Decision Date: 26th March 2023
What happened
Miss Y has Down’s Syndrome and lives in supported accommodation away from her parents. Miss Y had a financial assessment following her first adult social care needs assessment. Her father, Mr X, asked for the Council to cover the cost of horse riding [the report doesn’t tell us on what basis Mr X was acting on behalf of his daughter i.e. appointee, deputy, etc]. The Council refused and so Mr X requested they review their decision.
The Council reviewed the decision but did not change their position and said the following:
- It did not accept the view that the cost of horse riding was a necessary cost specifically related to Miss Y’s disability.
- The need for horse riding was not supported by a health professional and were it to be a health need it would be for the GP to consider under social prescribing provisions.
- Activities that confer a health benefit are not automatically able to be considered a disability related expense.
- The disability related expenses were fairly considered and the horse riding expense was reasonably declined.
The Council properly considered Mr X’s request. However, Mr X subsequently provided the Council with a letter from Miss Y’s GP, which the Council did not consider.
What was found
The Council’s failure to consider the letter from Miss Y’s GP caused a potential lost opportunity for Miss Y. The LGSCO recommended that the Council apologise to Mr X and consider the letter from the GP and whether it has any effect on its decision about disability related expenditure.
The Council agreed to follow the LGSCO’s recommendations within two months of the LGSCO’s decision and show them evidence of compliance.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public.
Disability related expenditure (DRE) is that expenditure resulting from the spending of one’s own money, on things or services that are incurred on account of one’s disabling illness or condition, and which are ‘needed’.
There is no requirement for that which is ‘needed’ as DRE to be accepted as an ‘eligible’ need under the Care Act, or detailed in an assessment or care plan but the things or services must still be asserted to be ‘necessary’, and not merely just wanted. This expenditure is then deducted from one’s income for the purposes of financial assessment, so operating to reduce the remaining net income and thus the maximum charge for care.
Costs relating to hobbies and getting out and about where these support health and well-being may be higher because of a disability, or may only be undertaken because of a disability. The Council is entitled to ask for evidence relating to any Disability Related Expenditure. This could be proof of the cost, such as bills/invoices/receipts, contracts, bank statements, receipts etc but also proof that the cost is related to disability, such as a letter from a health professional or a care-plan that states a need not met by the Council.
In this case, although we are not given any indication of what the Doctor’s letter says, it may well be crucial in setting out a therapeutic or wellbeing benefit provided by the riding and linked to the disability or health issue. The LGSCO is therefore following the law in asking the Council to review this.
The other element not mentioned at all in the report is whether the complainant, as a result of her Down’s Syndrome, needed additional support because of this to access the horseriding. If this was a specialist riding for disabled provision it may be more expensive than a riding provision a non-disabled person would access due to the extra support and staffing required. This being the case then that additional expense should qualify as a DRE albeit that this would still not determine the question of necessity. Overall we think it worrying that the Ombudsman did not specifically address the assertion that health related expenditure is not within the confines of DRE.
The full Local Government Ombudsman report on the actions of West Sussex County Council can be found here: https://www.lgo.org.uk/decisions/adult-care-services/charging/22-011-273