Summary: Mrs X complained the Council charged her for care without advising her of the costs first. Mrs X says she now owes the Council a lot of money and has needed to cancel her care with the Council. We did not find fault with the Council.

The complaint

1. Mrs X complained the Council has delayed providing a suitable Personal Assistant for her since 2023 despite being eligible for Direct Payments. Mrs X said the Council instead put in place a care company who have not provided a suitable quality of care.
2. Mrs X said the Council billed her in October 2023 but she had not signed any agreement or been informed about charges. Mrs X said she did not receive a response from the Council when she disputed these charges.
3. Mrs X said despite raising complaints with the Council since 2024 she did not get a formal response until 2025. By this point, Mrs X owed a lot of money to the Council and has needed to cancel her care with the care provider.

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The Ombudsman’s role and powers

4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
6. 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)
7. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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)
8. 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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What I have and have not investigated

9. I have investigated Mrs X’s complaint from 4 December 2023 to 25 April 2025.
10. I have not investigated matters before 4 December 2023 because Mrs X only brought her complaint to the Ombudsman in March 2025 and matters before 4 December 2023 are beyond 12 months from this date. This time period includes the dispute about whether the Council should have arranged Direct Payments or a care company to meet Mrs X’s care needs. Additionally, since the Council has now withdrawn all charges before 4 December 2023, there is no injustice to Mrs X for this time period over the charging for the care provided. There is no good reason to exercise discretion to investigate before this point.
11. I have ended my investigation on 25 April 2025. This is the date the Council issued a formal complaint response to Mrs X outlining its position. I have made reference to relevant matters after this date which directly relate to the matters under consideration for this complaint but have not brought in new complaint issues. I have also made no finding of whether the Council was at fault on any matters after 25 April 2025 with any reference to information after this date purely contextual or informative.
12. Mrs X raised a new complaint with the Council in May 2025. Any matters related to this new complaint would be the subject of a new complaint with the Council. The Ombudsman must give the Council opportunity to consider and respond to a complaint before we can investigate.

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How I considered this complaint

13. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
14. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

15. 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)
16. 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 treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
17. 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)
18. 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. For example, above average heating costs should be considered.

Council’s disability-related expenditure policy and guidance for charging for care and support

19. The Council’s policy outlines it will consider if a person has any additional expenditure due to a disability or medical condition and decide if it can exempt this as a DRE. The Council says the onus is on the person to provide all evidence required to support a request for a DRE.
20. The Council details the following for allowance as a DRE:
• Fuel costs, gas and electricity, and metered water charges are compared to average usage for the type of property and household size and it will provide an allowance above the average costs.
• Regular expenses are calculated as an average weekly cost.
• It sets maximum rates for Community Alarms (weekly), Privately Arranged Care (hourly), Landry, Bedding, communication and entertainment, Housing Maintenance and Clothing amongst others.
• It can award above the maximum costs for many regular items if evidence is provided to support it but this must be signed off by a team manager.
• One-off expenses are calculated over the items life span such as 1 year, 5 years or 10 years.
• It can allow a DRE for Council Tax in line with the rate charged.
• It will allow a maximum cost for holidays where the person needs to pay extra towards it because of their illness or disability.

What happened

Matters before start point of our investigation

21. I have included the following information in this decision statement for contextual reasons but have not made any findings on these matters as explained in paragraphs 9 and 10.
22. In November 2022, the Council discussed support options with Mrs X and the potential for care charges.
23. In 2023, Mrs X started to receive care from a care company as a managed service by the Council rather than Direct Payments as Mrs X says she previously requested.
24. The Council acknowledged receipt of Mrs X’s Financial Information Form in April 2023. The Council asked Mrs X to provide evidence of any extra costs she incurred because of her disability so it could consider any Disability Related Expenditure. The Council said it would complete a financial assessment.
25. The Council completed a backdated financial assessment on 1 December 2023 detailing the cost of Mrs X’s care and sent this to Mrs X. The Council confirmed what Mrs X’s care charges would be per week moving forwards. The Council also detailed the backdated rates to the start of her care. The Council said it completed a provisional assessment based on the information it had available but asked Mrs X to provide some missing information otherwise it may have to charge the full cost of care to Mrs X. The Council reminded Mrs X to submit any information she had about any DREs she may have.

Matters about this complaint

26. Mrs X contacted the Council at the end of December 2023 to provide the missing information for her financial assessment and provided information about her DREs. Within Mrs X’s DRE form she included yearly costs for clothing and bedding, said she would provide costs of gas once she can get this but in the interim provided electricity and water bills and confirmed she did 4 loads of laundry each week.
27. In February 2024, Mrs X’s advocate provided extra evidence about Mrs X’s DREs.
28. In March 2024, Mrs X’s advocate contacted the Council to advise they considered the care charges the Council asked Mrs X to pay are inaccurate. The advocate also said the Council had not calculated the DREs correctly. The advocate also raised concerns the Council has not correctly told Mrs X about her care charges.
29. The Council responded to Mrs X’s advocate to seek more information about why it considered the DREs were not correct. The advocate offered to send more information in April 2024.
30. On 4 April 2024, the Council wrote to Mrs X to confirm it had allowed DREs for Council Tax, Housing Maintenance and Laundry costs and backdated this to the start of the care. The Council confirmed Mrs X revised care charges.
31. On 5 April 2024, the Council asked Mrs X’s advocate to provide a full list of Mrs X’s DREs so it could consider any allowances for these.
32. The Council continued to liaise with Mrs X’s advocate about their concerns. The advocate confirmed they were not making a formal complaint. The Council held a meeting with Mrs X’s advocate in May 2024.
33. Following the meeting, the Council confirmed it had only previously used the standard PIP rate for Mrs X’s financial assessment but had now found out Mrs X gets enhanced PIP. The Council said it had only backdated this charge to 8 April 2024 and not before because this was its mistake.
34. At the end of June 2024, Mrs X’s advocate provided a full list of Mrs X’s DREs.
35. The Council acknowledged this contact and said it would complete a new financial assessment and reconsider Mrs X’s DREs.
36. In September 2024, the Council asked Mrs X’s advocate to provide evidence of Mrs X’s costs as it cannot allow certain DREs without this evidence.
37. On 6 March 2025, Mrs X’s advocate contacted the Council to dispute the bill. The advocate said they had now submitted full evidence of the DREs but the Council had not calculated these yet. The advocate said Mrs X did not want outreach but wanted Direct Payments. The advocate said Mrs X wanted the debt wiped and the Council to complete a new assessment for Direct Payments.
38. On 12 March 2025, the Council completed a full DRE reassessment for Mrs X and backdated these to 27 March 2023. The Council applied DREs for:
• Bedding.
• Clothing.
• Footwear.
• Council Tax.
• Housing Maintenance costs.
• Laundry costs.
• Holiday costs.
39. The Council confirmed Mrs X’s total DREs for each time period and the weekly cost of her care following this reduction. The Council issued a full statement of account for Mrs X’s care up to 10 March 2025.
40. On 14 March 2025, the Council responded to Mrs X’s advocate to explain how it had calculated the DREs and what it had allowed and not allowed.
41. Mrs X’s advocate contacted the Council for further information about what DREs it had allowed.
42. The Council provided a formal complaint response on 25 April 2025. The Council said:
• It accepted it failed to provide the full information to Mrs X about her care costs in 2022 and failed to follow the correct procedure.
• It carried out a financial assessment for Mrs X on 1 December 2023. The Council said because of its delay in completing a financial assessment it had waived all charges up to 3 December 2023.
• It shared the relevant costs of Mrs X’s care with her in December 2023 and she could therefore review her support options based on that cost.
• It promised to review Mrs X’s care records to determine if care has been provided in line with her care plan. If it can confirm that Mrs X’s care costs were lower than her assessed contributions to would amend Mrs X’s charges.
• It has reviewed Mrs X’s DRE requests and recalculated her care charges in March 2025. The Council acknowledged this continued to be in dispute but said it needed evidence of the DRE costs which had not been provided.
• It understood Mrs X previously asked for Direct Payments but this was not followed up on. The Council partially upheld this complaint.
• It had considered Mrs X’s application for CHC but had assessed Mrs X and determined her ineligible for this.
43. In May 2025, Mrs X suspended her care provided by the Council before formally cancelling her care in July 2025.

Analysis

Charging for care

44. It is important councils give sufficient information to a person about paying for care at an early stage. This is to enable informed decision making. Where a council is not able to complete a prompt financial assessment it should still give appropriate written general information about the likelihood of needing to make a contribution towards care costs. The Council has a duty to provide clear information about charging and the financial assessment process, in a format service users can understand.
45. As explained in paragraph 10, I am not investigating matters before the charges raised from 4 December 2023 because the Council has waived these charges. As such, I will only make comment on the information Mrs X had available to her from 4 December 2023.
46. By 4 December 2023, the Council had completed a financial assessment of Mrs X and confirmed with her what her care charges would be moving forwards. The Council sent this to Mrs X. The Council also told Mrs X to provide any information about DREs at this time.
47. Since the Council told Mrs X about the cost of her care by 4 December 2023, I consider the Council has provided suitable information to Mrs X about charges following this date and I do not find fault.
48. The Council has since reduced Mrs X’s charges for the time period 4 December 2023 to April 2024. This means any changes to her charges have not caused an injustice to Mrs X.
49. Since 4 December 2023, the Council has kept Mrs X suitably informed about changes to the cost of her care. The Council provided communication in April 2024 and May 2024 about Mrs X’s costs for the financial year 2024/2025 and in April 2025 about the financial year 2025/2026. I do not find fault with the Council as it provided information that Mrs X’s care was chargeable and about the cost of this care.
50. Following the Council’s Stage 2 complaint response it promised Mrs X it would complete a review of her care records to determine if care had been provided as specified in her care plan. The Council has followed through on this action and provided a breakdown of Mrs X’s care to the Ombudsman. This breakdown shows Mrs X has received the correct care for which the Council charged.
51. While Mrs X has asked for the care charges to be waived, I cannot support this request. This is because Mrs X received the care and was told about the charges for this care. As such, Mrs X should expect to contribute towards the cost of her care.

DREs

52. The Council has been in contact with Mrs X’s advocate about the correct DREs to apply to her charges since December 2023. The Council has shown a willingness to liaise with Mrs X’s advocate to get relevant and correct information to evidence the DRE requests. Ultimately, the Council made the most up to date DRE decision for Mrs X in March 2025 which the Council has backdated to 4 December 2023. While it has taken over 12 months to reach this point, I do not find the Council at fault for this. The Council has shown it has tried to work with Mrs X and her advocate to obtain all relevant evidence which has contributed towards this delay.
53. When considering if a cost is a DRE, the Council must consider any reasonable additional costs directly related to a person’s disability. The Council should consider each request and apply consistent rationale based on the individual merits of each cost.
54. The Ombudsman is not an appeal body, so cannot comment on the merits of judgements and decisions made by councils in the absence of fault in the process.
55. The Ombudsman must decide if the Council has considered the relevant legislation and policies in making its decision. If the Council has considered the relevant policies and reached a suitable decision in line with these policies, the Ombudsman cannot find fault.
56. In March 2025 the Council has shown consideration of Mrs X’s full DRE requests. I have checked the Council’s consideration of Mrs X’s DRE requests and the Council has reached a decision on each request in line with its policy and the relevant legislation.
57. The Council has issued a revised invoice to Mrs X following application of the March 2025 DREs and removal of all charges before 4 December 2023. This updated invoice details total outstanding charges owed of £8,239.83 up the date Mrs X stopped her care. The billing produced by the Council is clear and transparent over Mrs X’s costs and I do not find fault with this billing.

Direct Payments

58. Mrs X has cancelled her care in July 2025 and advised she wants Direct Payments to manage her care moving forwards.
59. As I am not investigating matters before December 2023, I cannot comment on whether the Council should or should not have set up Direct Payments for Mrs X previously. However, the Council has confirmed Mrs X would still be entitled to receive Direct Payments moving forwards but would need to complete a new care assessment with the Council. Should Mrs X wish for this care assessment and Direct Payments, she would need to contact the Council to arrange this.

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Decision

60. I have completed my investigation as there was no fault by the Council.

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Investigator's decision on behalf of the Ombudsman