Decision Date: 26th March 2021
What Happened
Mr B and Mrs D complained on behalf of their parents, Mr and Mrs C.
Mrs C lived at home with her husband. She received a period of free care and support, following which, her family, knowing Mrs C would have to pay for her care, opted to have an ongoing care package arranged by the council.
Mrs D told the LGO despite knowing Mrs C would have to pay for the care package, they were not made aware of any administrative charges. No evidence of information being given to the family regarding these charges has been provided to the LGO.
Mrs C was informed in writing of the additional £4.85 charge for arranging care 20 days’ care following the start of the care package and a subsequent financial assessment.
Mrs D requested the council cancel the care package – the family were unhappy with both the standard of care and the administrative cost they were being asked to pay.
The council had arranged two calls per day at 9.30am and 8pm from the care provider. This was to support Mrs C with showering, dressing, meals, medication, toileting and getting in and out of bed. It was agreed Mr C would provide Mrs C her lunchtime meal.
Mrs C’s family complained that due to the care staff regularly arriving late, family members would often be required to provide the care. Mr C is reported to have found providing the care alone distressing. The family complained that the care package neglected to provide any benefit to Mrs C, the care staff were not required to do anything by the time they arrived and were therefore merely signing the log book and leaving.
No evidence was provided to the LGO to show the Council or care provider had informed the family of the possibility of care visits not always being provided at the agreed time. In addition the care provider would charge for the calls if they were made within a reasonable time frame of the agreed times, but information regarding what the provider considered ‘reasonable’ or what exact times the calls had been made was not available due to the provider no longer being in business.
What was found
The LGO found no evidence of information having been provided to the family regarding the administrative charge for arranging the care and that this was at fault.
Although there was a lack of evidence pertaining to the standard of the care provided, the LGO found it was likely the standard of care was poor. The Care Quality Commission (CQC) carried out an inspection and published a subsequent report of its findings on the care agency providing Mrs C’s package of care. The inspection was carried out at the time Mrs C was receiving the care package. The LGO found that the CQC had reported on similar complaints from other clients of the care provider regarding the timings of care calls and also found adequate time was not factored into the rotas for travel between care calls.
The LGO found that the late calls, care staff arriving late in the evening and being required to provide Mrs C’s care alone caused Mr C and other family members distress.
The LGO recommended the Council:
- Acknowledge the failings by waiving and refunding any charges paid or owed toward the care package and the administrative cost, due to the lack of benefit it provided Mrs C and the distress caused to her and her family.
- To highlight to social work staff the importance of individuals and their families being able to make informed decisions regarding their care, which includes the need to provide information on costs and charges, including administrative charges.
Points for the public, especially full cost payers – care managers and families
The law in England is that even if you have more than the upper capital threshold of £23250, you can still insist on having your care arranged for you by the council – you will be charged the full cost of the service – or at least the maximum cost the means test generates for everyone under that council’s charging policy. On top of that you can be charged an administrative fee for the privilege and economic advantage of being commissioned for, if you see it as worth while and to your benefit. This fee is sometimes called a shopping fee, a commissioning fee – or a full cost payer’s fee. It cannot be more than the council incurs by way of its commissioning function, but there is no guidance as to how that should be worked out.
In this case, the LGSCO finds it to be maladministration that no information about this fee was provided. That is the tip of the iceberg when one considers how very little advice and information there is provided by councils to people if they don’t know how to look for it themselves. It is as if the internet has been regarded as absolving councils of their duties in this regard – unless one assumes that everyone in need has got someone who can look this sort of thing up, for their needier relatives.
The law regarding this charge only applies (in 2022) to care arrangements outside of care homes. People with more than the capital threshold are not able to make a council meet their needs in a care home, even if eligible, on account of their above threshold assets (unless they lack capacity and have nobody authorised or willing to do so on their behalf or for their benefit). There is a power to charge full cost payers ONLY for non residential care at present, and there is no power to charge for letting a person with above threshold assets into commissioned care home arrangements even if the authority decides to do so merely as a matter of discretion.
So the information is here and the expectation of government is that councils WILL tell people about this ‘commissioning’ fee: see the Care and Support Guidance, chapter 8:
8.58 Where the person’s resources are above the financial limit, the person’s entitlement to local authority support in meeting their needs may be dependent on the request having been made. Therefore it is important that the person, and any carer, advocate or other person they wish to involve, are aware of this ability and the consequences for their care and support. The local authority must make clear to the person that they may be liable to pay an arrangement fee in addition to the costs of meeting their needs to cover the costs of putting in place the care and support required.
8.59 Arrangement fees charged by local authorities must cover only the costs that the local authorities actually incur in arranging care. Arrangement fees should take account of the cost of negotiating and/or managing the contract with a provider and cover any administration costs incurred. Where a local authority chooses to meet the needs of a person with resources above the financial limit who requires a care home placement, it must not charge an arrangement fee. This is because it would support that person under its power (rather than its duty) to meet needs, and the ability to charge the arrangement fee applies only to circumstances when the authority is required to meet needs.
The full Local Government Ombudsman report of London Borough of Bromley can be found here:
https://www.lgo.org.uk/decisions/adult-care-services/domiciliary-care/20-006-260