Summary: Mr X complained the Council delayed invoicing for Mrs Y and her late husband’s care, and gave no explanation or context for the charges. Mr X said the Council is failing to meet the communication needs of vulnerable client groups. There was fault causing injustice when the Council delayed and incorrectly completed Mrs Y’s financial assessment, and when it failed to give her clear and timely charging information. The Council will complete a financial re-assessment and provide Mrs Y a symbolic financial remedy for the avoidable distress suffered.

The complaint

1. Mr X complained the Council delayed invoicing for Mrs Y and her late husband, Mr Y’s care, and gave no explanation or context for the charges. It was then difficult for Mrs Y to navigate the Adult Social Care process with different departments involved. Mr X said the Council is failing to meet the communication needs of vulnerable client groups.
2. When Mrs Y received backdated invoices, it caused her significant distress. This was made worse by the Council’s lack of explanation and delays.

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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. 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(1), as amended)

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How I considered this complaint

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

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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 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)
9. The approach to charging for care and support needs should be clear and transparent, so people know what they will be charged. (Paragraph 8.2, Care and Support Statutory Guidance)
10. Councils should ensure there is sufficient information and advice available in a suitable format for the person’s needs, in line with the Equality Act 2010, to ensure they or their representative are able to understand any contributions they are asked to make. (Paragraph 8.3, Care and Support Statutory Guidance)
11. 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. It should explain how the assessment has been carried out, what the charge will be and how often it will be made, and if there is any fluctuation in charges, the reason. Councils should ensure this is provided in a manner the person can easily understand, in line with its duties on providing information and advice. (Paragraph 8.16, Care and Support Statutory Guidance)
12. 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.

What happened

13. I have summarised below some key events leading to Mr X’s complaint. This is not intended to be a detailed account of what took place.
14. The Council referred Mrs Y for a financial assessment in April 2022.
15. Mrs Y chased the Council about her financial assessment in July 2022 as she wanted to know what her charges would be.
16. The Council wrote to Mrs Y in September 2022 asking for financial information for her assessment. The Council also sent a chaser letter to Mrs Y in October asking for financial information.
17. Mrs Y received an invoice of over £9,000 in February 2023 for Mr Y’s care charges since June 2022. This caused Mrs Y anxiety as she did not know how the Council calculated the charges or why they owed such a large.
18. Mr X queried the invoice on Mrs Y’s behalf.
19. The Council sent a financial assessment in May 2023 showing Mr Y had to pay the full amount of his care charges.
20. Mr X asked the Council to re-assess Mr Y’s charges in August 2023 because various expenses were not included in his assessment that should have been. Mr X said he chased the re-assessment many times.
21. Mr X sought financial reassessments for Mrs Y and Mr Y in October 2023 based on financial changes.
22. Mr Y sadly passed away in February 2024.
23. The Council wrote to Mrs Y on 4 April 2024 confirming it carried out a financial assessment after she returned the financial circumstances form. It said if someone has savings and investments above £23,250 the Council will not help towards the cost of their care. It said Mrs Y must pay the full cost of her care, effective from 6 June 2022. The letter gave a telephone number for Mrs Y to contact if she had any questions.
24. The Council then sent Mrs Y an invoice dated 19 April 2024, requesting backdated charges of £9,921.76 for her care from 6 June 2022 to 20 April 2024. The invoice states Mrs Y’s charging contribution between June 2022 and August 2023 was £98.30 per week, a total of £6,080.56. And her contribution between August 2023 and April 2024 was £106.70 per week. The total here was 3,841.20.
25. Mr X emailed the Council on 12 May advising the invoice caused Mrs Y distress and seeking clarification on the charges and for detailed statements of both Mrs Y’s and Mr Y’s accounts.
26. Mrs Y emailed the Council on 13 and 22 May authorising Mr X to have access to her financial information and asking the Council to send a breakdown of the invoices to Mr X.
27. The Council emailed Mr X on 30 May 2024 enclosing account statements for Mrs Y and Mr Y. It confirmed there was a balance of £10,348.56 outstanding on Mrs Y’s account, and £5,896.21 on Mr Y’s account.
28. Mr X complained to the Council on 5 June 2024. He said Mrs Y is vulnerable and recently widowed. She has difficulty understanding how care contributions are calculated and why she and Mr Y have been invoiced. Mr X said he tried to help Mrs Y with this but, despite many telephone calls and emails, the Council has not clarified all their questions. Mr Y passed away in February 2024 with his requested financial re-assessment still outstanding. Mrs Y has now received a backdated invoice of nearly £10,000 for her care, which came as a shock as she received no previous invoices. The Council did not explain the charges or the reason for the delay, despite an email requesting this.
29. Mr X asked the Council to speed up Mr Y’s re-assessment, explain why it sent a backdated invoice for Mrs Y’s charges, and why it did not invoice her in a timely way. He also asked for details of the financial assessment used to calculate Mrs Y’s charges, and details of the weekly charges for Mrs Y’s care package. Last, he asked for a named contact to coordinate responses for Mrs Y, so she does not have to contact multiple teams.
30. The Council confirmed it completed a reassessment for Mr Y on 5 August 2024 and reduced the outstanding charges.
31. The Council said an account was listed as a sole account on Mrs Y’s assessment, rather than a joint account, so it will amend this. The Council asked for recent bank statements so it could update Mrs Y’s financial assessment. It also confirmed it added Mr X as a contact for Mrs Y going forward.
32. Mr X thanked the Council for agreeing to review Mrs Y’s care costs from 2022 until February 2024. He said Mrs Y would consider whether she wishes a review of her financial assessment from February 2024 onwards once she has the revised invoice for Mr Y’s care charges.
33. The Council responded to Mr X’s complaint on 27 November 2024. It said:
• It apologised for the delay responding.
• It sent a revised assessment on 5 August 2024 for Mr Y’s contribution dating back to May 2021.
• It apologised for the delay properly assessing Mr Y’s contribution.
• It implemented changes in the last few years which should make the difficulties Mrs Y suffered less likely in future.
• It referred Mrs Y for a financial assessment on 14 April 2022. There was then a delay until 29 September 2022 sending the financial assessment forms. Mrs Y did not return them, so the Council sent a reminder on 26 October. It then took no further action until it contacted Mr X in 2024, and the assessor noted Mrs Y had savings of over £37,000. The Council wrote to Mrs Y on 4 April 2024 advising she must pay full costs for her care from 6 June 2022 as her savings exceeded £23,250. The Council passed this decision to its charging team, which is why Mrs Y then received invoices.
• It recognised this assessment was wrong, as it used the full value of a joint savings account and it should only have taken half into account. It should have asked for details of the balances throughout the period care has been in place rather than relying on the current balance. It also recognised it should have sent the letter to Mr X as Mrs Y’s financial representative.
34. The Council asked for copies of Mrs Y’s bank statements so it could accurately assess her contribution.
35. On 4 December 2024, Mr X expressed gratitude the Council re-assessed Mr Y’s finances and reduced the outstanding charges. However, he was dissatisfied with the Council’s complaint response. He said:
• The Council had not addressed all issues satisfactorily.
• Changes the Council said it made over the last two years did not prevent the issues occurring or being resolved efficiently.
• The Council was silent on its failure to ensure it communicates sensitively and appropriately with vulnerable clients.
• The Council had not explained why it took two years to invoice Mrs Y, or why it did not contact her to explain what happened when it realised it would need to send retrospective invoices.
• This was particularly insensitive because Mrs Y was grieving the loss of her husband.
• The Council had not responded to his request for a named contact to coordinate responses.
36. The Council sent its final complaint response on 6 January 2025. It said:
• It experienced unprecedented demand for financial assessments since April 2022, regretfully resulting in delays. This also affected its ability to issue invoices in a timely manner and meant some customers received larger invoices.
• It implemented an automated approach to financial assessments in April 2023 to minimise delays where it already held financial information on record.
• It does have processes in place for when it identifies a customer is vulnerable and needs more support, including where someone passes away. It understood how the delay providing the information Mr X requested could have been managed in a more considerate and timely manner and it would feed this back internally.
• Several teams are involved where the Council supports someone’s care needs. Given the complexity of care requirements, it is not possible to have a single point of contact for each customer to coordinate all these areas. Customers should know their key contacts for each service area, and Mrs Y had been in regular contact with Mental Health, her social worker, Occupational Therapy, and the support brokerage team.

My investigation

37. Mr X told me he is concerned the Council is failing to meet the communication needs of vulnerable client groups. Because of resource issues there are repeated delays in sending communications, and when the Council does communicate it does not explain or give context.
38. The Council told me, given the large number of invoices it issues, it does not include a covering letter. Invoices include an explanation of the charges in the ‘description’ section. Invoices also include contact details for customer queries.
39. The Council confirmed it can review Mrs Y’s previous financial assessment, to complete an assessment for the period from 6 June 2022 to 10 April 2023, and has assigned an officer to do this.
40. The Council provided me with its action plan for financial assessments. This includes:
• A two-year plan to reduce its backlog.
• Compulsory disability awareness training.
• Producing an ‘understanding your financial assessment’ leaflet.
• Telling customers in writing before any financial assessment or re-assessment.
• Financial assessment officers having caseloads, so customers have a named contact.
41. Because of its plan, the Council told me its turnaround times for new financial assessments is 18 days.

Analysis

42. The Council referred Mrs Y for a financial assessment in April 2022. However, it did not send assessment forms to her until September, five months later.
43. The Council recognised it took no action after October 2022 when it did not receive the financial assessment forms back from Mrs Y. It did not contact Mrs Y to complete the assessment until 2024.
44. It is appreciated the Council experienced high demand for its services, but this is a significant delay and amounts to fault. Particularly where the Council did not keep Mrs Y updated or tell her about the delays.
45. The Council wrote to Mrs Y on 4 April 2024 confirming it completed her financial assessment. It said if someone has savings and investments above £23,250 the Council will not help towards the cost of their care. It said Mrs Y must pay the full cost of her care, effective from 6 June 2022. The letter gave a telephone number for Mrs Y to contact if she had any questions.
46. Under the Care and Support Statutory Guidance, the Council should have explained how it carried out Mrs Y’s financial assessment, what her charges would be, and how often it will be made.
47. The Council’s letter referred to the upper capital limit of £23,250, but did not actually say Mrs Y’s capital was above the threshold. It also did not say how the Council reached this conclusion. While the letter said Mrs Y must pay the full costs of her care, it did not say what the charges were, how often Mrs Y had to pay, or when the Council would bill her. That was fault.
48. Mrs Y knew the Council expected her to pay for full costs, but nothing else. She did not know why she had to pay full costs, what those costs were, or when and how she would have to pay.
49. The invoice dated 19 April 2024, requesting nearly £10,000, came as a shock to Mrs Y. The Council had not told her how much it expected her to pay, or to expect an invoice backdated by two years.
50. Considering the Council’s delay completing Mrs Y’s financial assessment, it should have made it clear to Mrs Y before it sent the invoices what her weekly charges were and that it would be backdating the charges to the time her care started. Alternatively, the Council should have sent the invoices with a covering letter clearly explaining this. Receiving a large invoice without clear supporting information, nearly two years after her care started, caused Mrs Y avoidable distress.
51. The Council recognised its financial assessments of Mrs Y’s charges between June 2022, and February 2024 are wrong. It mistakenly treated a joint savings account as being Mrs Y’s sole account. This error led to the large, backdated invoice Mrs Y received. The Council has agreed to re-assess Mrs Y’s finances for this period, which should remedy some of the injustice.
52. It took the Council over five months to respond to Mr X’s complaint. This is a significant delay and is fault. Despite the delayed complaint response, officers were communicating with Mr X during this time. They had recognised the error in Mrs Y’s financial assessment and confirmed they would carry out re-assessments. There were still unresolved issues, however, and the delayed complaint response caused avoidable frustration at a time when Mr X was trying to get answers. The Council did apologise for its delay, and I consider this is a suitable remedy for Mr X’s injustice.
53. Mr X said the Council is not meeting the communication needs of vulnerable client groups. I appreciate it can be confusing to deal with different departments. However, each department has its own distinct role. I therefore do not find the Council at fault in saying it could not give Mrs Y a single point of contact. And the Council’s action plan will ensure people receiving care have a named contact within the financial assessment team.
54. The Council has put suitable measures in place to address the problems with its financial assessments. I therefore do not make any service improvement recommendations.

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Agreed Action

55. Within four weeks of my final decision the Council will:
• Apologise to Mrs Y for incorrectly completing her financial assessment and failing to provide clear and timely charging information.
• Pay Mrs Y £300 for the avoidable distress its faults caused.
• Carry out a financial re-assessment for the period between June 2022 and February 2024 and amend Mrs Y’s charges accordingly.
• Write to Mrs Y clearly explaining the result of the financial re-assessment and offer a repayment plan for the outstanding charges if necessary.
56. The Council should provide us with evidence it has complied with the above actions.

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Decision

57. I found there was fault causing injustice when the Council delayed and incorrectly completed Mrs Y’s financial assessment, and failed to give her clear and timely charging information.

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Investigator's decision on behalf of the Ombudsman