Summary: Ms B complained that the Council was seeking to recover contributions towards the cost of her late mother’s (Mrs C’s) care costs, which Ms B believes she does not owe. She also complained the Council had failed to explain why the balance is outstanding and why it had discounted evidence provided by Ms B. We found fault with the actions of the Council. The Council has agreed to apologise to Ms B, confirm the money is not owed, pay her £250 and improve its complaint-handling procedures.

The complaint

1. Ms B complained that Worcestershire County Council (the Council) is seeking to recover contributions towards the cost of her late mother’s (Mrs C’s) care costs, which Ms B believes she does not owe. The Council has failed to adequately explain why the balance is outstanding and refused to meet with the family to explain the situation and answer their questions. This has caused Ms B and the family significant distress, frustration and time and trouble.

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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(i), as amended)

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How I considered this complaint

4. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Ms B 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

5. Ms B’s mother, Mrs C required care. In November 2020 Mrs C started to receive care from a Care Provider and the Council referred the case to the direct payments team to work out Mrs C’s eligibility. In December 2020 the Council sent a financial assessment form to Ms B, which she returned in January 2021. Ms B and Mrs C signed a direct payment agreement in February 2021. This outlined the amount of the direct payment and the requirement for Mrs C to pay her client contribution separately. Mrs C and her family also agreed to make a top-up payment as the care was more expensive than the direct payments.
6. On 16 March 2021 the Council informed Mrs C that her contribution to the care would be almost £100 per week. On 23 March 2021 the Council made the first payment into the direct payments bank account for the direct payments due since the care started in November 2020.
7. On 8 April 2021 the Council informed Mrs C of her client contributions owing since November 2020 and the ongoing amount.
8. In June 2021 the family arranged a live-in carer for Mrs C as she did not wish to go into a residential care home.
9. In August 2021 the Council sent Ms B a new direct payment card as the other one had been lost and she had not been able to make payments into or out of the account. The Council transferred the direct payments since April 2021 into the new account.
10. In September 2021 Ms B started to make payments into the account including Mrs C’s contribution. The Council increased the direct payments for Mrs C’s increased care needs and backdated the payments to June 2021.
11. Ms B has provided evidence that since November 2020 Mrs C and her family had been paying the full care charges directly to the Care Provider.
12. Mrs C died in 2022.
13. In September 2022 the Council sent an invoice to Ms B for an overpayment of direct payments for a period after Mrs C died and unpaid client contributions of £4434 for the period from November 2020 to September 2021.
14. Ms B queried the invoice in November 2022, but the Council did not respond.
15. In February 2023 Ms B complained to the Council that Mrs C had already paid the client contribution directly to the Care Provider.
16. In April 2023 Ms B provided to the Council, copies of bank statements from Mrs C’s account and other family members showing payments made directly to the Care Provider, the invoices from the Care Provider confirming the payments received. The Care Provider did not consider any money was outstanding and confirmed that all its invoices had been paid in full.
17. The Council responded in May 2023. It apologised for the failure to respond to Ms B’s email in November 2022. But it said Mrs C had not paid the client contribution into the direct payments bank account until September 2021. The Council said the money Mrs C and the family paid to the Care Provider was for top-ups and extra care outside the direct-payment funded package. It did not give any evidence for this conclusion or refer to the financial information Ms B had provided. It confirmed the invoice was correct.
18. Ms B complained to us. She said she had offered to meet with the Council to explain what had happened, but the Council had refused.
19. After making three rounds of enquiries to the Council, it finally accepted that if Ms B and Mrs C had paid the full care charges between November 2020 and September 2021 and provided proof via bank statements, then the Council would accept that no client contribution was owed. Ms B says she cannot get hold of Mrs C’s bank statements as the account was closed some time ago. She provided an email from the Care Provider confirming that it had gone through its bank statements and recorded all payments received from or on behalf of Mrs C. There were no charges outstanding.

Analysis

20. Ms B provided the Council with evidence (including bank statements and confirmation from the Care Provider) that she, Mrs C and other family members paid the full care charges (including the client contribution) directly to the Care Provider between November 2020 and September 2021. Without any explanation or reasoning, the Council discounted this evidence and insisted that the client contribution remained unpaid because it was not paid into the direct payment account.
21. It has stuck to this view since May 2023 and repeated it to me on two more occasions without providing any evidence to explain why the amounts paid by Ms B and Mrs C were only for top-ups and extra care. This was fault.
22. I appreciate it has finally accepted that Ms B’s position could be correct but only if she provides more evidence in the form of bank statements. I consider this request is unreasonable because Ms B provided this evidence to the Council in April 2023, and I do not consider she should have to provide it again.
23. The Council did not make any payments to the Care Provider and so there is no debt owing to it for the client contribution.
24. This fault has caused Ms B significant distress and inconvenience over a prolonged period at a very difficult time after her mother died.

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Agreed action

25. In recognition of the injustice caused to Ms B, I recommended the Council within one month of the date of my final decision:
• apologises to Ms B, confirms the debt of £4434 is not owed and pays her £250.
26. I also recommended that within three months the Council reviews its complaints procedure to ensure that when a complainant has provided evidence to support their complaint, the Council properly considers that evidence in conjunction with its own records. Furthermore if it intends to discount the complainant’s evidence it should provide full reasons for that decision with reference to its own records where appropriate.
27. The Council has agreed to my recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

28. I consider this is a proportionate way of putting right the injustice caused to Ms B and I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman