Summary: Mr X complained the Council failed assess his disability related expenditure properly when calculating his contribution towards his care costs. On the evidence available we have found fault in how the Council considered some of Mr X’s disability related expenditure. We recommend the Council apologise to Mr X and review its decision on some of his disability related expenditure. It should also backdate disability related expenditure for the support Mr X needs to attend social and religious events, from the date of his financial assessment until the end of January 2025.

The complaint

1. Mr X complains the Council failed to assess his Disability Related Expenditure (DRE) properly when calculating his contribution towards his care costs.
2. Mr X states the Council’s actions have caused him stress and resulted in him being unable to meet the cost of his DRE.

Back to top

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)

Back to top

How I considered this complaint

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
7. I set out my initial thoughts on the complaint in a draft decision and invited Mr X and the Council to comment on my draft decision.

Back to top

What I found

8. 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 settings other than care homes. A council has discretion to charge for non-residential care following a person’s needs assessment. Where it decides to charge a 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)

Financial assessment

9. Where a council has decided to charge, 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. The Council should ensure that the information is provided in a manner that the person can easily understand in line with its duties on providing information and advice.
10. People receiving care and support other than in a care home need to retain 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 government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)

Disability Related Expenditure

11. Where a council takes disability-related benefit into account when calculating how much a person should contribute towards the cost of their care, it should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs the council is not meeting. The Care and Support Statutory Guidance sets out a list of examples but 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.
12. The guidance also says that some expenditure may be allowed based on a person’s liability and circumstances to cover housing costs. These may also be determined through discussion with a person and include consideration of average levels for household types. Evidence of expenditure may be requested to verify requests for example receipts, bank statements or invoices involving exceptionally high values, unusual types of expense. Failure to supply evidence will result in those expenses being excluded from the calculations.

The Council’s Fees and Charges Policy for Adult Social Care 2024/2025

13. This explains that if a person is receiving a disability related benefit, such the Personal Independence Payment (PIP) it will automatically apply a £23 per week DRE allowance to their financial assessment.
14. If a person feels they have DRE above £23 per week it will complete an assessment of their DRE to see if other expenses should be disregarded when calculating their contribution to their care costs. Evidence of the DRE may be requested.
15. The policy clarifies that DRE which relate to any type of support will only be included if this is being provided but does not form part of the package of care which is being financially assessed. The policy also provides an annex which provides details on the maximum amount of DRE it will allow for certain types of DRE.

What happened

16. Mr X is visually impaired. He receives a care and support package from the Council.
17. In 2024 the Council assessed Mr X as needing to contribute towards the cost of his care package. The assessment included an allowance of £23 for Mr X’s DRE because he receives the Personal Independence Payment (PIP). It also considered Mr X’s request for extra DRE, but it did not agree all of Mr X’s DRE.
18. Mr X was unhappy with the Council’s assessment, and he made a complaint. He said it previously allowed his DRE, and so it should do so again.
19. The Council replied to his complaint. It said:
• guide dog expenses should be funded fully by the charity providing the guide dog. The Council said it would allow £45 per week as a goodwill gesture while Mr X asked the charity to help him.
• it would not allow DRE for attending social and religious events. It said any physical support he needs to attend events should be assessed under the Care Act and form part of his Care and Support plan. It would ask Mr X’s social worker to review his care and support plan.
• Mr X receives PIP and this should pay for his travel expenses.
• Council Tax is not specific to disability and so it cannot allow this expense.
• medical expenses should be paid for by the NHS.
• it awarded Mr X the maximum amount allowed in its guidance for both garden and podiatry costs.
• it will need evidence showing the costs incurred and that it is related to Mr X’s disability in respect of his request for DRE for maintenance, telephone and medical costs.
20. Mr X remained unhappy and made a stage two complaint to the Council.
21. The Council replied to Mr X’s complaint. The reply said:
• it has allowed the maximum amount in its guidance for Mr X’s podiatry and gardening expenses.
• invoices for items including carpet cleaning and guide dog bathing were related to his guide dog for which £45 per week has been allowed.
• invoices for matters including decoration, fixing a tap, window cleaning and gutter cleaning are general maintenance costs and not specific to Mr X’s disability.
• travel costs are meet by Mr X’s PIP award. If Mr X needs physical support to attend social or religious activities this can be assessed under the Care Act and be part of his Care and Support Plan.
• it would allow £0.43 per week for the cost of speech and braille software.
22. Unhappy Mr X complained to the Ombudsman.
23. We made enquiries of the Councill. In response it said it reassessed Mr X’s needs under the Care Act in January 2025. It has updated his Care and Support Plan to provide an extra three hours of support to help Mr X attend his social and religious activities.

Finding

24. The Ombudsman cannot criticise the merits of a discretionary decision unless the Council has acted with fault in the way it made the decision. This can include being excessively restrictive in how applies its charging policy or the statutory guidance.
25. The Council did not properly consider Mr X’s podiatry and gardening costs. It’s complaint responses shows it focused solely on the maximum amounts it says it can apply for each cost. There is no evidence the Council properly considered Mr X’s individual circumstances and whether these warranted a higher amount of DRE than it would usually apply. This is fault.
26. Further I note the Council’s complaint replies referred to its charging policy allowing a maximum amount for gardening and podiatry costs. However its policy does not state there is a maximum amount for either cost.
27. Mr X also asked for DRE for his travel costs. The Council did not agree because he receives PIP, which should cover his transport costs. However the Council’s charging policy says it will allow reasonable amounts over and above the mobility component of PIP. There is no evidence the Council considered whether Mr X’s travel costs were a reasonable DRE or not. This is fault.
28. Mr X also asked for DRE for the cost of physical support to attend religious and social activities. The Council refused and said such support should be provided by his care and support plan. Mr X needs were reassessed and additional support for three hours per week provided. I am pleased Mr X is now receiving the support he needs. However I am concerned Mr X was not allowed DRE for this expense between the Council completing his financial assessment and January 2025. This has caused Mr X an injustice because he has been financially disadvantaged.
29. I do not find fault with the Council’s decision on the other costs Mr X asked it to consider as DRE. The Council properly considered those costs, including evidence provide by Mr X, and it explained its decision to him. The Ombudsman cannot criticise the merits of the Council’s decision unless there is evidence of fault.

Back to top

Recommended Action

30. Within one month of my final decision the Council should:
• Apologise to Mr X for the frustration and uncertainty caused by the fault I have found.
• Review Mr X’s financial assessment to consider whether, the circumstances of his case, it should allow the cost of gardening, podiatry and additional travel costs as DRE. If it decides to do so it should backdate this to the date of Mr X’s financial assessment and refund any over-paid contributions.
• Backdate DRE in respect of Mr X’s need for support to attend social and religious events from the date of Mr X’s financial assessment to the end of January 2025.
31. The Council should provide us with evidence it has complied with the above actions.

Back to top

Draft Decision

32. I propose to end my investigation of Mr X’s complaint providing the Council agrees to my recommendations.

Investigator’s draft decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman