Summary: We will not investigate this complaint about fee increases for privately arranged residential adult social care. This is because investigation is unlikely to lead to a different outcome. On our ordinary reading the Care Provider has acted in line with its contract. A court would need to decide if the Care Provider has breached its contract.

The complaint

1. Mr C is unhappy with the Care Provider’s increase for his relative, Mr D’s, residential care fees. Mr C says the Care Provider later said part of the increase was because of an increase in Mr D’s care need without evidencing this. Mr C does not accept the Care Provider’s justifications for the increase and wants more details and evidence to justify the cost. While the dispute is continuing Mr D is unsettled and worried about whether he can remain living in the care home he has lived for many years.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is another body better placed to consider this complaint.

(Local Government Act 1974, sections 34B(8) and (9))

3. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)

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How I considered this complaint

4. I considered information provided by the complainant and the Care Provider.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. The Ombudsman can consider a contract on ordinary reading and examine how it appears to the reasonable member of the public. The strict interpretation of a contract is for the courts. The Ombudsman cannot say what is a fair cost for care or stipulate how much a Care Provider can charge or increase its fees by.
7. The Care Quality Commission regulates care providers in England. Regulation 19 of the Care Quality Commission (Registration) Regulations 2009 is about fees. This requires providers to give people information about the terms and conditions of their care, treatment or support, including the expected costs and the requirement to pay for their care, treatment and support. Providers must notify people of any changes to their terms and conditions, including increases in fees and give them enough time to consider whether they wish to continue with the service.
8. The Care Provider has given Mr C the terms and conditions of its care and has updated Mr C of any changes. Although Mr C did not sign and agree a new set of terms and conditions, he also did not end the service when he knew the terms were changing. So the Ombudsman is considering the most recent set of terms and conditions even though Mr C disputes they apply.
9. The Care Providers contract allows it to raise its fees each year or when a residents’ care needs change and they need more support. In both cases the Care Provider will give 28 days’ notice where practicable before increasing the fee. At the annual fee review the Care Provider will raise its fee by at least 7%.
10. Mr C challenges the Care Provider’s 2024 increase and says it is significantly above the Consumer Price Index including Housing (CPIH). However, the Care Provider’s contract does not state it will use CPIH as a benchmark. The Care Provider’s contract gives it a wide scope, with the only stipulation being there will be a minimum increase of 7%. Therefore, the Care Provider has acted in accordance with that contract.
11. In response to Mr C’s queries about the increase in Mr D’s costs, the Care Provider has mentioned an increase in Mr D’s care needs. This was not given as a reason in the March 2024 letter for the increase in costs. The Care Provider has explained it has a care banding system for fees, with standard, enhanced, and complex care rates. The Care Provider has not answered Mr C’s queries about which band Mr D is in, when he may have moved band, and how much of the fee increase is made up of this care banding. The Care Provider suggested Mr C discuss this with the home manager, I do not know whether that happened. However, Mr C accepts there was a change in Mr D’s care needs, and he would need to pay the associated costs.
12. The Care Provider has responded to Mr C’s requests for more information about the increase in care charges and has given reasons for the increase. Although Mr C wants a greater breakdown of how the care fees are calculated, the Ombudsman would not investigate to provide that. If Mr C is no longer satisfied with the contract terms and fees, he is open to find an alternative provider. Though we appreciate the impact that has on Mr D having to move.
13. In my view the Care Provider has acted under its contract. It has reviewed its fees each year and has written to Mr C with enough notice period before it imposed the increase on 1 April each year. It has met its duty to advise of any changes and allow enough time for Mr D to decide if he wants to continue with the service. If Mr C wishes to challenge a breach of contract, he would need to take legal advice.

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Final decision

14. We will not investigate Mr C’s complaint because further investigation would not lead to a different outcome. The issue about a lack of information about Mr D’s specific care banding, does not alter the main concern about the level of the fees. The Care Provider has told Mr C the new fee and given a reasonable notice period before imposing the change. If Mr C wishes to challenge whether the new terms and conditions apply to his contract or challenge the interpretation of the contract terms on fee increases, he needs to take legal advice. If Mr C is not happy with the costs of care, it is open to him to look for an alternative provider.

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Investigator's decision on behalf of the Ombudsman