Summary: Ms X complains on behalf of her cousin, Mr Y that the Council failed to provide a breakdown of outstanding charges for his care. We have found fault by the Council in the way it responded to Ms X’s request for information about the charges. We have also found fault with the Council’s complaint handling. The Council has agreed to apologise, review Mr Y’s support package, make a symbolic payment and service improvements to remedy the injustice caused.

The complaint

1. Ms X complains on behalf of her cousin, Mr Y. She says the Council has failed to provide a breakdown of charges for the balance of £55,556.60 for his care and support.
2. Ms X has paid this invoice however she still does not know whether these charges were correct and should have been paid. This has caused Ms X stress, uncertainty and unnecessary time and trouble.

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The Ombudsman’s role and powers

3. 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)
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 discussed the complaint with Ms X and considered the information she provided. I made enquiries of the Council and considered the information it provided.
6. Ms X and the Council had the opportunity to comment on my draft decision. I considered all comments before reaching a final decision.

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What I found

The relevant law and statutory guidance

7. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved.
8. The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget. This is the money the council has worked out it will cost to arrange the necessary care and support for that person.
9. There are three main ways in which a personal budget can be administered:
• As a managed account held by the local authority with support provided in line with the person’s wishes;
• As a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; and
• As a direct payment. (Care and Support Statutory Guidance 2014).
10. ISF refers to an arrangement where the service provider works with the person to provide flexible support. The Council gives the personal budget directly to the service provider. The funds must be spent on meeting personal outcomes set out in a person’s care and support plan, for example:

• community activities, joining local groups, staying healthy, hobbies, following interests;
• support to get out and about to see friends or family;
• short breaks or replacement care;
• purchasing services from an agency;
• equipment; and
• training.

11. Where a person lacks capacity to make decisions themselves, the court can appoint a deputy to make decisions on their behalf.

What happened

12. Mr Y has down syndrome and lives in supported living accommodation. Mr Y’s cousin, Ms X, is one of three court appointed Deputies for his property and financial affairs.
13. Prior to 2019, Mr X was not making a financial contribution towards his care as his assets fell below the threshold of £23,250.00. Following the sale of a property in January 2019, Mr X was assessed as a self-funder and therefore responsible for paying for the full cost of his care.
14. In August 2021, Ms X complained to the Council. Ms X explained that Mr Y was a self-funder, lived in supported living accommodation (Accommodation A) and Company B was responsible for the management, day to day running and care of residents. Mr Y had received an invoice from the Council for £4,840 per month for services provided by Company A. Ms X said Mr Y also paid £1274.78 in rent. Ms X said she had no further information on the breakdown of these costs or what Mr Y was paying for. Ms X also said that Mr Y’s hours of care were reduced in May 2021 however the bills remained the same.
15. On 19 October, the Council responded to Ms X’s complaint and apologised for the delay. The Council confirmed the service was recommissioned in May 2021 and a review and reassessment of Mr Y’s care and support needs was completed in June 2021. The Council acknowledged, the costs of the placement had changed, and the amount of support hours Mr Y received had also reduced. The Council said it had identified that the charges that Mr Y had been invoiced for were inaccurate as there were discrepancies on the system.
16. On 5 July 2022, the Council registered a new stage one complaint on behalf of Ms X, because its initial response had been inadequate.
17. On 2 August the Council responded to Ms X at stage one of its complaints procedure. The Council said that Accommodation A was a service commissioned by the Council and run by Company B. In May 2021, the Council completed a new tendering exercise which resulted in costs being split into core hours which was divided into two rates depending on the needs of each tenant. Mr X was charged at the lower rate at Accommodation A of £652.36 per week. The Council provided details of the support that was included in the core costs. Mr Y needed extra support in addition to the core hours and an ISF was calculated accordingly. The extra ISF costs were based on the additional hours Mr Y needed.
18. The Council said the review of Mr Y’s needs had resulted in minor changes to his weekly core hours and ISF hours as follows:

• 3 May 2021 to 5 September 2021: core costs £649.29 and ISF £211.90. Total cost to Mr Y was £861.19;
• 6 September 2021 to 1 November 2021: core costs £652.36 and ISF £211.90. Total cost to Mr Y was £864.26;
• 1 November 2021 to 6 February 2022: core costs £652.36 and ISF £301.88. Total cost to Mr Y was £954.24; and
• 7 February to present date: core costs £652.36 and ISF £301.88. Total cost to Mr Y was £954.24. The ISF payment of £301.88 per week was for Mr Y to meet his assessed need for 17.25 hours of 1:1 support.

19. Ms X says the ISF payments are set at four 1:1 hours per day regardless of whether Mr Y uses them or not.
20. The Council explained the re-tender exercise had resulted in a saving for Mr Y as prior to May 2021 he was paying £1,210 per week. However, due to technical problems the reduced costs were not passed on to Mr Y at the time. The Council said this had been rectified and going forward Mr Y’s charges should be calculated on the correct amounts of the service costs. The Council said the finance team would recalculate the costs and inform Ms X of the outcome. The Council upheld Ms X’s complaint on the following basis:

• Ms X had been asking for clarity about Mr Y’s costs since August 2019;
• The Council had not resolved her query and concerns in a timely manner; and
• This had prevented Ms X from being able to pay the correct amount for Mr Y’s cost/charges as necessary.

21. Ms X remained dissatisfied, and the Council responded to Ms X’s questions as follows:

• Ms X asked how the cost of £1,210 per week was calculated. She said Company B said the fees it billed to the Council were several hundred pounds less weekly than the fee Mr Y was charged. The Council said the cost of £1,210 was a standard cost for core support. It said the invoice from the provider determined the costs the Council would pay therefore there should be no variation between the costs invoiced and the cost paid.
• Ms X asked about the costs from May 2021 based on the service user’s needs and how these were broken down. The Council explained Mr Y’s core costs at Accommodation A were £652.36. This rate was for tenants who were supported to live more independent lives. Mr Y was supported by Accommodation A from 8:00 a.m. to 9:00 pm. Mr Y also received two nights of waking support of eleven hours for each night. The waking night support were part of the core support costs which were shared between the residents. The Council provided a breakdown of support provided by Accommodation A.
• Ms X asked how much Mr Y had been overcharged. The Council said it had reviewed Mr Y’s support plan and it was not clear that he had been overcharged. The Council said its finance team would carry out a review and calculate the costs charged to Mr Y.

22. On 14 March 2023, the Council wrote to Ms X. The Council said the support plan and charges billed were for the core hours Mr Y received as part of his placement costs. The outstanding balance for these core hours was £55,556.60. The Council provided a copy of Mr Y’s account which included the assessed contributions and payments made since January 2019. The Council said it would ensure all future invoices included a breakdown of the weekly costs for the core hours and Mr Y’s chargeable contribution.
23. The Council said there was also a separate agreement for one-to-one support hours at Company B paid for via Mr Y’s ISF. The Council explained that Company B would continue to bill Mr Y separately for this. The Council offered to pay Ms X £250 in recognition of service failure and the distress and time and trouble caused. Ms X declined the payment.

Analysis

24. The Council said the invoice from the provider determined the costs the Council would pay therefore there should be no variation between the costs invoiced and the cost paid. As Mr Y pays the full cost of his care the Council’s invoices should reflect the amounts charged by the care provider for the core costs. However, the Council has not provided Ms X with a copy of the invoices it received from the provider and its breakdown of charges does not provide this information either. The breakdown of charges only provides details of the charging period, weekly rate and the total costs. Some of the periods have a different weekly charge and the Council has not explained the reason for these discrepancies. Furthermore, whilst the Council completed a review of the charges, Ms X says she has not received a copy of the review with evidenced calculations.
25. I appreciate the core hours are shared hours with other residents at Accommodation A, but the lack of information provided by the Council is fault. I understand Ms X has now paid the invoice of £55,556.60 but she did so with uncertainty as she could not determine whether the Council’s invoice was correct based on what she was told by Accommodation A. The Council should establish if the charges are correct and ensure that such a large debt is not allowed to accrue again.
26. I have also considered the Council’s handling of Ms X’s complaint. Ms X first approached the Council in August 2019. It took the Council 19 months to fully respond to Ms X’s complaint and request for information. This is a considerable delay and has caused Ms X frustration and time and trouble pursuing matters with the Council. I am also concerned about the quality of the Council’s complaint response as Mr Y is referred to as Ms X’s brother in the stage one response and then as her husband in the stage two response. This is fault and would have added to Ms X’s frustration about the Council’ handling of her complaint. I acknowledge the Council offered to pay Ms X £250 for the injustice caused. I have made an additional recommendation below.
27. The Council told Ms X that it could only comment on the core hours not the 1:1 hours funded through an ISF. The ISF hours are a private arrangement between Mr Y and Company B and no financial contribution for this would have been collected via the Council. I understand that Company B has attempted to liaise directly with Ms X about these payments. I do not find fault by the Council here. The Council has offered to approach Company B on behalf of Ms X and request a breakdown of hours, activities and rates of pay set up for Mr Y under the ISF. Ms X will need to provide consent to Company B so that it can share this information with the Council.

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Agreed action

28. The Ombudsman’s guidance on remedies recommends a remedy payment for distress of up to £500. In cases where the distress is severe or prolonged, we may recommend more.
29. Within one month of my final decision the Council will:
1. apologise to Ms X for the faults identified in this statement;
2. pay Ms X £400 for the injustice in the form of distress and uncertainty caused by the faults identified in this statement;
3. ensure invoices are issued in a timely manner so that such a large debt is not allowed to accrue again.
4. The Council should arrange for an urgent review of Mr Y’s whole support package including his needs and ensure all parties moving forward are clear on their accountabilities, which includes the costs of care and how they will be invoiced. If the review establishes any discrepancies in the way the invoice of £55,556.60 has been calculated, the Council should take appropriate action to review the invoice and write to Ms X with the outcome.
30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. I have found fault by the Council causing and injustice to Mr Y and Ms X. I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman