Summary: The Council’s stated process for care needs and financial assessments appears to be in accordance with The Care Act 2014 but in practice 87% of cases do not follow this process. Failure to provide a personal budget as part of the care and support plan and before services are provided, is fault. The Council should review its processes to ensure cases are assessed in accordance with the Care Act requirements.

The complaint

1. The Council is failing to meet the requirements of The Care Act 2014 when arranging care as it carries out the financial assessment within 15 days of the care package starting and does not provide a care and support plan which includes a personal budget and specifies the amount the adult must pay towards that cost.
2. As a result, service users are incurring costs without knowing the actual amount.

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The Ombudsman’s role and powers

3. We may investigate matters coming to our attention during an investigation, if we consider that a member of the public who has not complained may have suffered an injustice as a result. (Local Government Act 1974, section 26D and 34E, as amended)
4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. If we are satisfied with a council’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
5. 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

6. While investigating a complaint about charging for social care services, matters came to our attention about the way the Council was carrying out financial assessments. Although the injustice in the other complaint had been remedied, we considered this could be affecting people who had not made a complaint and so decided to investigate.
7. I made enquiries of the Council and considered the comments and documents it provided. I sent the Council a copy of my draft decision, invited its comments and considered the comments it made in response.

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What I found

Care Act requirements

8. The Care Act 2014 sets out the steps a local authority must take when it is required to meet a person’s eligible care needs. The Act states it should prepare a care and support plan which should specify the identified needs, how it is going to meet those needs and include the personal budget for the adult concerned.
9. The Act goes on to state the personal budget for an adult is a statement which specifies the cost to the local authority of meeting the adult’s needs and the amount which, on the basis of the financial assessment, the adult must pay towards that cost.

This Council’s procedure

10. Currently the Council provides a personal budget at the point it has completed both a needs assessment and a financial assessment. It says that where timescales allow the process is as follows:
• A needs assessment is conducted;
• A financial assessment is conducted;
• A personal budget is provided; and
• The care package begins.
11. However, it says this is not always possible such as in cases where the person’s needs are complex and/or require immediate intervention. In those cases, the Council aims to complete the financial assessment within 15 working days of the care package starting.
12. The Council does provide information to individuals about charges while it is finalising the care package. Information booklets which include general information about the factors considered in the financial assessment, funding options available and the likely contribution. It also produces a booklet with sets out the notional costs for residential care, home care and day care services which it runs. It does not provide details of the costs for privately run care homes.
13. The Council has also recently introduced an online financial estimator tool. This enables an individual to input details of their income and expenditure and it will provide an estimate of their likely contribution towards their care and support needs. This tool can be used at any time to provide general information about care costs, even before any assessment of needs has been carried out.
14. The Council provides a letter to all service users following the needs assessment which they are required to sign. They are required to sign that they understand they may be charged for the services provided and that they will have to pay for any charges accrued prior to the completion of the financial assessment. The Council offers people a payment plan to pay off any arrears that have accumulated before the financial assessment has been completed.
15. During 2022, the Council completed 1120 financial assessments before the care was started and 7928 financial assessments within 15 days of the referral being made. This is equivalent to 87% of all assessments.

Analysis

16. The Care Act is clear about what steps must be taken when providing a package of care to meet a person’s needs. It requires the care and support plan to include details of the personal budget and this means that it should include the amount the adult is required to contribute to the cost of the care package. Failing to provide details of the cost of the care and the personal contribution before the care package begins would not be in line with the requirements of the Care Act and so is fault.
17. I acknowledge the Council provides general information about charges and the financial assessment process. I also welcome the introduction of the online financial assessment tool which I tried and found helpful. However, it should be noted that this may not be accessible to all service users particularly if older or with disabilities. While providing information is helpful, it cannot be considered a replacement for the actual financial assessment which gives the accurate cost and enables an informed decision.
18. The Council describes its usual process which would be in accordance with the requirements of the Care Act, but then provides data which shows that this is not actually the usual process. The data provided shows that the vast majority, 87%, of financial assessments are completed after the care package starts and so before the service user has details of how much it will cost them. Completing that number of financial assessments within 15 days means the Council is avoiding excessive delay in most cases but it goes against their policy and is therefore fault . For some service users, the cost of their care package may be more than they are able to pay and so could incur costs which cause financial difficulties. The Council should therefore look at its processes to try to reduce this possible impact.

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Agreed action

19. The Ombudsman has the power to make recommendations to remedy the injustice experienced by complainants and members of the public affected by fault we identify. (Local Government Act 1974 31 (2B)). I have set out below recommended service improvements to prevent the fault causing injustice to other service users in the future.
20. The Council should, within three months of my final decision, take the following action:
• Review its care and financial assessment processes to enable the financial assessment to be completed, prior to a care package starting and to ensure compliance with their policy and the Care Act
21. The Council should provide us with evidence it has complied with the above actions.

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Investigator's decision on behalf of the Ombudsman