Summary: Mr X complains on behalf of Mrs Y that the Council has not dealt properly with care charges. The Council is at fault because it did not respond to Mr X’s concerns about charges between October 2023 and July 2024. The Council should apologise and provide a detailed explanation of charges.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on behalf of Mrs Y that the Council has failed to deal with care charges properly since October 2023, because it has:
• Not completed a care review for Mrs Y in the past year;
• Not taken proper account of disability related expenditure;
• Failed to provide a requested explanation of bills; and
• Not registered his complaint as a complaint
2. Mr X says he and Mrs Y have suffered avoidable distress and uncertainty, and Mrs Y may have been charged too much.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. Our role is not to ask whether an 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.
5. When considering complaints, 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.
6. 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)
7. 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

8. I have investigated that part of Mr X’s complaint about disability related expenditure and charging.
9. I have not investigated the issue of a care review because there is no indication of fault or serious ongoing injustice.

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How I considered this complaint

10. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
11. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Law, guidance and policies

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)
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.
14. 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)
15. 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.

What happened?

16. This is a brief chronology of key events. It does not contain everything I reviewed during my investigation.
17. Mrs Y received a package of care from the Council. Until October 2023 she was assessed as not needing to make any contribution to the costs of the care.
18. The Council reassessed Mrs Y’s financial circumstances in October 2023 and determined she would need to pay a contribution to her care, backdated to July 2023.
19. Mr X contacted the Council about Mrs Y’s DRE and not understanding the invoices he was receiving for her.
20. The Council reassessed Mrs Y’s circumstances in June 2024 and determined she would need to pay a revised contribution to her care, backdated to April 2024.
21. In July, Mr X asked for invoices to be stopped until they were reviewed.
22. Mr X sent in further details of what he considered DRE to the Council.
23. Mr X complained to the Ombudsman. The Council then considered Mr X’s concerns as a formal complaint.

Analysis

DRE

24. I have seen emails showing the Council has provided information to Mr X about what it constitutes DRE.
25. I have seen letters and assessments showing the Council has accepted that some costs are DRE and has incorporated this in its calculation of Mrs Y’s circumstances.
26. The Council has carried out a financial re-assessment of Mrs Y’s circumstances in June 2024. Mr X’s advocate emailed the Council saying he and Mr X agreed with the calculations in that financial assessment.
27. I have seen emails which shows the Council has requested information from Mr X in 2024 about claimed DRE in order to be able to properly assess it.
28. The Council properly considered, in so far as it was able to, whether expenses raised by Mr X were DRE. This is not fault by the Council.

Bills and Complaint handling

29. I have seen copies of all the invoices from the Council between July 2023 and November 2024.
• All the invoices are addressed to the same address. On the balance of probabilities these invoices were sent to Mrs Y by the Council.
• Each invoice outlines the dates and costs relevant to each date, split between home care and day care.
• The invoices include retrospective adjustments to charges for contributions to care costs as a result of DRE and financial assessments.
30. I do not consider there is fault by the Council in relation to its charges and invoices.
31. However, Mr X did not understand how the contributions to care costs set out in the October 2023 financial assessment matched up to the bills he had received.
32. In July Mr X told the Council he had not received invoices up to January 2024 and did not understand the charges.
33. I have seen emails which show the Council corresponded with Mr X about this at the time. Mr X asked for a breakdown of figures just before the Council reassessed Mrs Y’s finances in July 2024.
34. I have seen an email from the Council to Mr X in August 2024 explaining how charges had been made since April 2024, sent in response to his concerns about not being able to understand the bills he was receiving.
35. The email from the Council in August 2024:
• gave a partial explanation to Mr X about charges from April 2024 but did not respond to his concerns about the period before April 2024.
• directed Mr X to the Council’s debt management team if he wanted a full breakdown of Mrs Y’s account.
36. Mr X did not submit a formal complaint to the Council. The Council raised and responded to a formal complaint after Mr X complained to the Ombudsman.
37. The Council’s complaint response, after it was contacted by the Ombudsman, covered charges from April 2024 and DRE. It did not cover any issues relating to charges before April 2024.
38. The Council should have responded to all the issues Mr X raised including not understanding invoices he had been sent between Oct 2023 and July 2024. This is fault by the Council. Mr X remains uncertain about charges and has not had a full response to his complaint.

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Action

39. To remedy the outstanding injustice caused by the fault I have identified, the Council has agreed to take the following action within 4 weeks of this decision:
• Apologise to Mr X for not fully addressing his concerns. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Provide Mr X with a detailed explanation of charges for the period October 2023 to July 2024.
40. The Council should provide us with evidence it has complied with the above actions.

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Decision

41. I find fault causing injustice. The Council has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman