The Ombudsman's final decision
Summary: We will not investigate Mr C’s complaint about the Council charging him for his care. This is because the Council’s actions have not caused Mr C a significant enough injustice to warrant an ombudsman investigation.
The complaint
Mr C’s representatives act on his behalf. Mr C’s representatives say Mr C should not have to pay his contribution towards his care fees because the Council delayed in completing a financial assessment and his family had no knowledge that he would have to pay a contribution. Mr C’s representatives say if he had to pay his contribution it would cause severe financial hardship and would have to be paid out of his Personal Expenditure Allowance (PEA). Mr C’s representatives want the Council to waive the debt.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect 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 the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended)
How I considered this complaint
I considered information provided by the complainant and the Council.
I considered the Ombudsman’s Assessment Code.
My assessment
Mr C received NHS Continuing Health Care (CHC) funding from 2017 until January 2020 when the NHS informed his family he was no longer eligible for health care funding. The Council completed a pre-service financial assessment and concluded Mr C should contribute £103.55 per week towards his placement. This was based on Employment Support Allowance (ESA) he was receiving at the time.
Mr C moved to a different home in June 2021. In August 2021 Mr C was invoiced by his Care Provider for his care. The Council undertook an online financial assessment of Mr C’s finances in October 2021. The outcome of the assessment was that Mr C had income to contribute £106.40 a week towards his care. The Council amended the invoices and reissued the correct invoices.
Mr C’s representatives say Mr C’s family were not told of the charges until November 2021 by which time he was in debt and could not afford to pay his arrears of £5,006.
The Council says a financial assessment form was sent to Mr C’s family for completion in 2019 and followed up with a reminder letter in February 2020. The Council says the information leaflet about paying for care would have been attached to the financial assessment form when it was sent out. I have seen evidence of these documents and cannot comment on why Mr C’s family did not receive them. Mr C’s niece completed and returned the pre-service financial assessment form on 25 February 2020. The form clearly states it is for the Council to determine charges to be made for services supplied within the requirements of the Care Act 2014.
Mr C’s representatives say if he is to pay this debt it will have to come out of his PEA. Although Mr C’s family were not aware of the actual amount of £106.40 he was assessed to contribute towards his care until November 2021, they were aware he was not eligible for CHC funding from January 2020 and knew of the pre-service financial assessment contribution of £103.55 per week from February 2020. Mr C’s family knew on that date he was assessed as having enough income to pay his contribution £103.55. Mr C moved in June 2021. The Council reassessed Mr C’s finances in November 2021. There is no fault with the Council for charging Mr C for care it provided during this period and no significant injustice to Mr C from its actions.
Final decision
We will not investigate Mr C’s complaint because the Council’s actions have not caused a significant enough injustice to warrant an ombudsman investigation.
Investigator's decision on behalf of the Ombudsman