Summary: The Council did tell Mrs X she would have to pay towards the cost of her care. However, it was at fault for taking over a year to complete its financial assessment. As a result, Mrs X had the shock of a large bill and was denied the chance to make informed choices about her care. Mrs X would have accepted less care and cancelled the care package sooner had she known the cost. This is an injustice to Mrs X. The Council has agreed to apologise, recalculate Mrs X’s bill and make a payment to recognise her avoidable distress.

The complaint

1. Mrs X complained that the Council:
1. failed to tell her about the costs to her of receiving care;
2. delayed carrying out the financial assessment which decided how much she should pay, resulting in a large bill;
3. charged her for care she did not receive; and
4. failed to review her care plan after 13 weeks.
2. As a result, Mrs X says she now has the stress of an unexpected bill at a time when she is dealing with serious illness. She says the Council's delay prevented her from cancelling the care sooner.

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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. 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. I considered the complaint and the information Mrs X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. I referred to the Ombudsman’s guidance on remedies, a copy of which can be found on our website.
9. Mrs X and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Charging for social care

10. A council has a duty to arrange care and support for those with eligible needs. 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)
11. 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 produce a personal budget which includes:
• The cost to the council of meeting the person’s needs;
• The amount the person must pay towards that cost, based on the financial assessment
• Any amount the council must pay towards the cost. (Care Act 2014, section 26)
12. It must not charge more than the cost to the council of meeting the assessed needs.
13. In most circumstances, councils should complete financial assessments before they create care and support plans and before any care services begin. This means people can make informed decisions about the care and support they want, considering the financial impact. An exception is where someone appears to have urgent care needs. Under section 19(3) of the Care Act, councils can meet needs that appear to be urgent without having completed a needs assessment or financial assessment, but this is the exception not the rule.

What happened

14. In November 2022, Mrs X contacted the Council. She wanted to know if she could get any funding to adapt her bathroom. She told the Council that she found it difficult to step in and out of the bath because of an ongoing health condition which affects her mobility. She wanted help to install a level access shower.
15. The Council told Mrs X that the wait for adapting her bathroom could be up to a year. It identified that she may have care and support needs, especially until the bathroom works were done. It arranged to assess her.
16. The records show that in late November, the Council completed this assessment. It was satisfied Mrs X had eligible needs for care and support. The Council noted that Mrs X was “made aware” there would be a charge for the care. It referred Mrs X to its financial assessment team.
17. The Council sent Mrs X a letter it asked her to sign and return, which she did. The letter was titled “agreement to pay a charge”. The letter said that by signing, Mrs X understood that she “will have to pay towards the cost of any social care provided through the County Council”.
18. In mid-December, Mrs X started receiving care from a care provider. The care plan said she needed:
• A 45-minute visit every morning
• A 30-minute visit every evening
• An hour visit on a Friday to help her with cleaning
19. The Council sent Mrs X another letter, setting out her personal budget. This letter said: "[f]ollowing your financial assessment, you may be required to pay a part of this cost. This is called your assessed contribution and we will inform you about this separately". The letter also said the Council would review the care plan after 13 weeks.
20. In February 2023, Mrs X provided the Council with a completed financial circumstances form.
21. In June 2023, the Council wrote to Mrs X with a “pre-assessment letter” to say it would be conducting the financial assessment.
22. In September 2023, Mrs X cancelled the evening care calls because she did not think she needed them anymore.
23. In January 2024, Mrs X cancelled her care. The social care team wrote to the financial assessment team to note that Mrs X’s assessment was not complete and so she had paid nothing for her care.
24. In February 2024, the Council wrote to Mrs X with the outcome of its financial assessment. This found that Mrs X should pay towards her care. It sent an invoice for the contributions Mrs X owed for the period she received care. This was a large bill.
25. Mrs X complained to the Council. She said the bill had come as a complete shock and that no one told her she would have to pay for care. She also complained that the Council had not reviewed her care plan after 13 weeks. The Council responded to the complaint in March. The Council:
• apologised for the delay completing the financial assessment. It said it usually completes these within 20 working days but at the time it had a high demand.
• acknowledged that it only wrote to say it was carrying out the assessment in June 2023 and “we then did not follow this up as we should have until after your care package ended”.
• did not agree that it did not tell Mrs X she would have to pay for care. It pointed out that Mrs X had signed the agreement to pay a charge.
• accepted that it should have reviewed the care plan, but said Mrs X had not contacted it about any change in her circumstances.
26. Mrs X asked the Council to consider her complaint at stage two of its complaint process in April. She said:
• she did not remember being told she would have to pay;
• she was never told what the actual cost of her care was; and
• the care provider had included an hour a week for cleaning when it billed the Council but she never received this.
27. The Council responded in early May. It said:
• the records showed it told Mrs X that there would be a charge for the care; and
• Mrs X’s contribution is used first to pay for the care, so her contribution would only reduce if the actual cost of the care she received, across the year, was less than she was assessed to pay.

Findings

28. I set out my findings on the complaint in the order they appear in paragraph one.

Telling Mrs X there would be a charge

29. The evidence is clear that the Council told Mrs X during its assessment there would be a charge. She signed the letter confirming she understood this. The Council repeated this again in the letter setting out her personal budget. Therefore, I do not find fault with the Council on this part of the complaint.
30. However, there is no evidence the Council provided copies of the leaflets it has about care costs. Nor that it signposted Mrs X to the information on its website about this. Mrs X had just received a cancer diagnosis. She was distressed and getting a lot of new information at that time. It is understandable that she may not remember the conversations or have taken in the information properly. The Council should consider providing copies of its clear written information alongside the “agreement to pay a charge” form.

Delay in financial assessment

31. As it accepted in response to Mrs X’s complaint, the Council took much too long to decide how much Mrs X should pay towards her care. It took the Council 15 months to complete the assessment. This delay was fault.
32. The Council did not, at any point, tell Mrs X how much her package of care cost or indicate what her contribution was likely to be. This was fault.
33. This meant Mrs X could not budget for her care costs and experienced the shock of a large bill. This is an injustice to Mrs X.
34. The Council’s fault denied her the opportunity to make an informed decision about whether to accept the care. This is an injustice to Mrs X.
35. We can decide what we think is more likely than not to have happened but for any fault to determine the extent of the injustice. In this case, I have considered whether, but for the fault, Mrs X would have made different decisions about her care.
36. On balance, based on the care records, I find that had she known the cost to her Mrs X would have:
• declined any visits on weekends from the start. The records show she cancelled these regularly from the beginning of the care package and this is when her family and friends were most available to help her.
• cancelled the evening care calls sooner and by the beginning of May 2023. From then, Mrs X regularly cancelled several evenings a week, was out when the carers visited or had other visitors.
• ended or significantly reduced the care package from mid-September 2023. By this point, the evidence suggests Mrs X was managing well and she was more frequently cancelling the care visits.
37. Therefore, the Council should recalculate Mrs X’s bill based on the cost to the Council of:
• two care visits a day, a total of 1 hour and 15 minutes, for five days a week from 19 December 2022 to 1 May 2023 (6.25 hours a week);
• one 45-minute visit a day from 2 May 2023 to 21 September 2023 (3.75 hours a week); and
• no care after 21 September 2023.
38. If the cost to the Council of this care, also considering weeks where Mrs X received fewer or no hours in reality, is less than it has asked Mrs X to pay, it should reduce her bill accordingly.

Charged for care not received

39. Mrs X’s care plan includes one hour a week for help with cleaning. There is no evidence she ever received this support. This was fault.
40. However, there is also no evidence that the care provider included this hour when it billed the Council. I do not, therefore, find that the Council has asked Mrs X to pay for care she has not received.

No care plan review

41. In its letter in December 2022, the Council told Mrs X it would review her care and support plan after 13 weeks. As it accepted in response to her complaint, it did not do so. This was fault.
42. This denied Mrs X the opportunity to review her support needs. It also means Mrs X missed out on an opportunity to understand earlier that she would have to pay for her care and to make an informed decision about whether and to what extent she wanted it to continue. These are injustices to Mrs X.

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Agreed action

43. To remedy the injustice to Mrs X from the faults I have identified, the Council has agreed to:
1. Apologise to Mrs X in line with our guidance on Making an effective apology
2. Recalculate Mrs X’s bill in line with my findings in paragraph 37 and the actual care Mrs X received, where less than this, and agree an affordable payment plan with her
3. Pay Mrs X £250 in recognition of the avoidable distress caused by receiving a large and unexpected bill
44. The Council should tell the Ombudsman about the action it has taken within four weeks of my final decision.
45. In response to my enquiries, the Council demonstrated that it now completes financial assessments in an average of 12 days. I am satisfied, therefore, that the fault in this case is not likely to happen to others in future. I have not, therefore, recommended any service improvements.

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Final decision

46. I have completed my investigation. There was some fault by the Council. The action I have recommended is a suitable remedy for the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman