Summary: Mr X complains the Council has increased the rate it pays to the care home where his wife lives by 2%, while other care homes receive a 5% uplift. Mr X complains this is unfair and means he now has to pay a larger top up for Mrs X’s care, which is unsustainable. We ended the investigation as we cannot achieve a worthwhile outcome for Mr X. We cannot achieve the remedy he wants.

The complaint

1. Mr X complains the Council has increased the rate it pays to the care home where his wife lives by 2%, while other care homes receive a 5% uplift. Mr X complains this is unfair and means he now has to pay a larger top up for Mrs X’s care, which is unsustainable. Mr X also complains the Council has suggested Mrs X move to another care home. He considers a move would lead to risks to Mrs X’s wellbeing and even her life expectancy.

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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:

• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is no worthwhile outcome achievable by our investigation.

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

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How I considered this complaint

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

5. Mrs X has dementia and has lived in a care home for over five years. The Council commissions Mrs X’s care. Mrs X pays a charge towards the cost of her care and Mr X pays a top up.
6. In May 2024 the Council introduced a Care Home Framework and a new long- term residential and nursing contract, and invited care homes to sign up. 
7. The Council continues to assess the annual uplift of rates it pays to care homes that have not signed up to the Care Home Framework as it had done in previous years. However the uplift for homes that have signed up is calculated based on a different formula set out in their contractual terms.
8. For the year 2025/2026 the Council assessed a 2% increase for care homes that had not signed up to the Care Home Framework. The Council assessed the uplift for care homes that had signed up to the Care Home Framework at 5%.
9. Mrs X’s care home has not signed up to the Care Home Framework so received the 2% uplift. Mr X complained this has led to an increase in the top up he now has to pay and asked the Council to pay a 5% uplift.
10. The Council told Mr X the care home had chosen not to sign up to the Care Home Framework and said the 2% increase was a fixed rate and would not be changed. It acknowledged this put Mr X at a disadvantage and that the increased costs of the placement would be very difficult to manage.
11. The Council told Mr X that if he was no longer able to pay the top up it could look at offering alternative placements where a top up is not needed. To do this it would need to assess Mrs X and complete a risk assessment.
12. Mr X questioned the suggestion to move Mrs X despite evidence that this would be detrimental to her wellbeing. Mr X considers the Council’s actions are unfair and penalise those who are already resident at a home that has not signed up to the Care Home Framework. He has asked the Ombudsman to investigate his concerns.

Analysis

13. The fundamental issues here are the contractual arrangement between the Council and Mrs X’s care home and the commercial decisions of the care home to pass on increased cost to Mr X. These are not issues we can resolve. It is not the Ombudsman’s role to determine the rates a council will pay care homes in its area, or how this will be calculated.
14. We cannot achieve the outcome Mr X wants.
15. If Mr X is unable to continue to pay the top up fees the Council should reassess Mrs X and the risks involved in moving her to an alternative home. This would include any detrimental impact a move may have on her physical and mental wellbeing.

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Decision

16. We ended our investigation as we cannot achieve a worthwhile outcome from further investigation. We are unable to achieve the remedy Mr X wants.

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Investigator's decision on behalf of the Ombudsman