Summary: Miss X complained about the financial assessment the Council completed. She said it did not include all her disability related expenditure, and her assessed weekly contribution is unaffordable. As a result, Miss X had to go without essentials for her disability. There was no fault in the Council’s decision-making.

The complaint

1. Miss X complained about the financial assessment the Council completed. She said the Council did not include all her disability related expenditure (DRE), and the assessed weekly contribution to the costs of her care is unaffordable.
2. Miss X said she had to choose between paying for essentials for her disability or paying her personal assistant, and she went without essentials.

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)

Back to top

How I considered this complaint

5. As part of the investigation, I considered the complaint and the information Miss X provided.
6. I made written enquiries of the Council and considered its response along with relevant law and guidance.
7. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

8. 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.
9. 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)
10. 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.

The Council’s charging policy

11. The Council’s policy provides for an increased MIG allowance for people of working age by an extra £45.75 per week to help with the extra costs of disability.
12. The Council awards set allowances for some DRE, but it can reconsider them where there is evidence of spending.
13. The Council has a guideline maximum allowance of £14 per week to help someone manage essential cleaning tasks in their home. This can be higher in exceptional circumstances.
14. The Council may provide a small allowance for any extra costs of a specific diet as prescribed by a doctor due to illness or disability. It has a maximum allowance of £6 per week for this. This is because different diets are not likely to cost more than the average cost of a diet which is already included in the MIG allowance.
15. Allowances for other extra costs must be reasonable and as a result of disability/medical issues rather than choice.
16. The Council considers £4.60 per week is reasonable as extra spending for laundry.
17. The Council will not normally allow costs that could be obtained free or should otherwise be met by other agencies, such as the National Health Service (NHS). This includes therapies, and applies to chiropody and continence pads.

What happened

18. I have summarised below some key events leading to Miss X’s complaint. This is not intended to be a detailed account of what took place.
19. The Council referred Miss X for a financial assessment in November 2021 to decide how much she must contribute towards the cost of her care package.
20. A Council officer visited Miss X as part of the assessment in February 2022. Miss X told the officer she paid for therapies and vitamins due to her condition. The officer advised these could only be included if Miss X provided medical evidence they are needed and why she cannot get treatment on the NHS. Miss X agreed to provide evidence.
21. The Council completed Miss X’s financial assessment in March 2022. It calculated she must pay £71 a week towards the cost of her care package.
22. The Council reviewed Miss X’s financial assessment in November 2022 after an appeal. It allowed £20 a week for the cost of therapies and reduced Miss X’s weekly contribution to £51.
23. Miss X asked the Council to consider more DRE and made a further appeal.
24. The Council wrote to Miss X with its decision in March 2023. It agreed to reduce her earlier contributions to £33 a week, and confirmed her contribution going forward would be £40 a week. It told Miss X it had already allowed the maximum for domestic services (£14 a week). However, it agreed to allow a further £16 per week making this up to £30 in total. It also agreed to increase the allowance for counselling to £25 per week from April 2023.
25. Miss X complained about the result of her appeal. She said her financial assessment suggests she can afford to pay £40 a week for her 8 hours of support. This is not affordable and will cause financial hardship. She also said the Council had not accounted for several of her DRE which are crucial to her wellbeing, including:
• Collagen and vitamins to support hormonal imbalance and physical burnout.
• Herbal remedies and treatment advice, due to side effects from traditional medicines. And medical soaps.
• Counselling and spiritual healing for her anxiety, Obsessive Compulsive Disorder (OCD), mental health and emotional regulation challenges resulting from autism.
• Counselling and holistic therapy to support anxiety, autism, and OCD.
• Monthly meetings with a psychologist.
26. Miss X said these treatments are not available on the NHS and she provided supporting letters from her GP and other health professionals. She also said she was due refunds from her backdated financial assessment.
27. Supporting letters from Miss X’s doctor and medical professionals confirms the treatments she is taking and that “she feels benefit from them”. They also confirm Miss X could not get NHS prescriptions for vitamins, herbal remedies, or alternative remedies.
28. Miss X’s doctor states she does not meet the criteria for a referral for prolonged counselling (beyond 6 sessions), or psychological interventions or psychiatric therapy.
29. A supporting letter from a mental health charity says Miss X “does not find traditional talking therapies helpful” and she “prefers spiritual techniques”.
30. The Council sent its final complaint response on 17 November 2023. After reading the supporting letters Miss X provided, explaining why the services she uses are beneficial to her wellbeing, the Council did not agree the costs should fall on the Council. It said:
• Collagen and vitamins are not eligible, and if they were necessary for Miss X’s health they should be prescribed by the NHS. It allowed £6 per week for vitamins as part of Miss X’s dietary expenses. Otherwise, it said these costs should come from the general MIG living allowance, which it allowed at an increased rate than that set by Government.
• It allowed £4.60 per week for laundry.
• Herbal remedies and spiritual healing should also be prescribed by the NHS if they are necessary for Miss X’s health.
• It recognised counselling and holistic therapy may help with autism and OCD, but said it already agreed a partial allowance of £25 per week for this.
• It said meetings with a psychologist are available for free from the NHS and gave details of this.
• It would refund Miss X £264 for periods where it needed to change and backdate her financial assessment.

My investigation

31. The Council told me Miss X claimed £345 a week for DRE in total, including private counselling, soaps, vitamins, and herbal remedies. The Council said the maximum disregard under its policy is £101.75 a week.
32. The Council considers some of Miss X’s expenses are a choice rather than necessity. She paid 10 different counsellors, including psychotherapy, life coaching, and spiritual healing, at an average of £219 a week. The Council would not expect to provide extra DRE for spiritual mediums and life coaches as these are not deemed as a necessity. However, it agreed to allow £20 per week for counselling and later increased this to £25 per week from April 2023. 
33. The Council allowed total DRE of £43.20 a week, including costs for a skin condition, dietary issues, and domestic services. The Council allowed £4.60 for laundry and £6 for dietary costs in line with its policy. The Council allowed a further £30 a week for domestic tasks (3 hours at £10 per hour).

Analysis

34. The Council does not normally allow DRE for therapy or treatments available for free from another agency. Miss X had several therapists and counsellors she saw regularly, costing about £219 a week. The Council considered her supporting medical evidence but decided some of these treatments were a personal choice rather than a medical necessity. I did not see evidence of fault in that decision, and I note Miss X’s doctor said she did not meet the criteria for longer term counselling sessions. I consider this supports the Council’s view that not all sessions were a necessity.
35. However, the Council agreed to exercise discretion and award a partial allowance of £25 a week towards the cost of therapy to support Miss X’s autism and OCD.
36. The Council would not award an allowance for herbal remedies, spiritual healing, or Collagen. While supporting letters from Miss X’s doctor state she feels benefit from these treatments, they do not say there is a medical need or necessity for them. I do not criticise the Council for not making a DRE award in these circumstances.
37. I appreciate Miss X’s supporting evidence said she did not find talking therapies helpful and preferred spiritual techniques. However, the Council considered this was a personal preference rather than a necessity, and I have not seen evidence of fault in that decision.
38. The Council allowed £6 a week for vitamins as a dietary requirement. This is in line with its charging policy. It also allowed £4.60 for extra laundry costs. Again, this is in line with its charging policy.
39. The maximum allowance for domestic services is £14 a week under the Council’s charging policy. However, it again agreed to exercise discretion when it awarded an extra £16 a week for this.
40. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether someone disagrees with the decision the organisation made.
41. I found the Council considered Miss X’s claimed DRE and supporting evidence from professionals involved in her care. It then applied this information to its charging policy when deciding the amount of DRE to allow. It considered Miss X’s appeals against earlier decisions, and agreed to exercise discretion to allow more DRE. I found no fault in the Council’s decision-making.

Back to top

Final Decision

42. There was no fault in the Council’s decision-making when it considered Miss X’s requests for DRE.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman