Summary: The Council delayed informing Mr D of the outcome of his financial assessment and delayed sending him an invoice. This was fault. The Council has agreed to apologise, cancel the invoice and carry out a service improvement.

The complaint

1. Mr B makes the complaint on behalf of his friend, Mr D. Mr B says the Council informed Mr D of the outcome of his financial assessment almost a year after Mr B sent Mr D’s financial assessment information to the Council. The Council then also sent Mr D a large invoice which he was unable to pay.

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The Ombudsman’s role and powers

2. 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)
3. 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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How I considered this complaint

4. I have discussed the complaint with Mr B. I have considered evidence that the Council, Mr B and Mr D have sent, the relevant law, policies and guidance and both sides’ comments on the draft decision.

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What I found

Law, policies and guidance

Care Act 2014

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.
6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which sets out the costs to meet the needs.
7. I have set out the regulations regarding charging which apply to Mr D.

Financial assessment

8. Councils must carry out a financial assessment if they decide to charge for the care and support. This will assess the person’s capital and income.
9. The Act sets out the duties councils have from the point of first contact with a person needing care to delivery of care services. It presumes the following order of events:
• The council carries out a needs assessment under section 9.
• The council makes a decision about the person’s eligibility under section 13.
• The council carries out a financial assessment under section 17.  At this point a council also has the duty to meet the person’s eligible needs, but this is subject to the requirement for the council to prepare a care and support plan, as follows.
• The council completes a care and support plan under section 25. This section presumes the council completes the plan before care services start and stipulates care and support plans must include a personal budget, which in turn must be based on the financial assessment.
10. Our interpretation has therefore been that, in most circumstances, councils should complete financial assessments before they create care and support plans and before any care services begin. This means people can make informed decisions about the care and support they want, taking into account the financial impact.

Capital

11. The upper capital limit is currently set at £23,250 and the lower limit at £14,250. A person with assets above the upper capital limit will have to pay for their own care. Those with capital between the upper and the lower limit will make a contribution known as ‘tariff income’ from their capital.

Income

12. If a person’s capital is below the threshold of £23,250, they may still have to pay a contribution from their income towards the costs of care. The regulations are different depending on whether a person is living in residential accommodation or is receiving a care package at home.

Income – residential accommodation

13. If a person is living in residential accommodation, The local authority must leave the person with a minimum amount of income. This is known as the Personal Expenses Allowance (PEA) and the amount is set out in regulations and updates sent via a local authority circular. Anything above this may be taken into account in determining charges. For example, the PEA for 2024/25 is £30.15.
14. Where a person has a spouse or civil partner they do not live with, and is paying at least half of the value of their occupational pension, personal pension or retirement annuity to their spouse or civil partner for their maintenance, the local authority must disregard an amount equal to 50% of the pension or annuity income concerned.

Income – domiciliary care

15. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. 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. For example, the MIG for 2024/25 for a single adult who has reached pension credit age is £228.70.

Council’s charging policy

16. The Council has its own charging policy which says that:
• The Council aims to complete financial assessments as soon as possible and ideally within ten working days of receipt of all the information required being provided. Confirmation of the contribution will be provided in writing.
• People taking short term or respite stays in residential accommodation will be assessed and charged as if they were receiving domiciliary care for the first four weeks of continuous duration of any one stay and then will be charged under residential rules for stays of over four weeks.

NHS funded care

17. NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
18. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses.

What happened

19. Mr D moved to a care home on 30 March 2023. Mr D had been admitted to hospital in February 2023 and he moved into a nursing home following the hospital stay. Mr D lived in rented accommodation and was paid housing benefit.
20. The NHS wrote to Mr D on 19 April 2023 and informed him that he was not eligible for continuing health care (CHC) funding but he was eligible for NHS-funded nursing care (FNC). The FNC would be paid directly to the care home. The letter did not specify the amount of FNC.
21. The Council wrote to Mr D on 18 May 2023 and said it had assessed his needs for care and support. Mr D’s needs could only be met in a care home. The Council sent Mr D a financial assessment form to determine what his contribution would be towards the cost of his care.
22. Mr B sent Mr D’s financial assessment form to the Council on 25 May 2023. On 5 June 2023 the Council asked Mr B to send in additional financial information including bank statements, evidence of his pension, rent and his tenancy agreement. Mr D replied to the Council on the same day and said he had requested the bank statements from the bank and would send them as soon as he received them.
23. Mr B sent further information to the Council on 15 June 2023. Mr B also added that the bank statements would show that Mr D made regular payments of around £1,000 to his disabled wife who lived abroad.
24. Mr B sent Mr D’s bank statements to the Council on 22 June 2023.
25. The Council assessed Mr D’s finances and wrote to him on 26 June 2023. The Council said Mr D would have to pay £268 per week from 30 March 2023, £295 from 9 April 2023 and £193 from 27 April 2023 and ‘thereafter’. The reason for the decrease was that Mr D’s income included disability living allowance (DLA) (care element) for the first four weeks of his stay but this would be stopped after the first four weeks so, once the DLA (care element) ended, his income would be lower. The letter said the Council could include Mr D’s rent only for the first four weeks of his stay, and only the rent element that was not covered by housing benefit.
26. Mr B wrote to the Council on 3 July 2023 and challenged the financial assessment. He explained that Mr D did not know whether his stay at the care home would be permanent when he was discharged from hospital so he did not immediately give up his tenancy. Mr D had kept his tenancy while he was living at the care home so he had to pay rent, associated costs and utility bills which the Council had not considered in its financial assessment. Mr B said the Council had also not considered the sum that Mr D paid to his wife every month.
27. Mr B spoke to a finance officer on 5 July 2023 who told him that the invoice should not have been sent and the finance officer said they would look into the invoice and it would be cancelled.
28. On 6 July 2023 the Council wrote to Mr D cancelling the charges from 30 March 2023 to 27 April 2023 (£2,578).
29. Mr D wrote to the Council on 3 September 2023 and said he surrendered his tenancy on 7 August 2023.
30. On 21 June 2024 the Council sent Mr D an invoice of £7,622 for charges from 24 August 2023. The letter was sent to Mr D’s old address so there was a delay in Mr D receiving the invoice.
31. Mr B wrote to the Council on 4 July 2024 and said:
• He previously wrote to the Council’s Financial Assessments team on 15 June and 3 July 2023 and provided all the financial information the Council had asked for. He also spoke to a finance officer on 5 July 2023 and the Council then cancelled the invoices it had sent.
• The Council had now sent an invoice, almost a year later, for £7,622.
• Mr D did not have £7,622 to pay the Council.
32. The Council replied on 11 July 2024 and said:
• The delay in sending out the invoice was due to a backlog of cases since the COVID-19 pandemic.
• The Council cancelled the initial invoices as Mr D was not a permanent resident at the time.
• It had not received Mr D’s bank statements so it had been unable to complete the financial assessment.
• It would not change its position.
33. The Council sent a Final Notice letter to Mr D on 12 August 2024.

Mr D’s complaint – August and September 2024

34. Mr B appealed the invoice on 15 August and Mr D made a complaint on16 September 2024. I have summarised the documents. Mr B said:
• He questioned whether the COVID-19 pandemic was a valid excuse for the delay.
• The Council sent an invoice in June but, after a discussion with Mr B, this invoice was cancelled. The Council did not write to Mr D to explain its reasons for the cancellation of this invoice. No replacement invoice was sent.
• The delay of almost a year gave Mr D ‘the legitimate expectation’ that the Council had completed its financial assessment and led him to ‘reasonably conclude’ that he had no liability for care costs. On this basis, he continued to make his regular payments to his wife which he would not have done if he had known that he was obliged to pay around £800 a month for his care.
• In addition, the DWP had now recalculated Mr D’s entitlement to DLA as it transpired that the Council had been funding Mr D’s placement since August. This meant Mr D had been paid DLA which he was not entitled to and had to repay this to the DWP.
• Even if Mr D sold his few possessions, he would not be able to repay the DWP or pay the Council back.
• Mr D had been ‘unfairly put in an impossible position.’
35. Mr D said:
• He assumed that the Council ‘must have known what it was doing in working out whether or not I was liable for care home costs when it didn’t send a new invoice, I assumed it had decided that it would be meeting my costs.’
• All his life he had met his financial obligations on time but the Council’s failures had put him in a position that he could not pay this debt.
• As soon as he received the invoice from the Council, he had paid his contribution on time every month.
36. The Council replied and said:
• The Council received Mr D's financial assessment form in May 2003, but it did not receive his bank statements. The Council asked Mr D to send his bank statements on 5 June 2023.
• The financial assessment was put on hold as the Council was waiting for Mr D to submit his financial details. To date this information had not been received by the Council.
• In the absence of Mr D's full financial information, the Council used the non-disclosure policy to calculate Mr D's residential contribution.
• The Council asked Mr D to send evidence of the payments to his wife from June 2023 to date.
• Mr D should also send copies of all his bank statements.
• The Council upheld Mr D’s complaint that there had been a substantial delay in completing his financial assessment and the invoice being raised. It said the level of service and communication he had received was poor and the Council sincerely apologised for this fault.
37. Mr D replied and said the bank statements were sent to the Council on 22 June 2023. He therefore did not accept this as an excuse for the 13-month delay.

Further information

38. Mr D came to the Ombudsman in November 2024 and provided more details on his complaint. He said:
• ‘From my first day at the care home, the Council paid for my accommodation, although I understand my costs are being met by the NHS (I'm not sure on this point).’
• ‘Although I don't have all the data to hand, I imagined costs falling to the Council will not be substantially in excess of the home care costs, rent rebate and council tax rebate they had been incurring when I lived at home. Indeed, if the Council isn't now paying for the care element of my care costs, the Council’s expenditure on my behalf will be lower than previously.’
• ‘I assumed that my costs at the care home were reckoned to be no more than those care, rent and council tax costs the council had been meeting when I lived at home and therefore the Council required no contribution from me to my care costs.’
• ‘Ever since the Council made clear in the summer of 2024 what my true liability for costs was, I have paid it monthly, in full and on time. Had the Council reissued an amended invoice as soon as they cancelled the incorrect one, I would have been able to manage my finances appropriately and I would have paid promptly all the while. As it is, I am being chased by two agencies, for money I simply do not have, all because of the appalling performance of the Council.’

Further information

39. Mr B has informed me that the DWP has cancelled the debt for the DLA which was overpaid.
40. The Council wrote to the Ombudsman in April 2025 and said it had in fact received the paperwork necessary to process Mr D’s financial assessment. The Council therefore proposed to:
• Apologise to Mr D.
• Make a payment of £250 in recognition of Mr D's time and trouble for submitting the complaint.
• Process Mr D’s financial assessment and, if it is found appropriate, backdate any reimbursement payments.
41. Mr B told the Ombudsman Mr D was not satisfied with that proposal to settle the complaint and he still wanted the Ombudsman to investigate the complaint.
42. The Council has clarified, in its response to the draft decision that Mr D was discharged under the ‘Discharge to Assess’ pathway and so the care costs up to 3 July 2023 were not chargeable and this is why the invoice was cancelled.

Analysis

43. The Ombudsman expects councils to process financial assessments and inform the applicant of the outcome of the assessment as soon as possible. This should happen around the same time as the care plan is put into place.
44. The Council completed the financial assessment in June 2023 but did not inform Mr D of the outcome of the financial assessment or sent him an invoice until almost a year later. This was fault. Clearly there was a substantial failure in the Council’s actions in this respect and there was no excuse for a delay of almost one year.
45. The Council then added to the fault by saying, in its complaint response, that Mr D had not returned the necessary financial information and he was therefore partly to blame for the delay. Mr D had provided all the information in June 2023 and so this claim was further fault.
46. When the Ombudsman finds fault, the next question is whether this has caused an injustice. If the fault has caused an injustice, we decide whether this can be remedied. The Ombudsman’s remedy aims to put the complainant into the position they would have been if the fault had not happened.
47. One of the reasons why councils should inform people of the outcome of the financial assessment as soon as possible and preferably at the time the care plan is decided, is to enable people to make informed choices about their care options.
48. Sometimes complainants will tell the Ombudsman that they would have chosen a different care package if they had known the cost of the care. And we will therefore adjust the remedy accordingly. That is not the case here. Mr D’s only option was to stay in the care home. Even if Mr D had known about the cost of the contribution, he would not have made a different choice.
49. However, Mr D says he genuinely believed that the Council had assessed his contribution to the costs to be nil and therefore he continued to pay his wife a monthly allowance. So he says that the real injustice is that he cannot repay the outstanding debt.
50. Generally speaking, the Ombudsman would expect people to know that adult social care is not a free service like health care. However, we would not expect people to know the details of the complex financing system of the NHS and the local authorities when it comes to funding adult social care.
51. I believe Mr D when he says he thought that the Council was not charging him. I say this for the following reasons.
52. Mr D was informed that he was eligible for funded nursing care, but was not informed how much the FNC was. The Council cancelled the invoices it had initially sent but did not explain clearly why it cancelled these invoices.
53. Mr D thought that the NHS was paying for all his care costs through the FNC and he thought the Council was paying for his accommodation. This is what he explained to the Ombudsman in his letter dated 2 November 2024. He therefore thought that the Council's costs were a lot lower than what they really were. He assumed that they were lower than the costs the Council incurred when he was living at home and that this meant that he did not have to pay any costs. He had provided all his financial information and the Council had cancelled the invoices it had sent. So I can understand why Mr D thought that his contribution was nil.
54. Of course, a lot of Mr D’s assumption were incorrect. The Council was paying all the costs (from August 2023) including the accommodation and the care costs. The NHS was only paying for the funded nursing care costs (FNC) which is a standard sum which covers only care costs related to health needs, not all care costs. But I would not expect Mr D to know this.
55. Also the calculation of the contribution is different when a person receives care at home or when they receive care in a residential setting. The minimum income guarantee is a lot more generous than the personal expenses allowance. But again, I would not expect Mr D to know this.
56. I believe Mr D would have paid the invoices if he had received them on time. I note that, as soon as Mr D received the invoices in July 2024, he started to pay his contribution.
57. Therefore, I am of the view that the injustice to Mr D was that he genuinely was led to believe that his contribution was nil. And therefore he continued to make regular payments to his wife and was unable to pay the large invoice when it arrived.
58. The Ombudsman can also sometimes provide a remedy for the distress caused by the fault. This will usually be a small symbolic payment to reflect the distress the complainant has suffered as a result of the fault. The Council has already offered £250 to Mr D and I agree that this remedy is in line with what the Ombudsman would have recommended. I therefore do not recommend a further financial remedy for the distress.

Responses to the draft decision

59. I had made a recommendation in the draft decision that Mr D should send in the bank statements, and, if these showed regular monthly payments of around £800 to Mrs D, then the Council should cancel the invoices between August 2023 and July 2024.
60. In his response to the draft decision, Mr B clarified that there was one month, September 2024, when Mr D did not make a payment to Mrs D but there were other months where he had paid more than a £1,000 so it averaged out at around £800 a month.
61. In its response to the draft decision, the Council said it accepted the Ombudsman’s findings and agreed that the backdated charging was unfair. It agreed to cancel the invoices from 24 August 2023 to 31 July 2024 at a total sum of £9,741.77 and said ‘while evidence of [Mr D’s] monthly contributions to his wife covers the period from 2022 to June 2023, we have no reason to doubt that these payments continued consistently through to July 2024’. I note that the Council has taken pro-active action in terms of agreeing this remedy.

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Action

62. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mr D in writing for the fault that I have identified.
• Pay Mr D £250 for the distress he has suffered because of the Council's failures.
• Cancel the invoices from 24 August 2023 to 31 July 2024 which total £9,741.77.
• Remind relevant officers of the importance of carrying out the financial assessment and informing the person of the outcome of the assessment as soon as possible and preferably at the same time as the care plan is being decided.

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Decision

63. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman