions of NHS staff, and therefore I cannot make any findings on the decision that was made in hospital that a package of care was required in order for Mrs X to be discharged safely. Nor can I comment on what the family was told by NHS staff, while Mrs X was in hospital, about how this care would be funded.
46. Once Mrs X was discharged from hospital, the oversight of her care and support needs, and deciding how these should be paid for, became the Council’s responsibility. I find there was no fault in the way the Council communicated with the family about the way this care would be funded.
47. The information provided by the Council on 15 September, and again on 18 September, included:
• The way the Council establishes a person’s ability to pay towards their own care is via a financial assessment, and the form for this needed to be completed and returned.
• Any contribution towards services would apply from the date services had commenced.
• If a person’s savings and investments are more than £23,250, then they would be charged the full cost of the service plus administration fees.
• If the council was unable to assess the person’s financial position, then they would be asked to pay the full cost towards the services.
48. Ms Y suggested that, when it did not receive a response to earlier requests for financial disclosure, the Council should have chased again. The family was asked to complete the financial assessment form on 15 and 18 September, 11 October, and 27 November. Full supporting information, in the form of explanatory leaflets, was also provided. The council advised, on each of these occasions, that the failure to complete the form would lead to Mrs X being charged for her care. This is in accordance with the requirements of the Care Act and the Council’s policy for charging. I find that the Council was not at fault in not chasing further for financial disclosure. The Council asked for the information four times and explained the potential consequences of failing to provide it. I consider this was good administrative practice.
49. During this investigation, the Council told me that it has secured additional resource to support residents with completing financial assessment documents. Whilst I welcome this service improvement, there is no evidence of fault by the Council in how it advised Mrs X and her family of the possibility of charges and no evidence that the family needed help to participate in the financial assessment process. While Ms Y may be unhappy at the charges, the Council is entitled to assess and require a contribution towards Mrs X’s care costs.

The family was told that funding was in place

50. Ms Y said that the family was told in hospital that the first six weeks of Mrs X’s care at home would be funded. Again, I cannot comment on what the family was told by NHS staff.
51. The only circumstances in which the Council would fund the arranged package of care were either a) up to six weeks of funded reablement care, irrespective of financial situation, or b) ongoing funding based on a full financial assessment establishing that Mrs X had less than the capital threshold. I find that option a) did not apply because the Care Act Assessment carried out on 19 October, shortly after Mrs X’s second discharge, sets out clearly that no reablement service had been provided because Mrs X had “no reablement potential”. Care was therefore chargeable from the outset. I find that the Council could not decide whether option b) applied, because the family did not engage with the financial assessment process, and therefore the Council had no documentary information about Mrs X’s financial position. In the absence of this information, the Council could not make a decision about whether or not Mrs X would need to pay for her care, and so could not communicate this to her family. Therefore the council acted without fault.
52. During this investigation, the Council told me that it had implemented a new process whereby team members, when sharing the Interim Services letter with families – as happened in this case – also share a letter setting out whether the care being provided in the immediate post-discharge period is reablement or a long-term care package, the latter being potentially chargeable from day one. I welcome this service improvement, but nevertheless find that the Council acted without fault. That is because Ms Y’s complaint letters make it clear that the family understood from the outset that reablement was not applicable in Mrs X’s case.
53. Ms Y complained that the family was told in person by the first Care Assessor, and again on a later telephone call with a member of administrative staff, that funding was in place for Mrs X’s care.
54. Ms Y said that, during the Care Act Assessment of 19 October 2023, the first Care Assessor said that Mrs X’s care would be funded. The assessment document completed by the first Care Assessor during the in-person assessment includes that funded reablement care did not apply in Mrs X’s case. It follows that the only other circumstances in which Mrs X’s care would be funded would be if her assets were below the capital threshold. The first Care Assessor could not have known, at the time of the in-person assessment, whether or not care would be funded, as a financial assessment had not been completed. She had set out, in the Strength Based Assessment of 14 October, that a full financial assessment would be required “to determine what, if any, financial contribution you will need to make towards any required care and support.” Whilst I cannot know what the first Care Assessor said during the Care Act Assessment, she may have been responding to information given to her verbally by Mrs X’s family. I find no fault in the actions of the first Care Assessor.
55. I consider next the comment made by a council administrator on the call of 8 December, “if it’s [funding] been approved it should carry on”. I find that this comment was not fault because it was factually correct – if funding had been approved, that arrangement would have continued.
56. In its response to Ms Y’s complaint, the council apologised that this call was not passed on to the Adult Social Care (ASC) team. The Council told me that, had this happened, the ASC team would have been able to explain that no decision had been made regarding who was responsible for paying for Mrs X’s care, because the family had not returned the financial assessment forms. The failure to pass the call through was fault, but I find it did not cause an injustice as the family had already been asked four times to complete the financial assessment forms, so was aware of the need to do so.
57. I consider that the apology offered by the Council was an appropriate remedy for the fault. During this investigation the Council told me that it had also had a discussion with the administration team lead to ensure that cases and calls such as this will be shared with the relevant service team in future.

The family did not receive invoices for six months

58. Ms Y complained that there was a delay in issuing invoices and, if they had been aware Mrs X’s care was not funded from the outset, they would have reduced the frequency of care visits from four to two per day, immediately. Ms Y said that the lack of invoices meant the Council had accepted the costs “by default”.
59. I set out at paragraph 15 that the Ombudsman usually expects councils to complete financial assessments before care services begin, to enable people to make informed decisions about the care and support they want, taking into account the financial impact. However, this is not usually realistic when care is initiated in an acute setting. I find that the Council initiated the financial assessment process in a timely manner, and the reason this was not progressed was that the family did not return the completed forms.
60. I find that the delay in issuing invoices before December 2023 was reasonable. In the absence of either a full financial assessment, or confirmation from the family that Mrs X had capital above the threshold, the Council was not able to issue accurate invoices. I would have been critical if the Council had rushed to issue invoices without first giving the family adequate opportunity to provide the relevant financial information.
61. I have already found that, after the fourth request in November, the Council did not need to chase the family further for the financial disclosure information. It follows that, when the completed forms were not received after that request, the Council should have issued an invoice in December for outstanding care costs
62. The delay in issuing invoices beyond December 2023, until March 2024, was therefore fault. However, I find that this fault did not cause Mrs X and her family an injustice because the family would have known, from September onwards, that Mrs X was a self-funder. Further, the primary cause of the delay was the family’s failure to provide the information that would have enabled a financial assessment and the issuing of accurate invoices.
63. I note that, when an invoice was issued, this was for care at home from 20 September 2023 to 20 February 2024. Mrs X was in hospital from 23 September to 4 October, and this period should be discounted from the invoice that remains outstanding.

A personal budget letter was not shared with the family

64. In response to Ms Y’s complaint, the Council admitted that, when the Panel considered Mrs X’s case on 31 October 2023, a personal budget letter should have been shared with Mrs X and her family.
65. The failure to send this letter was fault, for which the Council has apologised. I find that the fault did not cause Mrs X and her family an injustice because, although the personal budget sets out the costs of care, it does not specify who is responsible for meeting these costs.

The family was not advised that Mrs X may have been eligible for CHC funding, and that they could apply for this.

66. Ms Y complained that CHC should have been considered at the time of Mrs X’s discharge from hospital, and again during the October 2023 Care Act Assessment. She said the family should have been advised that they could apply for CHC.
67. Taking the second point first, the decision to complete the CHC checklist is one made by a health or social care professional, using their professional judgment. It is not something that an individual needing care, or their family, can apply for – although they can request that the need for the checklist to be completed should be considered.
68. I cannot come to any findings on the actions of the NHS in its assessment of Mrs X’s needs while she was an inpatient.
69. The submission considered by the Panel on 31 October 2023 included that CHC was not applicable because Mrs X’s needs did not meet the threshold. That decision was made with professional judgment by a social worker, based on Mrs X’s presentation at the time of the 19 October Care Act Assessment. Our role is not to ask whether a Council (or other organisation) could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did so, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome. In this case, I find that there is evidence that the applicability of CHC was considered by the Council, and I cannot say it should have reached a different decision because of that consideration.
70. I have made Ms Y aware that CHC funding can be applied for retrospectively, and that the family may wish to consider making a request for an assessment of a previously unassessed period of care.

Back to top

Final decision

71. I have concluded my investigation with a finding of fault which did not cause injustice.

Back to top

Investigator's decision on behalf of the Ombudsman