Summary: Mr X complains about the way Kent County Council and NHS Kent and Medway managed his care charges and communicated with him about them. We will not investigate Mr X’s complaint about communication because there is insufficient injustice to warrant an investigation. We will not investigate Mr X’s complaint about the Council’s financial assessment as we are unlikely to find fault in the way the Council completed this.

The complaint

1. Mr X complains about the way Kent County Council (the Council) and NHS Kent and Medway ICB (the ICB) managed his care charges following his discharge from hospital in March 2024. Mr X says he was not given any information about the change from free health funding to Mr X paying his fees in September 2024. He says this resulted in an unexpected invoice of over £8,000.
2. Mr X also disagrees with the way the Council assessed his finances, by including the value of a property which Mr X says is life insurance for him and his family.
3. As a result, Mr X says that he has been caused a significant amount of stress and should not have needed to pay the backdated fees. Mr X would like to be refunded for the disputed care fees.

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The Ombudsmen’s role and powers

4. The Ombudsmen consider complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
5. The Ombudsmen provide a free service but must use public money carefully. They may decide not to start or continue with an investigation if they believe:
• it is unlikely they would find fault, or
• the injustice is not significant enough to justify their involvement, or
• we cannot achieve the outcome someone wants

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

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

What happened

8. Mr X lived at home with Council arranged care. In 2021, Mr X was financially assessed by the Council as a full cost payer, which meant he paid for all his care. Further financial assessments in 2022 and 2023 also confirmed Mr X as a full cost payer.
9. In February 2024, Mr X was admitted to hospital.
10. In March 2024, Mr X was discharged home with a care package. Mr X’s care was arranged and fully funded by the ICB for a short-term period of rehabilitation.
11. In May 2024, Mr X called the Council with concerns about the risk of receiving a backdated invoice once his free health funded care ended. The Council completed a further financial assessment and wrote to Mr X, confirming he was still a full cost payer.
12. In September 2024, Mr X was no longer eligible for health funding and the ICB stopped paying for his care. The Council assessed Mr X’s care needs and assessed his finances. The Council records say Mr X was told, verbally and in writing, that he was still a full cost payer. Mr X wanted to stay with his current care provider and for the Council to manage his care package. Several discussions took place between Mr X and the Council about his care package. The Council advised Mr X that they may not be able to arrange his care with his current care provider as it was not a Council approved provider.
13. In late October 2024, the Council records say it confirmed to Mr X it could not arrange a care package with his current provider and advised him to contact the care provider directly to make arrangements for his invoices.
14. In November 2024, Mr X received an invoice for over £8,000 from the care provider for his care backdated to 3 September 2024, when the health funding ended. Mr X raised concerns about the Council’s financial assessment including the value of a second property in his capital calculation.
15. Mr X complained to the Council about their handling of his care fees and financial assessment. The Council acknowledged an avoidable delay communicating with Mr X about funding and accepted that its information could have been clearer. The Council apologised to Mr X for any confusion and inconvenience. The Council did not accept that Mr X’s second property could be considered life insurance.

Analysis

Change of funding

16. Mr X complains about lack of communication when his care fees changed from free health funding by the ICB to Council assessed social care funding. Mr X says he was not given any information about care fees when he was discharged from hospital. When the health funding ended, Mr X says the Council failed to communicate clearly and delayed confirming that he would pay his fees in full. Mr X says Council delays meant he received a backdated invoice for over £8,000, which he does not think he should have had to pay.
17. Based on the information I have seen, it seems Mr X was aware the health funding would last for around 6-8 weeks. As such, Mr X would have been aware that the free health funding was for a limited period only. The health funding ultimately continued for several months, allowing Mr X time to plan his finances accordingly.
18. While Mr X would not have had all the information about his care fees at this point, he knew he had been assessed as a full cost payer for the previous years. Therefore, he would have had an expectation that this would likely continue to be the case. The Council records also show Mr X was aware of the possibility of a backdated invoice after the heath funding ended. Mr X could have obtained further information about the cost of his care fees directly from the care provider to assist with financial planning.
19. The Council has accepted its communication could have been clearer. However, its records show Mr X was advised on multiple occasions that he would be a full cost payer, whether or not the Council was able to manage his care package. I acknowledge Mr X disputes this.
20. When commenting on my draft decision, Mr X insisted he received no communication about the dates the health funding would end. The Council records note Mr X was advised by telephone that he was no longer eligible for health funding on 3 September, 5 September and several occasions after that. The records say Mr X was advised to contact the care provider directly to arrange invoicing as he was now responsible for his care. The records also note the ICB said it had told Mr X that the health funding had ended.
21. I acknowledge Mr X’s recollection differs significantly from the Council’s written records of these telephone calls. When faced with two conflicting accounts, it can be difficult to resolve this what happened without independent evidence, such as a phone recording, to confirm what happened. Further investigation by us is unlikely to uncover further evidence to definitively resolve these conflicting accounts.
22. When investigating complaints, if there is a conflict of evidence, we may make a decision on the balance of probabilities. This means we will weigh up the available evidence and base our decision on what we think is more likely to have happened. Based on the evidence I have seen, I am satisfied Mr X was provided with information that he would be a full cost payer from the point that his health funding ended. On this basis, an investigation by the Ombudsmen would be unlikely to find evidence of significant fault here.

Refund of care fees

23. Mr X says he should not have to pay the backdated invoice of over £8,000 due to the Council’s poor communication around the change to his care fees.
24. When we consider how any fault by an organisation has impacted someone, we consider what would have happened but for the fault.
25. We will not normally investigate a complaint unless there is good reason to believe that the complainant has suffered significant personal injustice as a direct result of the actions or inactions of the service provider. We do not start or continue an investigation if we decide the impact of the fault a person complains about is not so significant that we should investigate.
26. Regardless of the Council’s poor communication, Mr X was still a full cost payer for his care. Therefore, he does not appear to have experienced a quantifiable financial injustice. It follows that any investigation by us would not recommend a refund of Mr X’s care fees. Therefore, we are unlikely to achieve the outcome Mr X is seeking.
27. If we investigated the matter, we would likely decide the injustice caused by the Council’s communication was frustration for Mr X.
28. The Council has apologised to Mr X for poor communication and addressed the matter with its staff. These are appropriate steps to recognise the frustration caused and further investigation by us is unlikely to make further recommendations. There is no ongoing injustice for us to consider the matter further.

Financial assessment

29. Mr X complains about the way the Council assessed his finances in 2024, which found he exceeded the financial threshold. As such, Mr X is fully responsible for the cost of his care fees.
30. Mr X says his second property should be disregarded as capital because this is life insurance for him and his family. Mr X feels he is being made out to be ‘a liar’ regarding what the capital is being held for.
31. The Care and Support Statutory Guidance (the Guidance) outlines how councils should go about performing their care and support responsibilities. Councils complete financial assessments to decide a person’s contribution to their care, taking into account their capital and income in line with the Guidance. People who have over £23,250 of eligible capital have to pay for the full cost of their care fees.
32. Annex B of the Guidance explains the treatment of capital by councils when conducting a financial assessment. It lists types of capital to be considering as part of the assessment, including buildings. This also provides a comprehensive list of what capital can be disregarded by a council in the financial assessment process. The disregard list includes the surrender value of any life insurance policy and property in specified circumstances (for example, in this case, Mr X’s main home where he is living and receiving care).
33. The Ombudsmen are not an appeal body. We cannot challenge the Council’s decision unless there is fault in its decision making. We cannot say the Council must disregard the property from the financial assessment. If we consider the Council followed processes correctly, we cannot question the decision, regardless of whether Mr X disagrees with it.
34. The Guidance states that a life insurance policy can be disregarded. However, Mr X’s second property is not part of a formal life insurance policy and therefore does not appear to meet the criteria for life insurance. Mr X does not live in his second property and therefore this would be considered an asset to be included in his calculated capital. The Council’s actions appear to be in line with the Guidance. As such, we are unlikely to find fault with the way the Council assessed Mr X’s finances and would not investigate further.

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Decision

35. We will not investigate Mr X’s complaint about the way his care fees have been handled. This is because there is insufficient injustice to warrant an investigation. We are unlikely to find fault with the way the Council assessed Mr X’s finances.

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Investigator's decision on behalf of the Ombudsman