Summary: There is fault in the Council’s decision not to cover the full cost of Mrs B’s respite care. There is also fault in how the Council communicated with Mr B regarding this, and how it responded to his complaint. The Council’s shortcomings caused Mr B frustration and put him to time and trouble trying to resolve the issues. The Council has agreed to my recommended remedy.

The complaint

1. Mr B complains that the Council has failed to make sufficient direct payments to cover the cost of his wife’s respite care.
2. Mr B has tried to resolve this with the Council but it did not always respond to his contact and took too long to respond to his formal complaint.
3. This has caused Mr B frustration, and put him to time and trouble trying to resolve the issues. It is not clear to him whether he has been paying for care that should have been covered by the Council’s direct payments.

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The Ombudsman’s role and powers

4. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. 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(i), as amended)

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How I considered this complaint

6. I considered the information provided by Mr B. I considered the information provided by the Council including its file documents. Both parties had the opportunity to comment on a draft of this statement. I took account of all comments received before issuing this final decision.

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What I found

What happened

7. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. Mr B cares for his wife, Mrs B at home. The Council has arranged direct payments for respite care. Mrs B goes to a day centre twice per week. This cost £55 but the Council only paid £50 for the respite care and Mr B had to pay the deficit of £10 weekly. The day centre increased its fees in March 2023 and the Council considered an increase in the direct payment.
8. Mr B raised the deficit with the Council via numerous telephone calls. He says he left messages for the Council to call him back. He understood that the difference in payment was because he had to take his wife early to the day centre and so she was there for slightly longer than originally planned.
9. The Council has explained to me that Mr B’s concerns that the direct payments were not covering the cost of the day centre, would be for the social work team to answer and not the direct payments team. The Council’s records show that Mr B called it and that it asked the social work team to call Mr B about the shortfall. The Council has acknowledged that it should have explained this to Mr B.
10. Mr B complained to the Council on 11 April about how the Council was managing the direct payments and that the Council had not responded to his telephone calls about this. The Council responded on 27 June. It told Mr B that it had to manage the payments this way. It did not explain why the direct payment did not cover the full cost of the respite care.
11. As a result of my investigation, the Council initially told me that it does not pay the full amount because £5 per visit is for a meal and this is not covered by direct payments. However, it has now established that the difference is as Mr B had been telling the Council: it is due to his wife arriving earlier at the day centre because they arrange their own transport.
12. The Council has agreed to submit the case for additional funding to its panel in accordance with its normal processes.

Analysis

13. There is fault in how the Council’s decided not to cover the full cost of the care home. This is because, despite information from Mr B, it had decided not to cover the full cost based on a misunderstanding.
14. There is also fault in how the Council dealt with Mr B’s enquiries about this. The Council did not fully investigate why the full cost was not covered. Had it investigated this properly, it might have resolved the issue sooner.
15. Mr B says he left numerous voice messages, that were not responded to. I have no reason to disbelieve him and it is part of his complaint to the Council made in April. I cannot establish that these messages were recorded, or for which team. There is no way to record a voice mail on the main contact line, but the caller can select options to be transferred to a team.
16. However, the Council cannot show that it properly explained to him that his concerns should be addressed by the social work team. The Council has explained that it took too long to respond to his complaint due to annual leave and an administrative oversight. And so in terms of the Council’s response to Mr B’s concerns, it did not investigate the issue sufficiently, communicate with Mr B properly, or deal with his complaint in good time.
17. The Council’s shortcomings have caused Mr B frustration, and put him to time and trouble trying to resolve the issues. It is not clear to him whether he has been paying for care that should have been covered by the direct payments.

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Agreed action

18. The Council has agreed to review the level of funding and submit this to the funding panel.
19. The Council will also within one month of the date of this decision:
• Submit the additional funding request to the panel and let Mr B and the Ombudsman know the outcome of the panel decision;
• If the Council agrees to cover the additional funding, it should backdate this to when it was first requested;
• apologise to Mr B for the delay and problems with communication; and
• make a symbolic payment to Mr B of £200 in recognition of the time and trouble he was put to in pursuing this matter.
20. The Council should provide us with evidence it has complied with the above actions.

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Final decision

21. I have completed my investigation. There is fault by the Council causing Mr B injustice.

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Investigator's decision on behalf of the Ombudsman