Summary: We will not investigate this complaint about the personal budget and funding of an adult social care home placement. There is not enough evidence of fault by the Council in these issues. There was some delay by the Council but that does not cause a significant enough injustice to justify an Ombudsman investigation when we would not consider the main issue of complaint.

The complaint

1. Mr B says the Council set the wrong personal budget for his relative, Ms C’s, nursing care. So, the third-party top-up is higher than necessary causing a financial burden. Mr B says the Council should reverse this decision and provide more funding for Ms C’s care.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused significant enough injustice to the person who complained to justify our involvement, or
• further investigation would not lead to a different outcome.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. 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)

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.
6. I considered the Care Act 2014 and associated statutory guidance.

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My assessment

7. The Council’s duty under the Care Act 2014 is to assess the care and support needs of adults in its area who it knows may need support. If the Council assesses the person has eligible needs, then it must meet those needs. The Council must complete a financial assessment to decide if the person must pay any or all the care costs.
8. The Council will set a personal budget, which is the cost in which it is possible for the Council to meet the person’s needs. The person may need to pay a personal contribution toward the care, based on the financial assessment. The Care Act allows people to have choice and control over their care. You can choose a more expensive placement than the one the Council chooses, but a third party must agree to pay the difference, this is a third-party top-up. The Council must offer at least one available, suitable placement, within your personal budget.
9. Ms C previously lived in residential care, with a personal budget of £1100 per week. Ms C’s needs changed, and she needed nursing care, so needed to move to a new placement. The Council offered an available placement who could meet Ms C’s needs for £850 per week. So, Ms C’s new personal budget was £850 per week.
10. Mr B challenges this was a suitable placement and disagrees the personal budget should be £850 per week. Mr B says the personal budget should therefore remain £1100 per week.
11. The Council agrees the offered placement needed improvement by the Care Quality Commission (CQC). However, the Council disagrees this made it an unsuitable placement. The CQC and the Council’s quality team was working with the provider, and the Council was satisfied it could meet Ms C’s needs. The Ombudsman could not challenge or criticise the Council’s decision that this was a suitable placement to meet Ms C’s needs. And nor could we therefore challenge or criticise a personal budget of £850 per week on the basis it was possible for the Council to meet Ms C’s needs within that budget.
12. Mr B chose a more expensive placement and signed and agreed to the third-party top-up. The Council gave Mr B relevant information to make an informed decision about that at the time.
13. The Council appears to have delayed billing for the third-party top-up and delayed responding to Mr B’s complaint. But that does not cause a significant enough injustice to justify an Ombudsman investigation, when we would not be considering the substantive issue complained of.

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Final decision

14. We will not investigate Mr B’s complaint because there is not enough evidence of fault in the substantive matter complained about. The Council followed the law, guidance, and its own professional judgement when reaching its decision on suitable placement and personal budget. There is no reason for the Ombudsman to question or criticise this even though Mr B strongly disagrees. Delays by the Council have not caused a significant enough injustice to justify an Ombudsman investigation.

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Investigator's decision on behalf of the Ombudsman