Summary: The Council was at fault for billing Mr P care following a period of intermediate care which is free of cost up to a period of six weeks. This is because the Council delayed in conducting a financial assessment to determine what relevant costs Mr P would need to contribute for the additional care beyond the intermediate care. Further, the Council failed to specify what costs, if any, would be involved prior to the financial assessment. This caused Mr P to incur unexpected charges and so the Council has agreed to waive these.

The complaint

1. The complainant, who I refer to as Mrs D, is making a complaint for her father, who I refer to as Mr P. Mrs D is complaining about Mr P being billed for unexpected care costs for home care arranged by the Council.
2. Mrs D says the Council did not specify there would be a cost payable for the care. Also, she told me that it delayed in conducting a financial assessment to decide what the cost of home care would be for Mr P.
3. Mrs D is of the view the amount billed by the Council is without merit and should be waived in full.

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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).

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How I considered this complaint

5. I have reviewed Mrs D’s complaint to the Ombudsman and Council. I have also had regard to the response of the Council, including supporting documents and guidance. Both Mrs D and the Council received an opportunity to comment on a draft of my decision before I reached a final view.

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What I found

Background

6. Any local authority must assess a person’s financial resources to decide whether they should pay for their own care needs. The legal framework for charging is set out in sections 14 and 17 of the Care Act 2014.
7. The local authority must not charge for certain types of care and support which must be arranged free. This includes intermediate care which must be provided free of charge for up to six weeks.
8. Paragraph 11.3 of the Care and Support Statutory Guidance 2014 says –

“The personal budget is the mechanism that, in conjunction with the care and support plan, or support plan, enables the person, and their advocate if they have one, to exercise greater choice and take control over how their care and support needs are met. It means:

knowing, before care and support planning begins, an estimate of how much money will be available to meet a person’s assessed needs and, with the final personal budget, having clear information about the total amount of the budget, including proportion the local authority will pay, and what amount (if any) the person will pay".

What happened

9. In March 2020, Mr P returned home following a period in hospital. To provide continued support for Mr P, the Council arranged for him to receive home care. This was intermediate and so was free up-to six weeks.
10. On 8 April 2020, the Council told Mr P that it would need to complete a financial assessment. This was to decide what contribution Mr P would need to make for any care after the intermediate care ended. There is no record the Council gave him any indication of what the care might cost if Mr P had to pay for it. On 18 April, the free intermediate care ended.
11. In mid-May Mrs P asked for the Council to provide increased support. This was agreed, but there is no record Mr or Mrs P were told what the care might cost if they had to pay for it.
12. In May 2020, the Council completed a financial assessment and decided that Mr P would need to contribute to the cost of any care beyond intermediate care. The Council has not said when it sent Mr P the financial assessment. On 8 June 2020 Mrs P’s wife asked for a copy of the financial assessment to be sent to her, as because Mr P was in the habit of destroying post. The Council did this.
13. Having now received the assessment and knowing what contribution was required to pay for the additional care, Mrs P contacted the Council on 8 June and asked for the care to end. The Council said cancellation was subject to a three-day notice period. The care ended on 11 June. The Council subsequently billed Mr P for the cost of care from 19 April to 11 June.
14. In July 2020, Mrs D, Mr P’s daughter, complained to the Council. She felt the Council should have completed the financial assessment before the free intermediate care ended. Further, Mrs D said the Council was wrong to insist on a three-day notice period for the cancellation of care. This is because she said this implied a contract for the extra care for which, in her view, there was none.
15. In August 2020, the Council issued its final response to Mrs D. It said it had no record of Mr P being told the care beyond the point of intermediate care would be free of charge. It accepted fault with respect to a delay in completing a financial assessment and for not specifying the costs of additional care. The Council also said it would raise the matter of the three-day notice period internally. However, the Council upheld its decision to bill for the cost of care.

My findings

16. The Council has accepted fault for a delay in completing the financial assessment after the free intermediate care ended. Also, the Council said that it did not specify the cost of any care Mr P would incur beyond the date of intermediate care. This is also fault, as the Council was not following the statutory guidance.
17. I have not seen any evidence Mr P could make an informed decision, before the free care ended, whether he wished to continue to receive care. On that basis, the delay in completing a financial assessment led to confusion for Mr P and costs which could not have been predicted.
18. Mr P never received a written agreement which gives him notice of the terms. As there was no formal agreement between Mr P and the Council, I do not consider Mr P was bound by any terms or conditions to make payment for care beyond the date of intermediate care. On this basis, I do not consider the Council was entitled to reply upon a three-day notice period for the cancellation of the care.
19. For the above reasons, I consider the Council was at fault and this resulted in an unexpected bill to Mr P which he could not have reasonably anticipated. This caused Mr P an injustice.

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Agreed action

20. To remedy the injustice identified above, the Council has agreed, within one month of this final decision, to do the following:

• Waive the full sum billed for care provided between 19 April and 11 June 2020 and apologise to Mr P for its faults.
• Review its practices as regards to the reliance on a three-day notice period for the cancellation of care in the absence of any expressed agreement for the provision of that care.
• Ensure people are given an indication of what their care may cost as soon as possible, and ideally before they begin receiving it.

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Final decision

21. The Council was at fault for billing for care following a period of intermediate care. This is because the Council delayed in conducting a financial assessment to decide what relevant costs Mr P would need to contribute for the extra care beyond the intermediate care. Further, the Council failed to specify what costs, if any, would be involved prior to the financial assessment. This caused Mr P to incur unjustified charges and so the Council has agreed to waive these.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman