Summary: Ms X complained the Council has incorrectly calculated her contribution towards her care costs in her 2024 financial assessment. We found fault with the Council applying the 2023/2024 Disability Related Expense disregard rate rather than the 2024/2025 rate for Ms X’s bedding disregard. We did not find fault with the Council’s other decisions or calculations in Ms X’s financial assessment. The Council agreed to apply the correct 2024/2025 bedding disregard rate to Ms X’s financial assessment, backdates this to 1 April 2024 and apologises to Ms X.

The complaint

1. Ms X complained the Council has incorrectly calculated her contribution towards her care costs in her 2024 financial assessment.
2. Ms X says the increase in costs is unaffordable and has meant she cannot afford things such as socialising and going on holiday which is impacting her wellbeing and mental health.

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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 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)
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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What I have and have not investigated

6. I have investigated Ms X’s concerns about the Council’s financial assessments about her client contributions completed in April and May 2024.
7. I have not investigated Ms X’s concerns about extra costs the Council applies through her Personal Assistance expenses for taking holidays or hiring other carers. This is because Ms X has not raised this matter with the Council as a complaint. Should Ms X have concerns about this, she would need to raise a complaint with the Council first. The Ombudsman must give a council opportunity to address a complaint before we investigate.

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How I considered this complaint

8. I have considered all the information Ms X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
9. Ms X and the Council now have opportunity to comment on my draft decision before I make my final decision.

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What I found

Relevant Law and Guidance

Financial assessments and Disability Related Expenses

10. The Care Act 2014 (‘the Act’) introduced a requirement that local authorities should promote ‘wellbeing’ and signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. (Care and Support Statutory Guidance, Chapter 1), (‘The Guidance’)
11. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. It must set out a personal budget which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)
12. The Guidance sets out what should be considered a Disability Related Expense (DRE) under Annex C. The list includes:
• any heating costs, or metered costs of water, above the average levels for the area and housing type;
• specialist washing powders or laundry;
• special clothing or footwear, for example, where this needs to be specially made; or additional wear and tear to clothing and footwear caused by disability;
• additional costs of bedding, for example, because of incontinence;
• purchase, maintenance, and repair of disability-related equipment;
• personal assistance costs, including any household or other necessary costs arising for the person;
• other transport costs necessitated by illness or disability, including costs of transport to day centres, over and above the mobility component of DLA or PIP, if in payment and available for these costs. In some cases, it may be reasonable for a council not to take account of claimed transport costs – if, for example, a suitable, cheaper form of transport, for example, council-provided transport to day centres is available, but has not been used. (The Guidance, paragraph 40)
13. The Guidance also says the following:
• It may be reasonable for a council not to allow for items where a reasonable alternative is available at lesser cost.
• The above list “… is not intended to be exhaustive and any reasonable additional costs directly related to a person’s disability should be included.” (The Guidance, paragraph 40)
• That a person’s care plan “… may be a good starting point for considering what is necessary disability-related expense. However, flexibility is needed. What is disability-related expenditure should not be limited to what is necessary for care and support.” (The Guidance, paragraph 41)

MIG

14. The (Charging and Assessment of Resources) Regulations 2014 outlines a person is entitled to minimum income guarantee (MIG) which is the minimum amount they must be left with after any contributions towards their care and support.
15. Section 78 Care Act 2014 outlines the secretary of state may provide guidance as part of its function. This includes updating the minimum income guarantee levels.
16. For 2024 to 2025, the time period relating to Ms X’s complaint, a person who is part of a couple, but only one is in receipt of Disability and Enhanced disability premiums, is entitled to a MIG of £138.80 per week.

Council’s disability-related expenditure policy and guidance for charging for care and support

17. The Council’s policy details how it will consider Disability Related Expenditure. The Council says it will consider these when a person receives a disability related benefit, costs incurred are evidenced and incurred due a person’s need and it is unreasonable to expect a lower cost alternative to be used.
18. The Council’s policy says that if a service is made up of different elements, it would only consider the cost for the part(s) of the service that meet a disability related need.
19. The Council will consider if a person needs to pay more for a service because of their disability, if the expense is specifically linked to their individual needs or if it would be incurred irrespective of these needs, if the cost is reasonable and if it identified in the person’s care and support plan.
20. The Council’s policy says that if a person has a partner and one person is in receipt of benefits, it will consider half of any means tested income received by them as a couple.
21. The Council’s policy details the costs it would consider as a Disability Related Expense at a maximum or standard rate. These include:
• Housing costs including rent and Council tax. The Council will consider any costs for these which are not met by the Department for Work and Pensions administered allowances, benefits or credits.
• Clothing and footwear at £3.59 per week. The Council details this is due to extra and wear and tear caused to clothes through certain disabilities.
• Wear and Tear in home at £3.59 per week. The Council details this is for additional wear and tear caused by disabilities (such as wheelchair scuffs and damage).
• Landline or mobile phone at £1.81 per week. The Council details this is a contribution cost because most of the time phones are not for emergencies.
• Metered Water at £2.01 per week maximum. The Council details that a person’s costs must be above the average for similar properties and details these.
• Energy at £11.83 per week maximum. The Council details that a person’s costs must be above the average for similar properties and household makeup and details these.
• Laundry at £4.86 per week for five or more loads. The Council details this is for the extra cost of washing clothes linked to disabilities.
• Bedding at £4.14 per week. The Council details this is for extra costs incurred because of disabilities.
• Transport at £16.52 per week. The Council says it will only provide costs incurred above the mount of DLA mobility allowance. The Council says ordinary day-to-day transport is not considered unless specialist transport is needed.
• Equipment at the cost of the item divided by 250 for a weekly payment. The Council says it will consider the annual maintenance costs and up front cost of equipment used to meet a person’s disability.
• Privately bought personal care at actual cost. The Council says it will consider payments for any evidenced private personal care to meet a person’s needs.

What happened

22. Ms X’s care and support plan details that she has eligible care needs. Within this care and support plan it detailed the daily support Ms X needed from her Personal Assistant who receives pay for 28.5 hours each week. Ms X’s Personal Assistant shops and prepares food, helps with accessing the toilet and shower, helps with taking medication, washes her hair and completes chores, housework and laundry. It is noted in the plan that Ms X also has use of continence pads and a mattress protector. The care and support plan also details that Ms X and her partner want to move somewhere with better access to public transport so Ms X can better access the community. The care and support plan detailed a personal budget of £330.16.
23. On 22 April 2024, Ms X asked for a review of her financial assessment because of an increase to both her rent and council tax.
24. The Council completed a financial assessment of Ms X on 30 April 2024. Within this financial assessment, the Council considered Ms X’s income, savings and expenditure. In considering Ms X’s expenditure the Council applied disregards for:
• Half the cost of rent above the cost of housing allowance in Universal Credit totalling £75.78.
• Half the cost of the council tax at £19.15.
• Wear and tear to the home at £3.59.
• Pads and wipes at £10.99.
• Equipment costs for scooter and battery at £5.60 and £0.72 respectively.
• Bedding at £3.88.
• Clothing at £3.59.
• Laundry at £4.86; and
• Telephone at £1.81.
25. The Council did not apply disregards for the remaining telephone cost, remaining clothing cost, remaining laundry cost, water or energy costs.
26. The Council summarised that Ms X had a zero contribution to her care costs because her net income would fall below her MIG.
27. On 8 May 2024, Ms X told the Council her Universal Credit had been reinstated to the full-rate.
28. The Council completed a revised financial assessment on 27 May 2024. Again, the Council considered Ms X’s income, savings and expenditure in this financial assessment. The Council applied consistent disregards for Telephone, Laundry, Clothing, Bedding, Equipment, Pads and Wipes, Wear and Tear and council tax. However, the Council recalculated Ms X’s disregard for her rental shortfall as £1.32 because of the increased income through Universal Credit.
29. The Council summarised that Ms X needed to contribute £71.04 to the cost of her care as this was the amount she had left above her MIG.
30. On 3 June 2024, Ms X raised a complaint with the Council about the financial assessment it completed. Ms X disputed the client contribution she had been asked to pay. Ms X said her car was an essential requirement for visiting hospital appointments and attending social engagements, both relevant for her coping with her illness and/or disability.
31. The Council provided its complaint response on 21 June 2024. The Council said it had reviewed the financial assessments and considered it had included the relevant disability related expenses applicable to Ms X’s needs. The Council said the reason for Ms X’s increase in client contributions was because of an increase in her Universal Credit resulting in a lower disregard for any rent shortfall reduced to £1.32. The Council apologised for a miscalculation in the financial assessment of 27 May 2024 and said this shortfall should have been £1.29 not £1.32; the Council said it had now corrected this. The Council provided a breakdown of how it had calculated Ms X’s client contribution and directed her to the Local Government and Social Care Ombudsman with her complaint.

Analysis

32. The Ombudsman is not an appeal body, so cannot comment on the merits of judgements and decisions made by councils in the absence of fault in the process.
33. The Ombudsman must decide if the Council has considered the relevant legislation and policies in making its decision. If the Council has considered the relevant policies and reached a suitable decision in line with these policies, the Ombudsman cannot find fault.
34. The Council has shown in both the financial assessments of 30 April 2024 and 27 May 2024 it has considered Ms X’s updated income through her relevant benefits obtained from the Department for Work and Pensions. The Council also used Ms X’s updated rent and council tax costs for 2024. The Council has used the correct baseline figures to calculate Ms X’s financial assessment. In neither financial assessment has the Council asked Ms X to contribute for more than her personal budget detailed in her care and support plan.
35. The remaining dispute in Ms X’s case is application of suitable Disability Related Expenses to her financial assessment. When considering if a cost is a DRE, the Council must consider any reasonable additional costs directly related to a person’s disability. The Council should consider each request and apply consistent rationale based on the individual merits of each cost.

Housing costs

36. The main change from the 30 April 2024 to 27 May 2024 financial assessment is the change in disregard applied for Ms X’s housing costs. This reduced from £75.78 to £1.32 per week.
37. The Council has shown it considered the increase in the housing allowance in Ms X’s Universal Credit to calculate the relevant shortfall in the costs associated with Ms X’s rent. The Council has detailed its calculation on the financial assessment dated 27 May 2024. The Council has correctly applied its policy to provide 50% of the weekly shortfall for Ms X’s housing costs. While Ms X’s partner does not work full-time, the Council should still apply a 50% share. This is because this is based on adults in a household and not based on how many hours of a full-time equivalent a person works.
38. In the Council’s complaint response, it has acknowledged an error in its calculations and corrected this so the shortfall reflects £1.29 rather than £1.32 disregard each week.
39. The Council has also shown in both financial assessments that it has considered 50% of Ms X’s current council tax costs. The Council has consistently applied this figure which is relevant to the 2024/2025 council tax costs.
40. The Council has correctly applied its policy for the disregards it has applied for Ms X’s housing costs and I cannot find fault.

Bedding

41. Ms X sought £20 per month for bedding costs in her financial assessment form. Ms X did not provide evidence to support this cost.
42. Ms X’s care and support plan detailed she had an eligible need for toilet needs and managing and maintaining a habitable home. The Council’s policy states it will provide a payment of £4.14 per week for bedding costs.
43. The Council provided a disregard for Ms X’s bedding costs at £3.88 per week. This was the disregard cost for 2023/2024. The Council has applied the wrong disregard rate for this Disability Related Expense. The Council should apply the correct rate of £4.14 for Ms X’s bedding costs backdated to 1 April 2024.
44. The Council has confirmed it will consider Ms X’s full requested cost of £20 per month if she provides evidence of this cost.

Clothing

45. Ms X sought a one-off payment of £60 for her clothing costs in her financial assessment form.
46. Ms X’s care and support plan detailed she had an eligible need for being appropriately clothed. The Council’s policy states it will provide a payment of £3.59 per week for clothing costs.
47. The Council has applied this £3.59 disregard to Ms X’s financial assessment. This £3.59 per week disregard amounts to more than Ms X’s request for the £60 one-off payment over the course of the year.
48. The Council has applied its policy correctly and I do not find fault.

Pads and Wipes

49. Ms X sought a payment of £10 per week for pads and wipes in her financial assessment form.
50. Ms X’s care and support plan detailed she had an eligible need for toilet needs. The Council’s policy says it will provide payment for privately sourced personal care at actual cost.
51. The Council calculated the cost of Ms X’s pads and wipes at £10.99 each week and applied this as a disregard to her financial assessment.
52. The Council has applied its policy correctly and I do not find fault.

Laundry

53. Ms X advised she needed to complete extra washing loads because of her disability in her financial assessment form.
54. Ms X’s care and support plan detailed she had an eligible need for being appropriately clothed including the washing and drying of clothes. The Council’s policy says it will provide a payment of £4.86 per week for people who need to do five or more loads of washing per week because of their care needs.
55. The Council has applied this payment of £4.86 per week as a disregard to Ms X’s financial assessment.
56. The Council has applied its policy correctly and I do not find fault.

Telephone

57. Ms X sought £93.44 per month for her landline, broadband and two mobile phones, costing about £22 per week.
58. The Council’s policy says it will provide a £1.81 weekly contribution to telephone costs for emergency situations. Ms X’s care and support plan did not detail any specific care needs related to needing access to a telephone.
59. Despite no specific reference to needing the telephone as a care need in Ms X’s care and support plan, the Council has applied the £1.81 disregard. Since the Council has allocated this amount to Ms X’s benefit and the amounts falls in line with its policy, I do not find fault with the Council.

Energy and Water

60. Ms X sought payment towards her water and energy costs in her financial assessment form.
61. The Council’s policy says it will consider costs for metered water and energy when a person’s costs are above the average for similar properties and household makeup.
62. The Council has shown it considered Ms X’s costs for both water and energy in the financial assessment. On both occasions the Council considered these costs against the average costs in the area for a similar property and household makeup. Neither the water nor energy costs surpassed the average for comparable houses so the Council did not provide a disregard for either.
63. The Council has applied its policy correctly and I do not find fault.

Wear and Tear

64. Ms X sought wear and tear costs for her washer, cooker, dryer, computer and car service totalling £44.53 per month. Ms X also sought costs for her washer and dryer in equipment costs but the Council has addressed this within this section. I have addressed the car service in the section titled “Car costs”.
65. Ms X’s care and support plan details that she has an eligible need for preparing and cooking meals. Ms X has not evidenced the extra wear and tear costs to her cooker caused by her disability above and beyond normal wear and tear.
66. Ms X’s care and support plan also detailed she has an eligible need for being appropriately clothed including the washing and drying of clothes. Ms X has evidenced a total weekly cost of £2.87 for her washer and dryer maintenance contracts.
67. The Council has accepted Ms X has eligible care needs related to general wear and tear. The Council has applied the standard rate of £3.59 per week for the extra wear and tear Ms X’s home may incur due to her care needs. This is above Ms X’s evidenced costs of £2.87 per week.
68. The Council has applied its policy correctly and I do not find fault.

Equipment

69. Ms X sought costs for her scooter and battery in her financial assessment form.
70. Ms X’s care and support plans details that she has an eligible need for her mobility. Ms X has evidenced the cost of her scooter and battery.
71. The Council has accepted Ms X’s costs for her scooter and battery and applied disregards for these costs to Ms X’s financial assessment. The Council has accepted these costs as these are directly related to her eligible care needs which a person without her care needs would not incur.
72. The Council has applied its policy correctly by providing the exact cost of Ms X’s disability related equipment over the course of their life expectancy spread out as a weekly cost.
73. The Council has applied its policy correctly and I do not find fault.

Car costs

74. Ms X sought costs for her car maintenance and services in her financial assessment form.
75. Ms X’s care and support plan details an eligible need for mobility. This was for mobility around the home and with direct references to the mobility scooter. The Council has addressed the scooter by covering the cost of the mobility scooter within its assessment of equipment.
76. At no point in Ms X’s care and support plan does it reference a need for Ms X to have access to a car. It has not been assessed that Ms X’s access to day centres and medical appointments is directly reliant on her, or her partner owning a car. Additionally, the supporting medical information provided by the NHS Clinical Nurse does not reference the need for transport by a car. Since use of a car has not been assessed as an eligible need with Ms X’s care and support plan, the Council should not be considering day-to-day use of a car as a Disability Related Expense.
77. The Council has acted within both the legislation and its policy by not providing any disregards for the care maintenance and service. I do not find fault with the Council for this matter.
78. Ms X would need to request a reassessment from the Council to consider her car as a disability related need before the Council could consider this as a Disability Related Expense.
79. The Council has also pointed to Ms X having the enhanced PIP mobility component which is disregarded from any financial assessment. Unless Ms X’s car costs exceed the enhanced PIP mobility income, the Council would not consider this as a Disability Related Expense. The evidence provided by Ms X does not show that her expenses on her car/transport exceed her enhanced PIP mobility component income. However, it is notable that Ms X may not have provided all potential expenses to the Council for this. Again, this would be something Ms X would need to evidence to the Council first.

Dental and Optical

80. Ms X has advised the Ombudsman the Council has not considered her optical or dental costs in its financial assessment.
81. I have seen no evidence Ms X has asked the Council to consider her optical or dental costs. Since Ms X has not asked the Council to consider these costs, the Council cannot be at fault for failing to include these within the financial assessment. Should Ms X wish for the Council to consider these costs moving forwards she would need to ask the Council to consider this and provide evidence of these costs.

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Agreed action

82. Within one month of the Ombudsman’s final decision the Council should:
• Apply the correct 2024/2025 rate of £4.14 for Ms X’s bedding Disability Related Expense disregard to her financial assessment and backdate this to 1 April 2024 and apologise to Ms X.
83. The Council should provide us with evidence it has complied with the above actions.

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Final decision

84. There was fault by the Council. This fault has not led to a significant personal injustice to Ms X but does require corrective action. The Council accepted my recommendations, so I have completed my investigation as I consider that a suitable remedy.

Investigator’s draft decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman