Summary: Mrs X complains about how the Council carried out financial assessments for her sons, Mr Y and Mr Z. Mrs X says this has resulted in them being charged for care. We find fault with the Council for its communication about charges, and its consideration of Mrs X’s complaint. We agreed the Council will apologise to Mrs X and carry out service improvements.

The complaint

1. Mrs X complains about how the Council has carried out financial assessments for her sons, Mr A and Mr B. Mrs X says the Council has failed to properly consider evidence and has not been clear in its calculations.
2. Mrs X would like the Council to request receipts once a year, give a breakdown of its calculations and have a direct contact for the payment team.

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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(i), as amended)

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How I considered this complaint

5. I considered evidence provided by Mrs X and the Council, as well as relevant law, policy and guidance.
6. Mrs 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

Legislation, guidance and policy

Financial assessments

7. 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. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
8. 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)

Disability related expenditure

9. 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.

What happened

10. Mr Y and Mr Z received care for which they had to send evidence of disability related expenditure to the Council. Their mother, Mrs X, acted as their representative during assessments and when communicating with the Council.
11. The Council carried out a yearly financial reassessment of Mr Y and Mr Z in July 2023. In September, it wrote to Mrs X to say neither had to pay any charges towards their care, but the Council would be reviewing the DRE in December 2023. It asked Mrs X to keep receipts for DRE to provide at the point of review.
12. In January 2024, the Council wrote to Mrs X asking for receipts from October 2023 for DRE.
13. In March 2024, the Council completed a reassessment of Mr Y and Mr Z’s DRE and decided they needed to contribute to their care costs. The Council said this was because Mrs X had not provided the receipts requested to evidence the DRE.
14. In April 2024, Mrs X provided receipts to the Council for both Mr Y and Mr Z. The Council then wrote multiple letters dated on the same day advising different costs for Mr Y and Mr Z and that they would need to pay care charges going forward.
15. Mrs X complained to the Council in July 2024. In her complaint she said:

• Mr A and Mr B previously received the same amount of DRE allowance, but this now kept changing without clear explanation.
• Mrs X has provided the receipts requested but the Council continued to ask for more receipts and evidence of spending.
• Both Mr A and Mr B have similar needs but must contribute different amounts.
• Mrs X has received bills for Mr A and Mr B, despite the Council sending letters which said they did not need to contribute.
• The Council changes its mind about whether Mr A and Mr B must contribute to their care costs, which they are all findings confusing and distressing.
• Mrs X found the Council’s requests and explanations for the costs confusing and unclear.

16. The Council responded to Mrs X’s complaint. It said:

• Before August 2023, both Mr A and Mr B did not need to pay for their care, and the Council had said it would review the DRE in December 2023. It therefore needed evidence of spending over the last 12 months.
• As Mrs X had not been able to provide the evidence needed, their DRE was reduced and both needed to contribute to their care.
• It recognised that communication between departments had been confusing, as receipts are not required for direct payments, but are required for DRE reviews.
• It accepted that both Mr Y and Mr Z needed to have replacement clothing often, and Mrs X needed to keep receipts going forward. It would accept receipts from the last six months if Mrs X could not provide 12 months.
• As Mr A and Mr B had different interests, their DRE is different amounts, which was set out in the April 2024 letter.

17. Mrs X remained unhappy. She explained to the Council that she had already provided receipts. She also said that both Mr A and Mr B had the same interests and attended the same activities, therefore their DRE should be the same amount.
18. The Council told Mrs X that it had nothing further to add in response to her complaint and signposted her to the Ombudsman.
19. In November 2024, the Council issued invoices for the care charges for both Mr Y and Mr Z between January 2024 and November 2024.
20. In January 2025, the Council heard both cases at panel. It agreed the DRE costs and approved new costs. It removed the outstanding care charges.

Analysis

21. The Ombudsman is not an appeal body. It is not our role to carry out financial assessments, decide what contribution someone should make to their care costs, or decide whether certain expenses should be classed as DRE. Our role is to investigate the process a council followed, to assess whether it made its decision properly. We look for evidence of fault causing injustice to the complainant. We cannot question the professional judgment of council decision makers where the process was not affected by fault.
22. The Council told Mrs X in September 2023 that it would need receipts for some of the expenses at the next assessment, and asked she keep the relevant information to be able to provide this. The Council then asked for this information in January 2024 but did not receive it.
23. The Council was clear in its need to carry out a reassessment of the DRE, and based on the evidence it had, it completed the review in March 2024. At this time, it did not have the requested evidence. I do not find fault with the Council for this part of the complaint.
24. Once Mrs X had provided the receipts, the Council again reviewed the DRE and adjusted how much Mr Y and Mr Z would pay because of the new information. I do not find the Council at fault for this part of the complaint.
25. Part of Mrs X’s complaint is there are different amounts of DRE approved for Mr Y and Mr Z. The Council has explained this is because they have different interests. I have reviewed the reassessments, and the DRE declared for both. I am of the view there are different amounts declared for different things, and therefore I am satisfied the Council has explained how it reached the decision to award different amounts.
26. The communication to Mrs X about the charges and how the Council calculated this the was unclear. In April 2024, Mrs X received multiple letters for both Mr Y and Mr Z, dated on the same day, but for different amounts. It was not clear what the final amount expected to be paid was. This was fault by the Council, causing uncertainty.
27. The Council’s complaint response does not fully address part of Mrs X’s complaint. Mrs X told the Council she had already provided receipts, and didn’t understand why she needed to provide them again. She felt the receipts had not been properly considered, because she had received letters stating different amounts. When the Council responded to Mrs X’s complaint, she had already provided receipts, however the Council’s response implied this had not been done. The Council should have addressed this in its complaint response and clarified to Mrs X how and when the receipts were considered, and why the letters gave different amounts.
28. The Council heard both cases at panel in January 2025, following Mrs X’s complaint and the ongoing dispute about approved DRE. It decided to approve the DRE costs and agreed new ones, meaning that neither Mr Y or Mr Z had to contribute to their care costs. It backdated the decision to January 2024 and removed any outstanding charges. There does appear to be delay by the Council in making this decision given that Mrs X raised her complaint in July 2024. However, the panel were also considering new proposed DRE as well as the previous costs. There is limited injustice to Mrs X, Mr Y and Mr Z from any delay as all outstanding charges were removed and the agreed DRE confirmed.

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Agreed Action

29. Within four weeks of the final decision the Council should:

• Write to Mrs X and apologise for the poor communication and complaint handling. We have published guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended;
• Pay Mrs X £150 for the time and trouble of bringing her complaint, and for the frustration and uncertainty caused by the faults above.

30. Within three months of the final decision the Council should:
• Carry out service improvements to ensure that complaints are fully responded to;
• Review how the Council can improve communication where the Council sends out multiple charging letters on the same day or close together, it will also tell people of the final amount to pay.
31. The Council should provide us with evidence it has complied with the above actions.

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Final Decision

I find fault with the Council for its communication about charges and how it handled Mrs X’s complaint, and have agreed a symbolic payment and service improvements to ensure this does not reoccur.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman