Summary: Mrs X complained the Council has failed to properly complete Miss Y’s financial assessment and give full consideration to her disability related expenditure (DRE). We found there is no evidence of fault in the way the Council considered whether the cost of the specialist toilet was DRE.

The complaint

1. Mrs X complained the Council has failed to properly complete Miss Y’s financial assessment and give full consideration to her disability related expenditure (DRE). In particular Mrs X complains the Council has refused to include the cost of a specialist toilet as DRE in Miss Y’s assessment.

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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(1), as amended)

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How I considered this complaint

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

Financial assessments and Disability Related Expenses

6. 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)
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. 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 what should be considered a Disability Related Expense (DRE) under Annex C. The list includes:
• any heating costs, or metered costs of water, above the average levels for the area and housing type;
• reasonable costs of basic gardening maintenance, cleaning, or domestic help, if necessitated by the individual's disability and not met be social services;
• purchase, maintenance and repair of disability related equipment need to enter or remain in work which include IT costs, where necessitated by the disability;
• personal assistance costs, including any household or other necessary costs arising for the person; and
• additional costs of special dietary needs due to illness or disability.
9. The Guidance confirms the list "… is not intended to be exhaustive and any reasonable additional costs directly related to a person's disability should be included."
10. The Council applies a standard allowance for DRE based on the rate of disability benefit a person receives. People who have expenses above the allowance or who do not receive a disability benefit can request a full DRE assessment.
11. For agreed one-off large expenses the Council will usually apply the costs over a one year period, with the cost being divided by 52 to provide the weekly amount. For large expenses over £500 the Council may consider an allowance over a longer period up to a maximum of five years.

What happened here

12. Miss Y requires support with all aspects of daily living and has had a care and support plan for many years. This currently includes a bespoke package of day care five days a week, a personal assistant three evenings a week and residential respite for 49 nights a year. Mrs X is Miss Y’s mother and main carer.
13. The Council has also completed financial assessments each year to calculate Miss Y’s contribution towards the cost of her care. As Miss Y receives the higher rate of disability benefit the Council applies the higher rate of DRE allowance. It also carries out a full DRE assessment and awards an additional DRE allowance.
14. According to the Council’s records Mrs X contacted the Council in June 2024 to ask about a VAT exemption certificate. Mrs X said she was getting the bathroom redone and installing a smart toilet as Miss Y needed assistance with toileting. The Council provided details of the government self-certification scheme.
15. In January 2025 Mrs X asked the Council to reimburse or offset the cost of the specialist toilet against Miss Y’s contribution as DRE. The toilet cost over £1800. The Council advised Mrs X to submit a receipt to the financial assessment team, which she confirmed she had done. An officer also advised an occupational therapist (OT) would usually assess the need for a specialist toilet and it could generally be considered for a disabled facilities grant (DFG). It agreed to consult the occupational therapy team about whether this could be done retrospectively.
16. The Council subsequently confirmed retrospective payments were not available under DFG funding for works already completed. Mrs X confirmed she did not want a grant, but rather for the expense to be set against Miss Y’s contribution as DRE. Mrs X said this was a legitimate disability related expense that needed to be accounted for.
17. Mrs X told the Council they had installed the toilet as she needs to assist Miss Y with toileting. Mrs X felt this was a good option as she was advancing in years and could not get up and down all the time. She said this type of toilet was mentioned by a social worker several years ago but they had not moved forward with it until now.
18. The Council reviewed Miss Y’s DRE allowance and wrote to Mrs X on 6 February 2025 confirming it did not agree the toilet as DRE. It noted Mrs X had purchased the toilet independently and had chosen to have it installed without consulting the Care Management Team. And without having an OT assessment which may have considered the suitability and provision of the equipment.
19. The Council set out Miss Y’s allowable DRE which totalled £55.23 each week and confirmed Miss Y’s contribution was £29.12 per week from 3 February 2025.
20. Mrs X appealed the Council’s decision not to allow the cost of the specialist toilet as DRE. She noted every support plan for the last 20 years had identified that Miss Y requires assistance with toileting and menstruation. And that the plans had highlighted the need for Miss Y’s personal dignity, physical and mental well-being and control over day to day care. Mrs X said Miss Y depended on the specialist toilet to maintain her quality of life and dignity.
21. In its response the Council confirmed its original decision that the toilet would not be included as additional DRE. Mrs X asked for her appeal to be escalated to the next stage and reconsidered based on the necessity of the toilet. The Council did not uphold Mrs X’s appeal.
22. Mrs X has asked the Ombudsman to investigate her complaint about the failure to treat the specialist toilet as DRE. Since contacting us Mrs X has also complained to the Council about Miss Y’s latest financial assessment, and a significant increase in her contribution. The Council has responded to Mrs X’s concerns and updated Miss Y’s financial assessment to reflect changing costs in her DRE and the receipts Mrs X had provided. It confirmed Miss Y’s total weekly DRE was £51.16 and her contribution for non-residential services from 7 April 2025 was £34.59 per week.
23. In addition the Council confirmed Miss Y’s assessed contribution for temporary residential (respite) services was £131.10 per week. It explained this sum was divided by seven to get a daily rate and then multiplied by the number of Miss Y’s respite days. In April 2025 Miss Y had had three respite days so the contribution was £56.18.
24. In response to my enquiries the Council maintains it has properly completed Miss Y’s financial assessment, giving full consideration to her DRE, particularly the toilet, in line with its policy and processes. It says it allows for DRE expenses which relate to an eligible assessed need.
25. The Council acknowledges Miss Y’s support plan from 2017 notes the family would “ideally” like a bidet for Miss Y to clean herself. However this is not recorded in Miss Y’s Care Act assessment as an assessed eligible need and was not therefore progressed. The Council says there were no further discussions and Mrs X did not raise the subject in subsequent assessments.
26. Based on Miss Y’s previous assessments the specialist toilet is not a Care Act assessed need. The Council says Mrs X renovated her bathroom privately and contacted the Council regarding a VAT exemption certificate, which it provided advice on. When Mrs X contacted the Council regarding reimbursement for the cost of the toilet the Council confirmed it could not be reimbursed retrospectively as a DFG and would not be allowed as DRE within Miss Y’s financial assessment.
27. The Council also confirmed it has discretion to deviate from the DRE policy, but it did not consider to appropriate in this case.

Analysis

28. 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 cannot criticise a council where officers have followed the correct procedures and reached a reasoned decision.
29. The Council has considered Mrs X’s request for the cost of a specialist toilet to be DRE and decided not to allow it. Although Mrs X disagrees, this is a decision the Council can make. The Council has given Mrs X a clear explanation of how it has considered the cost of the toilet and why it does not consider this to be DRE.
30. It is possible the cost of the toilet could have been covered by a disabled facilities grant, but this cannot be applied for retrospectively.
31. Mrs X asserts Miss Y’s need for the specialist toilet is well established and an OT assessment would only confirm what had been documented for over 20 years. There is no dispute Miss Y’s support plans refer to a need for support with toileting and maintain her hygiene levels. The plans also note that Mrs X supports Miss Y with this. They do not suggest there is an unmet need or that Mrs X is no longer able to provide this support.

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Decision

32. I find no fault.

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Investigator's decision on behalf of the Ombudsman