Summary: There was fault in the Council’s delay in sending an invoice and in the information it provided to Mr D and his family on what the cost of a care package would be. This meant that Mr D and his family did not have the necessary information to make informed decisions about the care package. The Council has agreed to apologise, to cancel a proposed invoice and has agreed a service improvement.

The complaint

1. Miss C complains on behalf of her father, Mr D, who has died. She says the Council put in place a package of care by an agency, but did not inform the family that this was a temporary arrangement and that, if the family wanted to continue using this agency, they would have to pay an extra fee.

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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 complained with Miss C. I have considered evidence provided by Miss C and the Council, the relevant law, policy and guidance and both sides’ comments on the draft decision.

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What I found

Law, guidance and policies

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.

Assessment, care plan and personal budget

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.

Financial assessment

7. 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.
8. 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.

Personal budget

9. Everyone whose needs the local authority meets must receive a personal budget as part of the care and support plan. The personal budget gives the person information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The personal budget must always be an amount enough to meet the person’s care and support needs.

Direct payments

10. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The amount of direct payment is derived from the personal budget set out in the care and support plan.

What happened

11. Mr D was an older man who had a diagnosis of dementia. He lived at home and his wife, Mrs D, provided most of the support.
12. The Council put in a package of support in 2023 which was provided by agency 1. The family made a complaint about agency 1 and the support was stopped in September 2023. The Council carried out a financial assessment of Mr D in September 2023 and concluded that he would have to pay a contribution of £100.28 per week towards the cost of his care package.
13. The Council wrote to Mr D on 18 September 2023 and informed him of the contribution. Miss C signed a document on 25 September 2023 where she confirmed that she understood that Mr D would have to pay a contribution towards the cost of his care package.

June 2024

14. Mrs D contacted the Council in June 2024 as Mr D needed urgent care as he had been cared for in bed for the last 2 weeks. The Council carried out an assessment of Mr D’s needs on 20 June 2024. The social worker noted that Mr D needed additional support which Mrs D could not provide. Mrs D provided support with meals, medication and Miss C helped with shopping and attending appointments. However, Mr D needed support with personal care, dressing, toileting and mobility which could be provided by care workers.
15. The social worker said Mr D needed support from two care workers, three times a day for 30 minutes.
16. The social worker spoke to Miss C and proposed agency 1 should provide support to Mr D. Agency 1 was the Council’s preferred agency for the area where Mr D lived. Miss C explained that the family had made a complaint against agency 1 so she did not want agency 1 to provide care again.
17. The social worker said he would discuss this with his manager. Miss C said they needed the support but ‘would rather look into urgent respite if it is between that and [agency 1]’.
18. The social worker spoke to his manager and it was agreed to hire agency 2. The social worker informed Miss C of the Council’s decision. The social worker discussed the financial assessment with Miss C. Miss C told him that nothing had changed financially since the previous financial assessment so the social worker concluded that a new financial assessment was not needed. Agency 2 started providing the care on 3 July 2024.
19. The social worker completed a care plan dated 20 June 2024. The plan said the hourly cost of the care was £21.24 and the weekly cost was £205.86.

August 2024

20. On 28 August 2024 Miss C contacted the Council as she had received an invoice for Mr D’s care package and said she had not been aware that that Mr D would have to pay for his care.
21. A different social worker visited the family the next day and the social worker explained the situation. I have summarised the social worker’s note of the conversation.
22. The social worker said:
• Agency 2 had been put in place as an emergency but the agency was not on the Council’s approved framework of agencies so the Council could not continue to employ agency 2.
• The Council would find an alternative agency which was registered with its framework.
• Agency 2’s hourly rates were higher than the rates of the agencies on the Council’s framework.
• If the family wanted to continue to work with agency 2, they could do so but would have to use direct payments. The social worker said: ‘I explained how the direct payments would work and explained that they would have to top up the hourly rate as we would only give them our hourly rate which was £21.24 and [agency 2’s] hourly rate is £32.’
23. Miss C said:
• Agency 2 was a good agency and the family did not want to change agencies. Mr D was familiar now with agency 2’s staff.
• She had made a formal complaint about agency 1 to the CQC and did not want agency 1 to return.
• The social worker who she spoke to in June 2024 did not tell her that agency 2 would only be providing care for a limited period nor did he inform her of any additional fees.
• Mr D should not have to change care agencies when this had not been explained to the family at the outset.
• Agency 2 had told them that the care package was free for the first 12 weeks.
24. The Council then found another agency, agency 3, which could provide care to Mr D. However, the Council did not inform the family that it had found an alternative agency that could provide the care.

Complaint – September 2024

25. Miss C complained to the Council in September 2024 and said:
• Mr D was charged for the care from 3 June 2024 to 4 August 2024 even though agency 2 had told them that the care package would be free for the first 12 weeks. The family was not informed about any charges until they received the invoice on 28 August 2024.
• The invoice was incorrect as agency 2 did not start until 4 July 2024.
• She had been informed that the Council could not continue funding agency 2 as agency 2 was not on its approved providers’ list and was more expensive.
• The family was never informed that agency 2 was temporary.
• The family was very happy with agency 2’s care and it was not acceptable for the Council to expect Mr D to move to a different agency because of a mistake made by the Council.

Response – October 2024

26. The Council responded to the complaint in October and said:
• The family had been informed that Mr D would have to pay a contribution towards his care and the Council had carried out a financial assessment of Mr D in September 2023.
• In the later complaint response, the Council upheld the complaint that there had been a delay in sending the original invoice (June to August 2024) and it apologised for this.
• The Council upheld the complaint that the invoice should not start until 4 July 2024 and amended the invoice.
• The other agencies on the Council’s framework did not have capacity to take on a new client in July 2024 which is why the Council agreed to hire agency 2, which was not on the framework, on a temporary basis.
• It upheld the complaint that the social worker did not inform the family that the recruitment of agency 2 was temporary and apologised for this.
• It repeated the offer of direct payments which would allow the family to choose agency 2. The Council would only pay the amount set out in Mr D’s personal budget. The family would have to pay the difference between the personal budget and agency 2’s rate.

Further information

27. The social worker reviewed Mr D’s care plan in November 2024 and noted that there had been an improvement in Mr D. The family said Mr D only required two 30-minute visits a day by one care worker. The care plan was therefore reduced accordingly to 14 hours per week. The document said Mr D’s personal budget was £429.69 per week.
28. I read all the Council’s documents but I could not understand how the personal budget had been calculated so I asked the Council to confirm what Mr D’s personal budget was in June 2024 and in November 2024.
29. The Council responded and said:
• The care package in June cost £56 per hour for 21 hours per week (2 carers) so £14,112 for a 12-week period.
• This was reduced to £28 per 30 minutes x 2 care calls in November.
30. I spoke to the Council’s manager as I wanted to clarify this further as the Council had still not provided me with the personal budget and the costs it had provided seemed very high.
31. The manager said the Council did not calculate a personal budget when an urgent assessment was done so the personal budget in June 2024 was the actual cost of the care package.
32. The manager confirmed that the hourly rate was £56 per hour. Agency 2 charged a sliding rate which went up if a shorter visit was needed.
33. So my calculation of the weekly cost in June is as follows. Mr D received 30 minutes care (£28 per 30 minutes) x 2 (2 carers) x 3 (3 hours a day) x 7 (7days a week) = £1,176 per week. The hourly rate for care agencies approved by the Council is £21.24 so the weekly personal budget would be £446 which means that the family would have to pay the difference of £730 per week if they chose to use direct payments.
34. In November the weekly cost was 30 minutes care by 1 carer (£28) x 14 = £392.
35. The Council has continued to pay agency 2 and has sent invoices to Mr D for his contribution only. It is my understanding that Mr D paid all the invoices including the invoices for the first 12 weeks.
36. Sadly Mr D died in June 2025.
37. In the response to the draft decision, Miss C said the social worker did not explain to her that the hourly rate the Council paid was £21.24 nor that the hourly rate of agency 2 was £32. She also said the Council had never sent her or the family Mr D’s care plans and the family had not been told what the personal budget was.

Analysis

38. When the Council started to provide care with agency 2, it did not carry out a further financial assessment because it had already carried out a financial assessment previously so it knew what contribution Mr D had to make to the cost of his care package. I find no fault in that respect.
39. However, the Council should have told Mr D and his family, at that stage, what Mr D’s contribution to the care package would be and should have started to send invoices. The Council failed to do this and that was fault.
40. The Council also did not inform Mr D and the family that agency 2 was more expensive than agency 1 and was not on its approved providers list. The Council had agreed to pay this extra cost only for a short term, until a different agency could be found from its approved provider checklist. The Council failed to explain all this to the family and this was fault.
41. The family only found out about the problem in August 2024 when the social worker told the family that agency 2 was more expensive than agencies that were on its approved list. If the family wanted to keep agency 2, it would have to switch over to direct payments so it could hire agency 2 directly and pay the extra fee from its own funding. Miss C disagreed with this position and complained to the Council. The Council continued to pay agency 2 and continued to invoice Mr D for his contribution only.
42. During the investigation the Council informed the Ombudsman that it planned to send an invoice to Mr D’s family for the extra fee starting from August 2024.
43. I asked the Council whether Mr D’s family had been informed of this decision at the time or any time since the complaint was made. The Council said that it was ‘implied’ that the extra fee was payable.
44. I agree that Miss C was informed in August 2024 that, if the family wanted to keep agency 2, it should transfer over to direct payments and would have to pay an extra fee.
45. However, Miss C was not told what Mr D’s personal budget was, she was not told what the extra weekly fee would be for keeping agency 2.
46. She was also not informed that the Council was starting to invoice her from August 2024 and that the family was, in essence, making the decision to choose to pay an extra £730 per week while the complaint was ongoing.
47. If the Council wanted to charge Mr D the extra fee from August 2024, it should have taken the following actions in August 2024. It should have:
• Informed Mr D’s family that, by pursuing the complaint, it was, in effect, making the decision to choose direct payments from the start of the complaint.
• Told Mr D’s family what Mr D’s personal budget was.
• Explained that agency 2’s hourly rate was £56, which was a big difference from the hourly rate set in the personal budget (£21.24)
• Set out the extra fee the family would have to pay, in addition to the contribution.
• Start sending invoices for the extra fee (not just the contribution) in August 2024.
48. The Council did not take any of these actions and this was fault.

Injustice

49. 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.
50. The main reason why councils should complete financial assessments and provide information about the costs at the same as the care plan is being finalised is that it allows families to make decisions about the care planning with all the information they need to make that decision.
51. In Mr D’s case, it is difficult to say what would have happened if the initial fault (in June 2024) had not occurred. Which agency would the family have chosen if the Council had explained to the family, when it offered agency 2, that this was a temporary arrangement as the agency was not on its approved list? It is unlikely that the family would have agreed to a return of agency 1 considering how strongly they felt about agency 1 at the time. It is more likely that they would have agreed to agency 2, but with the knowledge that this was only temporary and they would then have to switch to a different agency.
52. So therefore the injustice is that the family was not forewarned that agency 2’s employment was only temporary, but they would have had to change agencies (or agree to pay the higher fee) in any event.
53. The injustice from the second fault in August 2024 is clearer. Mr D’s family was not given the necessary information to make an informed decision. The family was also not told that, by pursuing the complaint, it was making the decision to pay an extra £730 per week while the complaint was ongoing. I doubt the family would have agreed to pay an agency that charges £56 an hour.
54. I recommended, in the draft decision that the Council should review the decision to charge the extra fee from August 2024. In its response to the draft decision, the Council agreed that it would ‘not take steps to recover the extra fee from August 2024.’

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Action

55. The Council has agreed not to pursue the extra fee from August 2024, as set out above.
56. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise in writing to Mr D’s family for the fault I have identified.
• The Council should remind relevant officers of the importance of providing financial information when care planning takes place.

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Decision

57. 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