Summary: The Council failed to provide Miss X with clear transparent information about charging for home care services consequently, she believed the service was free of charge. This led to Miss X accruing a large debt.

The complaint

1. Miss X complains the Council has invoiced her for home care that she believed to be free of charge. Miss X brings her complaint with the support of an advocate.

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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 have:

• considered the complaint submitted by Miss X;
• considered the correspondence between Miss X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Miss X and the Council an opportunity to comment on a draft of this document.

Relevant legislation

5. The Care Act 2014 provides a single legal framework for charging for care and support. Where a local authority arranges care and support to meet a person’s eligible need, the local authority has a power to charge that individual, except where the local authority is required to arrange care and support free of charge.
6. The Care and Support Statutory Guidance (CSSG) is statutory guidance which councils should have regard to when charging people for care they provide.
7. Councils must be transparent so people know what they will be charged. There should be enough information available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3).
8. Councils should also consider any disability related expenditure (DRE) a person incurs. This ensures that assessed charges do not result in a person being left without the means to pay for any other necessary care, support or for other costs arising from their disability.

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What I found

9. Miss X is in her fifties. She has complex medical issues and mobility difficulties. She has been in receipt of domiciliary services since 2019. She had been assessed as eligible for services in previous years, but either refused services or cancelled them because of the required financial contribution.
10. In 2019, Miss X’s health deteriorated, and she needed services. During the assessment of her needs, she said she wanted to know the cost before accepting care. Following concerns about Miss X’s health, and her reluctance to accept chargeable care services, social services referred Miss X’s case to its ‘complex case panel’. The Panel concluded care should be put in place to reduce the risk of further health deterioration. The Council says the social worker was “…advised to initiate the POC and whilst the Financial Assessment review is undertaken and following this, the issues with her contribution can be discussed going forward”.
11. Miss X says the social worker informed her she would not have to pay towards the cost of her care.
12. The Council completed a financial assessment in July 2019. I have had sight of this document which records the chargeable contribution to be £121.25 per week but records the ‘invoiceable’ amount as zero.
13. Ms X began receiving invoices for her care, but she says she was told by a social worker these had been automatically generated and she did not have to pay. She contacted the Council on18 October 2019 to explain her position. The officer taking the call asked Miss X to forward the emails to confirm her claims, that she did not have to pay. Ms X says she explained her difficulty with using technology and that she communicated with the Council by telephone, so did not have such emails. The officer said she would refer the matter to a manager.
14. The Council’s records show an internal discussion between a manager and a social worker on 19 October 2019, and that an officer was “…advised to have a conversation with [Miss X] following the outcome of her financial review as the expectation is to contribute towards her care in the longer term. She advised that if [Miss X] is not able to contribute, she would need to put this in writing and also a budget plan is also be expected’.
15. An email between council officers dated 29 October 2019 confirms a telephone conversation between Miss X and the social worker, that Miss X had been informed of the manager’s decision, and that she needed to ‘put in writing’ why she could not afford to pay the charges. The officer confirmed Ms X had given her postal address as Miss X did not have access to email.
16. Miss X contacted the Council again in December 2019 to say she had received debt recovery letters chasing payment of outstanding care contribution charges.
17. Miss X sent her income/expenses information to a social worker in early December 2019. The social worker sent an email to the Council’s financial assessment team saying a financial reassessment needed to be completed.
18. The Council records show a financial assessment was completed with Miss X by telephone on 31 March 2020. The assessing officer asked Miss X to provide bank statements, and receipts of expenditure. Miss X told the officer her washing machine had ‘broken down’. I have had sight of the financial assessment dated April 2020; this shows the assessed weekly contribution to be £125.57. There appears to have been no consideration of disability related expenditure. The Council wrote to Miss X on 2 April 2020 and enclosed a copy of the completed financial assessment form.
19. Miss X says she did not receive any correspondence from the Council confirming the charge,
20. Miss X then received debt recovery letters for the outstanding charges. She telephoned the Council and the officer taking the call referred the matter to the Council’s financial assessment team.
21. A further financial assessment was completed on 18 April 2021. It concluded Miss X’s weekly contribution to be £127.15. Again, there appears to have been no consideration of disability related expenditure.
22. In June 2022, Miss X received a bill from the Council for £13,788.66 for outstanding care charges. She then sought support from the citizens advice service. A caseworker (advocate) was appointed.
23. The advocate contacted the Council in June 2022. She received no response.
24. The Council completed a reassessment of Miss X’s care needs and finances in July 2022, during which the Council says Miss X confirmed she had been financially assessed and that she had received invoices for her care.
25. Miss X’s advocate says the first time Miss X was made aware of needing to pay a contribution towards her care was on 22 July 2022 when she (advocate) called Miss X following an email from the Council saying the current financial assessment calculated a client contribution of £130.90 per week. This charge was applicable from 11 Apr 2022.
26. The advocate chased the Council again for a response in October & December 2022. She received no response.
27. The advocate contacted the Council again on 5 January 2023. It responded in February 2023 saying, it “agreed that a full backdated review of the financial assessment is carried out. This will also include the collation of case notes and correspondence to allow us to consider the appropriate liability of the invoice for care from 29 July 2019 to 17 April 2022… I do accept that there has been delays in regard to the progression of the financial assessment and for this I apologise… We have requested necessary information from our Adult Social Care colleagues that will help us understand the background to this case and enable us to present a balanced perspective to the decision makers and budget holders in this regard. We will aim to have this completed within the next 14 days”.
28. The advocate heard no more and subsequently submitted a complaint to this office in April 2023.
29. In August 2023, Miss X received a revised invoice from the Council for an amount of £21,299.75 for the period 14 October 2019 to 11 June 2023.

Analysis

30. The evidence I have seen persuades me that Miss X was told her care would not be chargeable when it commenced in 2019. At this point, the Council was aware Miss X would not accept chargeable services, and that she had previously refused services on this basis. The Council’s panel decided to provide services because of the risks Miss X faced if she went without services. Miss X accepted services based on a nil charge. I am not persuaded Miss X was told that the offer was temporary and/or based on discussions about her future ability or willingness to pay.
31. Given Miss X’s history, it is also difficult to understand why the Council thought Miss X would agree to pay after services commenced.
32. The Council’s financial assessment completed in July 2019 confirms a zero contribution from Miss X.
33. The Council should have written to Miss X confirming the offer of services was based on a zero contribution. This would have enabled Miss X to quickly resolve matters when she began receiving invoices in October 2019. There appears to have been no communication between social services and the financial assessment team about the zero-charge agreement. On the balance of probability, I find Miss X was told verbally the initial invoices she received had been automatically generated. However, this placed Miss X in a difficult situation as she had no evidence to support her position.
34. The Council’s request that Miss X provide it with copy emails to evidence her position shows a lack of communication and understanding of Miss X’s circumstances. The Council’s own records highlighted Miss X did not use email. This caused Miss X, a vulnerable adult, unnecessary worry, and distress.
35. The Council’s communication with Miss X was poor. Information was inconsistent with no consideration given to any reasonable adjustments. Contact from the Council was reactive not proactive with no attempt at meaningful contact other than the completion of financial assessments.
36. The completed financial assessments do not appear to have considered disability related expenditure. This may significantly impact on any assessed charge.
37. I accept the Council’s position that Miss X was informed of the cost of care charges from April 2020, however given the mixed messages and lack of clarity about previous invoices, Miss X’s confusion about the need to pay was understandable.
38. Paragraphs 8.2 and 8.3 of CSSG says people have a right to receive information so they can understand the charge. This is not what happened in this case. The Council’s actions lacked transparency from the outset.
39. Retrospective charging does not allow a person to make informed choices. The accrued debt is not one of Miss X’s making.
40. Miss X accepted services on a false understanding. It is unfair for the Council to pursue the outstanding debt.
41. The Council’s communication with Miss X’s advocate was also poor. It failed to respond to some emails, delayed in responding to others and failed to follow through with actions agreed. This has added to Miss X’s uncertainty and distress.
42. Adult services are chargeable; however, the Council has a discretion (a choice) to impose such charges. Given the decision the Council took in 2019, to provide services to Miss X based on wellbeing concerns, it would be prudent for the Council to review the situation at its complex case panel.

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Agreed action

43. The Council should within four weeks of the final decision:

• apologise to Miss X for the failings set out above;
• waive the outstanding charges in full;
• allocate a social worker to meet with Miss X and her advocate to discuss her circumstances and undertake a fresh financial assessment, and give consideration to DRE;
• refer Miss X’s case back for consideration at the complex case panel.

44. The Council should provide us with evidence it has complied with the above actions.

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Final decision

45. The Council failed to provide Miss X with clear transparent information about charging for home care services consequently, Miss X believed the service was free of charge. This led to Miss X accruing a large debt.
46. The above recommendations are a suitable way to settle the complaint.
47. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman