Summary: Mr X complained the Council did not tell the family in advance that Mrs Y’s care and support would be chargeable from day one after she was discharged from hospital. This affected Mrs Y financially and caused distress. The Council was at fault for failing to follow its procedures on reablement support, and failing to provide proper advice to Mrs Y and her family. The Council agreed to reimburse Mrs Y’s care fees and provide a symbolic financial remedy for Mr X’s time and trouble.

The complaint

1. Mr X complained the Council did not tell the family in advance that Mrs Y’s care and support would be chargeable from day one after she was discharged from hospital.
2. Mr X said the family was told by several people, including a social worker, that the first six weeks of care would be free of charge, with a financial assessment carried out to determine any charges after that point.
3. Mr X also said the Council did not provide any information in writing, and if the Council had informed the family Mrs Y’s care was chargeable from day one, they may have asked for her to remain in hospital, as she was making good progress.
4. The Council’s actions affected Mrs Y financially, as she received an invoice for over £2,000. This also caused distress and frustration.

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The Ombudsman’s role and powers

5. 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)
6. 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

7. As part of the investigation, I considered the complaint and the information Mr X provided.
8. I made written enquiries of the Council and considered its response along with relevant law and guidance.
9. Mr 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

Hospital discharge

10. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs. The NHS can claim money back from councils that have caused delays transferring patients. The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment.
11. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
12. On receiving an assessment notice, the council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.
13. To avoid any risk of having to pay back money, the council must start a needs assessment and put in place any care arrangements for meeting eligible needs before the ‘relevant day’. The relevant day is either the date when the NHS proposes to discharge the patient or the minimum period (two days after the council has received the assessment notice), whichever is the later.

Intermediate Care and Reablement

14. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.
15. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Charing for social care services

16. 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)
17. 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. Councils have no power to assess couples according to their joint financial resources. 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.
18. Information and advice is fundamental to enabling people, carers and families to take control of, and make well-informed choices about, their care and support and how they fund it. Not only does information and advice help to promote people’s wellbeing by increasing their ability to exercise choice and control, it is also a vital component of preventing or delaying people’s need for care and support. (Paragraph 3.1, Care and Support Statutory Guidance)

What happened

19. I have summarised below some key events leading to Mr X’s complaint. This is not intended to be a detailed account of what took place.
20. Mrs Y was hospitalised following a fall in which she sustained a back injury.
21. Mrs Y’s hospital discharge plan, dated 31 March 2025, states Mrs Y’s therapy goals were to progress in her own environment to reduce care calls and increase her independence before referral for a long-term package of care. This was to be achieved within six weeks.
22. The Council visited Mrs Y in hospital on 2 April 2025 to discuss discharge support. The Council recorded Mrs Y wanted to go home with a package of care. The Council also recorded it would source a double manned package of care and complete a financial assessment to determine Mrs Y’s contribution. Mrs Y was happy to have a financial assessment.
23. The Council submitted a request for reablement care for Mrs Y the same day. The request was for four double manned calls per day.
24. The reablement service told the Council on 3 April that it had no availability. The Council therefore approached private care providers about a package of care.
25. The Council telephoned Mr X on 4 April. Its records state it informed Mr X of its visit to Mrs Y, and that she wanted to be discharged with a package of care, which the Council was sourcing.
26. The Council met with Mrs Y and Mr X on 7 April, at Mr X’s request, to discuss discharge. The hospital confirmed Mrs Y could be discharged with a frame and did not need support or supervision to mobilise. She could also transfer independently from a bed or chair. The Council recorded Mrs Y agreed to have a package of care with four calls a day. The Council discussed finances, and Mr X said he did not know if Mrs Y’s savings were above or below the capital limit. The Council recorded it told Mrs Y it would complete a financial assessment to determine her contribution towards the cost of her care from day one, and Mrs Y agreed.
27. The Council approached private care providers on 8 April about a package of care for Mrs Y consisting of four calls a day. The calls were no longer double manned.
28. The Council telephoned Mrs Y on 9 April to ask if she was happy with the calls times offered. Mrs Y confirmed she was.
29. Mr X received a letter from the Council on 1 May stating Mrs Y was liable to pay the full cost of her care, backdated to 9 April.
30. Mr X cancelled Mrs Y’s care package on 12 May as she no longer required support.
31. Mr X complained to the Council about Mrs Y’s care charges on 12 May. He said the family were told on three occasions, including by Mrs Y’s social worker, that there would be a period of six weeks care that would be free before Mrs Y would need a financial assessment to determine whether she would have to pay anything. Mr X said Mrs Y received care since 9 April, and at no point did the Council say this was chargeable or how much it would cost. Mr X said if they had known it was chargeable they would have looked closer at whether Mrs Y needed the care, rather than focusing on her return home.
32. The Council responded to the complaint on 14 May. It said it visited Mrs Y on 2 April to discuss discharge, and she agreed to a financial assessment. It held a discharge planning meeting on 7 April and assessed Mrs Y needed four daily calls to enable safe discharge. It was agreed this would be sourced. Finances were discussed and the social worker said Mrs Y’s care would be chargeable from day one. It apologised if hospital staff gave incorrect information about six weeks free care.
33. Mr X said it was not true Mrs Y’s social worker told them payment would be due from day one. He asked the Council to check with the hospital staff member present at the meeting on 7 April. He said if the Council told him the care was chargeable, he would have asked how much it would cost.
34. The Council responded to Mr X’s complaint review request on 13 June. It said hospital staff were unable to confirm the content of the conversation on 7 April. It said it reminded the hospital to make its staff aware the Council does not automatically offer non-chargeable care services on discharge.
35. Mr X said the Council was missing the point. He asked it to send a copy of the written correspondence where it informed him or Mrs Y the cost of the care package or the start date of the contract where payment would have to be made. He also asked the Council to send correspondence where he or Mrs Y agreed to the charge and the start date of the contract to pay for Mrs Y’s care. He said it was not acceptable to backdate an invoice for an amount it never quoted or explained. He said people have a right to expect the Council to give accurate and relevant advice.
36. The Council sent its final complaint response on 1 July 2025. It said it cannot confirm how much a person will need to contribute unless it completes a financial assessment and it therefore does not share written correspondence until it confirms the outcome. It said it directed Mr X to its website on 16 April where he could complete an online assessment and see a leaflet explaining what Mrs Y should expect to pay. It also said it explained funding processes to Mr X and Mrs Y on 7 April.

My investigation

37. Mr X told me that, at a time Mrs Y was very ill, a doctor and a nurse said she needed care, but this would be free for six weeks. This was also confirmed by a social worker who came to discuss discharge.
38. Mr X said no one told the family Mrs Y’s care would be chargeable from day one. Mr X also said the Council did not send the family anything in writing about this, and did not say how much Mrs Y’s care would cost.
39. Mr X may have considered asking for Mrs Y to stay in hospital longer if he knew she had to pay for her care, as she was improving all the time. The family would not have rushed into a care package if they knew it was chargeable.
40. The Council told me it had verbal discussions with Mrs Y and her family about charging on 2 April and 7 April 2025. It recorded these discussions in Mrs Y’s case records. Mrs Y received five weeks of support before cancelling her care package as she was managing her needs independently.
41. The Council said it asked the reablement service to provide care consisting of four calls and day which needed to be double manned. This was not something the reablement team could facilitate when first contacted. The Council therefore requested a package of care, and said the family was aware of this.
42. However, by the time of Mrs Y’s discharge, the care she needed had reduced by half and she no longer needed a double manned package of care. The Council said it should therefore have contacted the reablement service again at that point to see if they had capacity. This did not happen, and the Council again requested a package of care. The Council also said there was no clear recorded evidence the distinction between the reablement service, and a sourced package of care and the associated costs was fully explained to Mrs Y and her family.
43. The Council said it is usual practice that, where the reablement service does not have capacity to meet all or part of a person’s needs, a non-chargeable bridging service is requested before offering a chargeable package of care. The Council should then revisit the reablement service when capacity becomes available. The Council said it should have explained this process more clearly to Mrs Y and her family.
44. The Council said it cannot confirm a written record of Mrs Y’s short-term assessment was provided to her or her family at the time. The Council has since strengthened practice in this area, and a copy of the short-term assessment is now handed directly to the individual or issued immediately following discharge.
45. The Council recognised and apologised for the fact it did not follow its advisory practice on this occasion. It offered to reimburse Mrs Y the full cost of her care for the period 9 April to 14 May 2025 to remedy the injustice.

Analysis

46. It was clear from Mrs Y’s hospital discharge plan that it was envisaged she would have some form of intermediate care or reablement support at home before being referred for a long-term package of care. This is also clear from the fact the Council sent a request for support to the reablement service on 2 April 2025.
47. When the reablement service told the Council it had no availability for the support Mrs Y needed, the Council approached private care providers. I have not seen evidence the Council told Mrs Y or her family that it had tried to source reablement care and been unsuccessful. That was fault.
48. According to the Council, it should then have looked at non-chargeable bridging services. It did not do so. That was also fault.
49. By the time Mrs Y was ready for discharge, she had made progress in her rehabilitation and no longer needed double manned care. The Council recognised it should have contacted the reablement service again at that point to see if it had availability. It did not do so, which was fault.
50. Overall, I found the Council failed to follow its procedures for sourcing reablement support on discharge from hospital. It also failed to provide proper advice to Mrs Y and her family in line with the statutory guidance.
51. The Council offered to reimburse the full cost of Mrs Y’s care. I consider this to be a suitable remedy for Mrs Y’s injustice.
52. And while I acknowledge the Council was open in response to my investigation, and accepted it did not follow its procedure, the Council should have identified this when it investigated Mr X’s complaint. Mr X was therefore put to avoidable time and trouble having to complain to the Ombudsman.

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Agreed Action

53. Within four weeks of my final decision, the Council agreed to:
• Apologise to Mrs Y for failing to follow its procedures on sourcing reablement care, and for the impact this had on Mrs Y.
• Reimburse the full cost of Mrs Y’s care.
• Pay Mr X £100 to recognise the avoidable time and trouble he was put to in bringing his complaint to the Ombudsman.
54. Within eight weeks of my final decision, the Council agreed to provide refresher training to staff in its Adult Social Care service about the Council’s procedures on hospital discharge and reablement care.
55. The Council should provide us with evidence it has complied with the above actions.

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Investigator's decision on behalf of the Ombudsman