Summary: Mrs X complained about how the Council calculated her daughter’s care contributions. There was no fault with the Council’s approach other than its failure to properly communicate changes to its policy. This did not cause Mrs X or her daughter an injustice.

The complaint

1. Ms X complains on behalf of her daughter, Miss Y.
2. She complains the Council is charging Miss Y too much towards her care contributions. She says:
• Miss Y’s Disability Related Expenditure (DRE) is incorrect.
• Miss Y must pay for activities at a day centre that she does not want to do.
• The Council will not pay for carers to take Miss Y on holiday.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I have considered Ms X’s complaint and have spoken to her about it.,
6. I have also considered the Council’s response to Ms X and to my enquiries.
7. Ms 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

The law

Care and Support Statutory Guidance

8. If a person requires care and support, the Council will carry out a financial assessment to work out how much financial assistance a person qualifies for. The Care and Support statutory guidance sets out how the Council should consider information such as a person’s welfare benefits, pension, bank statements, investments, property and land, Disability-related expenses (DRE). The Council’s guidance says that if a person wants their DRE to be considered in their application for assistance, they must provide the last four weeks’ worth of any bills or receipts which detail these additional costs.

National Association of Financial Assessment Officers (NAFAO) guidance

9. This sets out a nationally recognised guide to Disability Related Expenditure (DRE). It identifies what aspects of income/expenditure should be considered when calculating DRE. The guide calculations factor in a range of ages, living arrangements, and personal circumstances when looking at the associated costs of living with a disability.

Disability-related expenses (DRE)

10. The Care Act statutory guidance says the council must leave a person with enough money “to pay for necessary disability-related expenditure to meets any needs which are not being met by the local authority”. DRE are costs that arise from a disability or long-term health condition.
11. The Council will take into account any reasonable DRE unless these are already funded in the person’s care and support plan, or they are funded by other government agencies (e.g. NHS).
12. The Council’s guidance outlines what kind of costs might be considered DRE. It explains there is no complete list and each person’s DREs are considered on an individual basis. It also highlights that anything a person pays for by choice is not a DRE. Any cost a person would be likely to have incurred anyway (even if they were not disabled or frail) must be met by their cost of living allowance.
13. Not all costs will be considered eligible. For example, if a person chooses to buy items/services when there is a cheaper alternative that meets the need.

Holiday expenses

14. Pre-2020 when there was no clear legislation on considering holiday expenses, the Council’s financial assessment included DRE for these types of expenses.
15. In 2020, the Council reviewed the process and determined that holiday expenses should be considered as an eligible need rather than as an expense in the financial assessment.
16. Since 2020, the Council advises service users that an assessment would be required for an eligible need for holiday expenses. Should there be an eligible need, the Council would set up a one off direct payment to help cover the cost. The Council says this is a more transparent way of dealing with these costs as would be hard to consider these costs as a weekly expense when they are ad-hoc and difficult to accurately assess on a rolling basis.
17. The Council said that unfortunately, it was not able to identify all service users of the change in policy, as the Council’s financial assessments do not breakdown the Disability Related Expenses by individual type.
18. The Council is currently reviewing the feasibility for the system to break down the costs to make these cases easier to identify in the future.

What happened

19. Miss Y is disabled. She lives in supported accommodation and receives home care and support from carers on a daily basis. She also attends a day centre where she participates in various activities.

Financial assessments and DRE

20. Between March 2022 and April 2023, the Council introduced two annual uplifts (in line with inflation) and carried out three financial assessments for Miss Y. The main factors which affected this amount were Miss Y’s Universal Credit amount and her Employment and Support Allowance. These both increased over the period.
21. Mrs X disagreed with the Council’s calculation for DRE in Miss Y’s financial assessment. Mrs X said that due to her daughter’s disability, she needs to wash her clothes and bedding more often, needs extra toiletries due to the number of showers she takes and needs extra cleaning products to keep her property clean.
22. The Council said that it calculated the amount for excessive laundry in line with the NAFAO guidance. Miss Y’s latest financial assessment showed an allowance of £4.56 per week. This is the standard amount set out in the Council’s policy and in the NAFAO guidance.
23. The Council considered the average costs for toiletries and cleaning products based on Office of National Statistics data. It said it then considered whether Miss Y’s excessive costs were due to necessity or choice of a particular brand. It said that Miss Y had offered no reason why she needed particular brands. The Council decided that Miss Y could buy cost effective alternatives.
24. The Council was not satisfied that the costs Miss Y incurred for toiletries and cleaning products were excessive in comparison to the average household. It therefore decided that neither should be allowed as a disability-related expense.

Day centre activities

25. Mrs X said that the activities available to Miss Y are relatively expensive and not something her daughter would usually choose to do. However, she participates because the other option is to stay at the day centre. If she doesn’t want to do any group activities, she would need 1-2-1 care to support her with the activities she wants to do.
26. Miss Y has two day service providers. The Council said that all activities are optional but Miss Y chooses to participate. The Council said that Miss X knows her own mind and is good at choosing what she does and does not want to do. The Council said that there are always no-cost options available which sometimes Miss Y chooses.
27. The Council explained that it does not contact carers weekly or monthly to update regarding timetables and activity participation. They discuss it at annual reviews or if a carer specifically asks about it.

Holiday expenses

28. Miss Y took two holidays in 2022 and Mrs X requested that the Council included the care expenses for these holidays as DRE in Miss Y’s October 2022 financial assessment.
29. The Council said it decided to make an allowance when it completed Miss Y’s most recent financial assessment (October 2022). This was because Miss Y had already taken the holidays. The Council informed Mrs X that, no further allowances will not be made in Miss Y’s financial assessment for the cost of supported holidays or trips.
30. The Council said that such costs will not be considered going forward and would need to be met by a direct payment if they are deemed to be and essential need under the Care Act 2014. The Council said that Mrs X would have to consider on behalf of Miss Y whether or not the cost of supported holidays and trips are affordable if not met by Adult Social Care with a direct payment.
31. The Council said the allowance made in Miss Y’s financial assessment in 2022 will be removed next year when a review of Miss Y’s financial assistance is undertaken.
32. Miss Y’s financial assessment from April 2023 shows the same amount for Supported Holiday Care Costs as the previous two financial assessments. The Council explained this is because the allowances from October 2022 are for a period of 52 weeks to ensure Miss Y receives the full allowance for DRE.

My findings

Financial assessment and DRE

33. The Council carried out Miss X’s financial assessments in line with the Care and Support statutory guidance. It took account of changes to Miss X’s income, outgoings, and disregards. The Council followed the guidance on how to assess DRE. I am satisfied that it properly considered the alleged additional costs for laundry and toiletries. The Council decided to attach an allowance for laundry costs but not toiletries. This was the Council’s decision to make, and I am satisfied that it considered all the relevant information. I have found no fault here.

Day centre activities

34. The day centres, on behalf of the Council offer a range of voluntary activities. These are not compulsory nor overpriced. There are also alternative free activities available. The Council said that Miss Y willingly chooses to take part in a range of activities. There is no fault here.

Holiday expenses

35. The Council did not adequately communicate its change in policy for holiday expenses from DRE to eligible need direct payments. This was fault. However, the Council agreed to pay for Miss Y’s 2021 holidays as DRE (in her 2022 Financial Assessment) as it had failed to contact her about the change before she had taken the holidays. Therefore, Miss Y did not experience any injustice as a result of this fault.
36. There is no fault with the Council’s decision to change in its approach to holiday expenses. The new process is more transparent and need-specific.

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Final decision

37. I have completed my investigation. There was no fault with the Council’s assessment of Miss Y’s DRE, its provision of day centre activities or with the Council’s approach to holiday expenses. There was fault with how the Council communicated the changes to holiday expenses policy, but this did not cause Mrs X or Miss Y an injustice.

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Investigator's decision on behalf of the Ombudsman