14th April 2024
Summary: Ms X complained about the handling of her father’s financial assessment. The Council accepted the identified failures; apologised for the inconvenience; reminded officers of the need to communicate effectively; agreed to make symbolic payments and should take steps to improve its working practices.
Ms X’s father, Mr Y, had dementia. Mr Y lived at home and was cared for by his wife. In June 2023, when Mrs Y began struggling with her role, the Council assessed Mr and Mrs Y’s needs as cared for and carer.
The assessment established eligibility for three weekly hours of support to provide for Mr Y’s needs while Mrs Y went out (respite). Thereafter the Council told Ms X only two hours were agreed. Ms X’s attempts to resolve the discrepancy were met with ineffective Council engagement.
The Council next asked Mrs Y to complete a financial assessment. The outcome defined a weekly contribution of £27.94. A subsequent care plan for Mr Y provided for three weekly support hours but it is not clear a copy of this was ever provided to Mr & Mrs Y.
A further financial assessment was requested of Mr Y. No explanation of the error underpinning this second financial assessment request was provided thereby causing confusion. [‘Respite’ services should normally appear on the care plan of the cared for person and are therefore chargeable to that individual – not the care giver – even when placed in the plan and budget of the care giver in exceptional circumstances.]
Ms X then complained about the discrepancy in the number of hours to be provided to Mr Y. On the same day, the Council contacted Mr & Mrs Y to discuss paying for three hours of support.
Some 26 days after Ms X first requested help, the Council stated it had corrected the hours from two, to three, 20 days earlier but could not explain why – until a subsequent call from a manager – that Mr Y now had to complete a financial assessment, as it was providing (respite) support for him.
In September the Council responded to Ms X’s complaint with an apology for her time spent trying to correct the mistaken hours, the time it took to respond to her concerns and for the inconvenience and confusion caused by asking Mrs Y to complete a financial assessment.
In October the Council advised Mr Y’s financial assessment indicated he would need to pay a weekly contribution of £581.66. Ms X made a further complaint to the Council.
In November the complaint response apologised, indicated the Council could not explain the 20 day delay in confirming three, not two hours as agreed, said staff had been reminded of the need to update clients and their families and confirmed that its policy was to charge the person receiving the respite care and that as charges were means tested, Mr Y could and would have to pay more than Mrs Y had previously been required to pay.
Ms X then appealed her father’s financial assessment resulting in a reduction of £1.38 to assessed available income of £580.28 a week. The Council said Mr Y could submit a stage two appeal but the family declined support from the Council noting it was cheaper for her parents to arrange it themselves.
The LGSCO found Bromley at fault around mistaking the number of hours’ support to be provided then failing to explain that error or that it had been corrected. Also for Ms X’s time and frustration resulting from the Council’s delayed responses. Furthermore for sending Mrs Y a time consuming financial assessment form, failing to explain this was an error or why Mr Y also needed to fill in the same form – causing further confusion and delaying Mr & Mrs Y’s ability to make an informed decision on whether to accept support from the Council or make private arrangements.
The Council was also at fault for failing to send Mr Y a copy of his care and support plan and for failing to include all the requisite components (such as Mr Y’s personal budget) in the plan as set out in the Care and Support Statutory Guidance as follows:
- The needs identified by the assessment
- Whether, and to what extent, the needs meet the eligibility criteria
- The needs that the authority is going to meet, and how it intends to do so
- For a person needing care, for which of the desired outcomes care and support could be relevant
- The personal budget
- Information and advice on what can be done to reduce the needs in question, and to prevent or delay the development of needs in future
- Where needs are being met via a direct payment, the needs to be met via the direct payment and the amount and frequency of the payments
Therefore, within four weeks the Council agreed to pay Mr & Mrs Y £200 and Ms X £100 and within eight weeks will take action to ensure officers sent people copies of their care and support plans, and that these should meet the requirements of the Care & Support Statutory Guidance and provide us with evidence it has complied with the above actions.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public:
This report represents a meeting of two counter-intuitive areas of social care.
The first – which Bromley also seemed to stumble over – relates to who (if anyone) must make a financial contribution to ‘respite’ services which are provided in order to allow a carer to have a regular break, so as to enable them to continue caring.
As the benefit of respite appears to be for the carer, it is widely thought that where charges for it are made, the charge would be levied on the carer receiving the respite.
However, if one sees respite as a form of ‘backfilling’ the care for the person in need while their usual carer exercises their absolute right to stop, then it becomes understandable that in fact charges for respite are always supposed to be applied to the cared for person and should appear in their personal budget statement.
Provision is made in the Care Act for when that is not possible, say because the cared for person is not a person willing to be assessed or not someone who’s been assessed or assessed and found eligible. In that situation, the carer will get no respite, unless the cared for person is agreeable to receiving true replacement care via the carer’s support plan, and is agreeable to being personally financially assessed.
The second counter-intuitive area relates to the amount required to be paid towards one’s care which is an issue we are frequently asked about – for example, when a person’s charges have remained the same even after a reduction to their care package it is common to hear from those who feel this must be an error.
However, this is because their understanding is based on the quantity of care as the factor driving the determination of the charge. Whereas, all charges made for care are based on an individual’s ability to pay – that is, on the amount of money or available assets a person has with which to pay for any quantity of care – often costing very much more than their contribution.
Carers CAN be charged by councils, for support services, but that is why the Guidance draws attention to the two ways of providing for respite. Paragraphs 11.45 and 11.46 refer.
We don’t think that the Guidance gets the position absolutely correct even there, in recognising that carers can be charged for services in their support plan. Giving the authors the benefit of the doubt, replacement care as a word for respite is clearly the response to the absence of ordinarily freely offered care, which the council must backfill in any event, once it knows about it, and there would be no charging a carer for something that ought logically to be in the cared for person’s budget.
Charging a carer for time off from something that they are not obliged to do in the first place, is a hiding to nowhere, one can only suggest, as a strategy for making carers feel appreciated.
In this particular case, what we suspect was an oversight as to the rules as to where the charge should appear, revealed what the significant difference can be in the applicable charges applied as between the cared for and carer, due no doubt to their very different financial circumstances: one would have been required to pay £27.94 towards the three weekly hours and the other could have been charged as much as his assessed income suggested he could afford to pay, which was £580.24.
It should be noted that it is possible the £580 figure has been mis-stated or misquoted in this report given that it is not conceivably possible that the charge for three hours of care could total almost £600. Instead, it may be that this sum was the total amount of the cared for person’s assessable income each week or even that a decimal has been misplaced, such that the figure may have originally been £58.24 representing the charge for three weekly care hours, with the man being assessed to be a full cost payer.
In any case it is concerning that staff conducting or overseeing basic Care Act functions within both needs and financial assessments may be falling into these fundamental errors, which care recipients may never realise have happened and which could have significant and far reaching effects on both the affected people and the overall efficacy and application of the underpinning legislation.
If you are affected by the issues in this report, please consider asking us a free One-off Question, at a level of principle, here.
The full Local Government Ombudsman report on the actions of Bromley Council can be found here:
https://www.lgo.org.uk/decisions/adult-care-services/charging/23-015-108