Summary: Mrs X complained about the Council’s delays and errors in calculating Mr X’s contribution towards his care home charges and in sending an unexpected invoice for substantial arrears. We found the Council’s significant delays in, and failure to advise Mrs X of, the financial assessment process are fault. This caused Mrs X unnecessary distress and concern and financial difficulties. To remedy this the Council has agreed to apologise, make a payment to Mrs X and agreed an affordable repayment plan.

The complaint

1. The complainant, Mrs X complained about the Council’s delays and errors in calculating Mr X’s contribution towards his care home charges and in sending an unexpected invoice for substantial arrears. This caused Mrs X unnecessary distress and concern as she was unable to pay the significant charges that had accrued.

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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)

How I considered this complaint

4. As part of the investigation, I have:
• considered the complaint and the documents provided by Mrs X;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with Mrs X; and
• Mrs 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

Charging for permanent residential care

5. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
6. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
7. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit must pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.

What happened here

8. Mr X was discharged from hospital to residential care in August 2020, where Mrs X says his care was partly funded by the NHS. Mr X then moved to his current care home in March 2021.
9. The Council’s social care team referred Mr X for a financial assessment in March 2021. Pending the financial assessment the Council asked Mr X to pay a provisional weekly charge of £156.95 towards the cost of his care at the care home. There is no record the Council completed a financial assessment in 2021.
10. Mrs X says she was not given any information about the financial assessment procedure and did not discuss the charges with anyone at the Council. She continued to pay what she assumed were the correct charges for Mr X’s care.
11. The Council contacted Mrs X in late August 2022 to request details of Mr X’s finances to complete the financial assessment. Mrs X questioned the need for a financial assessment as Mr X had been paying a contribution since August 2020. Mrs X noted she had received a letter on 31 March 2022 confirming Mr X’s contribution from April 2022 had been assessed at £156.95 per week. She said she would visit the Council office the following day to discuss the matter.
12. The Council explained the financial assessment two years ago was for home care services. The assessment for residential care was a slightly different. It said Mr X was paying a provisional charge for his residential care pending a full financial assessment of his residential care charges. It asked Mrs X to return the financial assessment forms.
13. Mrs X asked the Council to send all future correspondence in large print. There is no record the Council resent Mrs X the financial assessment forms in large print.
14. The next contact was in October 2022 when the Council wrote to Mrs X advising that as she had not returned the financial assessment forms the Council considered Mr X was responsible for the full cost of his care. Mrs X was distressed to receive this letter and called the Council to discuss it. She told the Council she had requested an extension of time in August and had asked for copies of the forms in large print. As she did not receive the forms or any further correspondence she assumed that was the end of the matter.
15. The Council sent Mrs X large print forms on 21 October 2022. Mrs X completed the forms and returned them with copies of her bank statements the following week. There is no record of any further action at this stage.
16. In mid-August 2023 the Council then asked Mrs X for additional information/ bank statements. Mrs X provided this information on 4 September 2023 and the Council completed the financial assessment on 4 October 2023.
17. The Council wrote to Mrs X advising it had calculated Mr X’s weekly contribution towards the cost of care at:
• £299.70 from 19 March 2021 to 10 April 2021
• £304.33 from 11 April 2021 to 9 April 2022
• £314.73 from 10 April 2022 to 8 April 2023 and
• £351.42 from 9 April 2023
18. It then sent Mrs X an invoice on 4 November 2023 for £21,969.57 for Mr X’s care contribution since 19 March 2021.
19. Mr X’s monthly contributions increased from £691.20 to £1,405.72. Mrs X says that although this increase charged caused her difficulties, she began paying as instructed in January 2024. She then received a letter from the Council threatening to refer the outstanding arrears to its legal department for recovery.
20. Mrs X made a formal complaint on 12 January 2024 about the way the Council had dealt with Mr X’s care costs. She complained the Council had failed to provide her with a financial assessment or to consult her on how the assessment was calculated. Mrs X also complained the Council had allowed her to continue paying a ‘provisional fee’ and had not told her that this charge did not cover the full cost of Mr X’s contribution. This had resulted in Mr X accruing significant arrears she had no knowledge or awareness of.
21. Mrs X also complained she had been presented with a bill for almost £22,000 out of the blue which had caused her worry and anxiety and affected her mental and physical health. Mrs X said the Council had failed to show her any empathy and that recent letters from the finance department had been aggressive and threatening in tone.
22. In addition, Mrs X said the Council’s delay in carrying out the financial assessment meant she had been unable to apply for benefits which could not now be backdated. She said the Council’s actions had caused her financial hardship.
23. The Council’s records show Mrs X’s complaint was considered by a panel of officers in March 2024 who agreed to reduce the arrears to take account of the Council’s delays.
24. The Council then responded to Mrs X’s complaint in July 2024. It set out the action it had taken in relation to the financial assessment. It acknowledged there was an initial delay in starting the financial assessment and then a further delay once it had received all of the information. The Council said information about the provisional charge was sent to Mrs X in August 2022 with the financial assessment forms.
25. The Council upheld Mrs X’s complaint and apologised for any upset and inconvenience caused to her. In addition the Council considered it reasonable to write off part of the arrears. It considered it reasonable for Mr X to only pay his assessed contribution for the six months prior to them being notified of the correct amount. The Council wrote off charges for the period 19 March 2021 to 3 March 2023 in the sum of £16,498.27. This reduced the amount outstanding to £5,471.30.
26. In relation to Mrs X’s concerns about the aggressive and threatening letters she had received, the Council said letters from its debt recovery team were generic and used standard wording. It had fed back Mrs X’s concerns about the tone and wording of these letters to the manager for review.
27. While Mrs X welcomed the reduction in arrears she did not consider this fully resolved her complaint. Mrs X asked the Council to place recovery action for the remaining arrears on hold pending her complaint to the Ombudsman. The Council advised it could not put a stop on the reminder letters but would let the debt recovery team know of Mrs X’s intention to contact the Ombudsman.
28. In response to my enquiries the Council says the delay in completing Mr X’s financial assessment was due to large backlogs in the financial assessment team completing residential assessments. The Council accepts this was not acceptable and has written off all the charges save for the six months prior to notifying Mrs X of the correct charge.
29. The Council has placed recovery action in respect of the remaining charges on hold pending our investigation. It says that once the hold is removed, it will offer Mrs X a repayment plan to run alongside the current direct debits payments. The Council says the instalments will be at an amount affordable to Mrs X.
30. The Council says it aims to complete financial assessments within 45 days of receiving a referral. To address the delays in completing financial assessments the Council employed additional financial assessment officers in 2022. It also employed a number of temporary agency staff from June 2023 to July 2024 to reduce the backlog.
31. It says that in the 12 months to July 2024, 36% of assessments were completed within 45 days. This increased between July to December 2024 to 60% of assessments completed within 45 days.

Analysis

32. Although there is no statutory timescale for councils to complete financial assessments, we expect them to be completed in a timely manner. In this case the Council took two and a half years to complete Mr X’s financial assessment. Delays of this nature are clearly both unacceptable and concerning and amount to fault.
33. Mrs X was aware Mr X would need to make a contribution towards his care costs as she was making regular payments. However she was not aware that this was a provisional charge pending a financial assessment. The Council had not explained how this amount was calculated or that it could be substantially less than the assessed contribution. The Council’s failure to properly explain the financial assessment process and Mr X’s charges at the outset is also fault.
34. Having identified fault I must consider whether this has caused Mrs X an injustice. Mrs X has experienced considerable distress, frustration, and uncertainty as a result of the Council’s delay and errors, which has affected her health and wellbeing. She has been unable to make informed decisions regarding her finances or her entitlement to benefits and as a consequence has experienced financial difficulty. Mrs X has also been put to unnecessary time and trouble in trying to resolve this matter.
35. The Council has written off a significant proportion of Mr X’s charges to recognise its error and will offer Mrs X an affordable repayment plan in respect of the balance. This is to be welcomed. But I do not consider this resolves fully resolves the matter. I consider an additional symbolic payment to Mrs X of £500 would be appropriate.
36. As the Council has already taken action to address the delays and backlogs in completing financial assessments, I do not consider it necessary to make recommendations for any further service improvements.

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Agreed action

37. The Council has agreed to:
• apologise to Mrs X for the faults identified and the distress, frustration, and uncertainty these caused her. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• make a symbolic payment of £500 to Mrs X to recognise the distress, frustration, and uncertainty she has experienced and the time and trouble she has been put to as a result of the Council’s delays and errors.
• agree an affordable repayment plan with Mrs X for Mr X’s outstanding care charges.

The Council should take this action within one month of the final decision on this complaint and provide us with evidence it has complied with the above actions.

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Final decision

38. The Council's significant delays in, and failure to advise Mrs X of, the financial assessment process are fault. These faults have caused Mrs X an injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman