Summary: We will not investigate this complaint about an alledged failure by the Council to properly assess whether the complainant’s therapy costs should be treated as disability related expenditure. This is because the complainant has not provided sufficient evidence to the Council to enable it make an evidence based decision. There is insufficient evidence of fault by the Council to warrant investigation.

The complaint

1. The complainant (Miss Q) complains the Council has failed to properly consider her disability related expenditure (DRE) when carrying out a financial assessment to determine her contribution towards the cost of providing her care and support. Specifically, Miss Q pays for therapy related to her disability which the Council has refused to count as DRE. Miss Q says the therapy is not available on the NHS and is essential for managing her disability. She believes the Council has failed to factor these considerations into its decision.
2. In summary, Miss Q says the failure to treat the therapy costs she incurs as DRE means she is paying too much towards the cost of her care and support. As a desired outcome, she wants the Council to treat the therapy costs as DRE and recalculate her contributions accordingly.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start an investigation if we decide there is not enough evidence of fault to justify this, or it would be reasonable for the person to ask for a council review or appeal. (Local Government Act 1974, section 24A(6), as amended, section 34(B)).

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How I considered this complaint

4. I considered information provided by the complainant and the Council. I also considered the Ombudsman’s Assessment Code.

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My assessment

5. I note Mrs Q provided the Council with a letter confirming what therapy she is paying for, why she is unable to access this through the NHS and that it directly relates to her disability. The evidence shows the Council considered the information provided. In response however, it said the information provided no medical recommendation that the therapy is needed in order to support Miss Q in managing her disability. Further, the Council explained the information received lacked certainty as to whether the therapy was available through the NHS, or if Miss Q was choosing to pay for this privately. It therefore refused to treat the costs incurred by Miss Q as DRE.
6. The Council’s assessment of the expenditure must be objective and evidence based. I consider it reasonable for the Council to request medical evidence that the therapy is needed in order for Miss Q to manage her disabilities, as well as evidence showing this is not available on the NHS. I consider Miss Q could make such evidence available to the Council through her general practitioner in order to request for a reconsideration of the decision. In my view there is insufficient evidence of fault by the Council to warrant an investigation.

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Final decision

7. We will not investigate this complaint. This is because the restrictions I outline at paragraph three (above) apply.

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Investigator's decision on behalf of the Ombudsman