Summary: There is no evidence of fault on the part of the Council in completing the financial assessment. Mrs X did not want a commissioned care package in place before the financial assessment was completed. Direct Payments could not have been put in place before the financial assessment was compete.

The complaint

1. Ms X (the complainant) complains on behalf of her mother and her late father about delays on the part of the Council in putting care in place for her late father Mr X.

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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 considered the information provided by Ms X and by the Council. I spoke to Ms X. Both parties had an opportunity to comment on a draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

5. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
6. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment.
7. In most circumstances, councils should complete financial assessments before they create care and support plans and before any care services begin. This means people can make informed decisions about the care and support they want, taking into account the financial impact. An exception is where someone appears to have urgent care needs: Under section 19(3) of the Care Act, councils can meet needs that appear to be urgent without having completed a needs assessment or financial assessment.
8. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the council must decide whether to provide a direct payment. In all cases, the council should consider the request as quickly as possible. The council must provide interim arrangements to meet care and support needs to cover the period in question.
9. In some circumstances direct payments can be used to pay family members (the Guidance says, “The direct payment is designed to be used flexibly and innovatively and there should be no unreasonable restriction placed on the use of the payment, as long as it is being used to meet eligible care and support needs.” (CSSG 12.35)

What happened

10. Mrs and Ms X cared for Mr X at home for some time. In February 2023 the Council was contacted on behalf of the family to say the family was paying for private carers and required a Care Act assessment of Mr X’s needs as soon as possible with a view to arranging a home care package.
11. A social worker carried out a needs assessment on 10 February. She asked the finance team to send out financial assessment forms to the family. She telephoned the family to explain they would receive the forms soon. Mrs X said she wanted to know the cost before any care package began.
12. The records show Ms X contacted the social worker at the beginning of March to say the forms were confusing. The social worker advised contacting the finance team for help with complaining the assessment. The records show Ms X then asked for new forms to be sent out. The social worker spoke to Ms X again on 31 March and advised her to ask for support with the forms if she needed it.
13. The community matron and Mr X’s GP were both in contact with the social worker over the next few weeks and expressed their concern that a care package should be put in place as soon as possible. The social worker explained they were still awaiting the financial assessment and Mrs X had clearly said that care should not start until they knew the costs.
14. The records show that the social worker explained to Ms X that the Council could put care in place before the financial assessment was complete, given Mr X’s deteriorating condition, and the family would then have to pay the cost of the care provided but Mrs X refused. Ms X then said they would like to keep the care agency they had in place and the social worker explained they would need to go through the Direct Payments process.
15. The social worker contacted the finance team in respect of the financial assessment at the beginning of May. The finance officer replied there were still outstanding items Ms X had not supplied. Ms X says the finance officer did not understand their particular circumstances and she felt the Council believed the family was trying to dissemble about the amount of money Mr X had. The community matron contacted the social worker and said the family now asked for care to be put in place as soon as possible and not await the outcome of the financial assessment.
16. On 22 May the social worker emailed Ms X and asked her to work with the finance team and provide the outstanding items requested as a matter of urgency. She said to safeguard Mr X she would put in place a package of care by 29 May whether or not the financial assessment was completed. She said “You and your mother will be responsible for supporting your father with paying the invoice that will be sent from Adult Social Care Services, as well as yourselves cancelling the care company that dad currently has now”

17. The package of care began on 16 June. There was some confusion over the number of calls required as Ms X said she wanted to support her father with the late evening care. Ms X then agreed to a late call from the care agency.
18. On 19 June Ms X emailed the social worker to say she was planning to keep on the existing carers as the new agency carers had not provided the care she expected. She emailed again on 20 June to say she had cancelled the commissioned care package. She said carers had not come at the right time and the agency had sent a male carer when a female carer was requested. The records show the social worker agreed it could take some time for a care package to settle but asked if Ms X had raised her concerns direct with the care agency.
19. The council sent the financial assessment outcome on 28 June.
20. The social worker began to contact agencies identified by Ms X with a view to providing care through Direct Payments. A meeting was arranged for 1 August to set up the Direct Payment. However, Ms X contacted the social worker on 17 July to say her father was now receiving palliative care and she did not think there was any point to the meeting. Mr X died on 19 July.
21. Ms X complained to the Council about the delays in setting up care and the care which was then provided. She complained the Council would not pay for the agency care she had chosen when the commissioned care package was cancelled. She had two informal meetings with officers.
22. The Council responded. The team manager wrote, “I am advised you appointed an alternative care agency whilst the Direct Payment set-up process was progressing, and it is for this care I understand you are seeking reimbursement. Unfortunately, we would not be able to pay for care which you sought privately, and our advice would have been to allow …. Care Agency/provider time to improve their service, or indeed to change care agency/provider until the Direct Payment set up had been completed”.
23. Ms X complained to the Ombudsman. She said they had been misinformed from the start of the process. She says Mrs X was told the financial assessment had to be completed before care began. She says in the end she just wanted the Council to repay Mrs X for the care she had paid for from the point the financial assessment had been completed, but the Council refused. She also says they should have been told at the start that they could have Direct Payments, and that she could have been paid to provide the care herself.
24. The Council says the delay in putting care in place between February and June was due to delays in completing the financial assessment and Mrs X’s assertion that she did not want to accept commissioned care with a commitment to paying until the outcome of the financial assessment was complete.

Analysis

25. The records show there was no delay on the part of the Council in completing the financial assessment. I can understand it was frustrating for Ms X to be asked for more documents at a time when her energy was devoted to helping her parents, but the evidence is that the finance team was trying to progress the assessment.
26. The records show that Mrs X did not want commissioned care to begin until the financial assessment was complete, but the Council was prepared to put care in place in view of Mr X’s urgent needs. There is no evidence the Council was at fault here.
27. Ms X cancelled the commissioned care package and put in place her own agency. That was her prerogative but there was no obligation for the Council to meet those costs. The Council essentially fast tracked the Direct Payment agreement in the event: it points out that the Direct Payment agreement date was sourced and agreed upon in less than 2 weeks.
28. The Council told Ms X in May that Direct Payments were possible and that the family would then manage the Direct Payments carers themselves. Mrs X confirmed a few days later that they wanted a commissioned care package. In any event, at that point the financial assessment was still not complete. It would not have been quicker to put Direct Payments in place then whether or not it was a care agency or Ms X who provided the care.

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Final decision

29. I have completed this investigation. I have not found any evidence of fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman