Date of decision: 15 December 2025
Summary
A woman complained that Essex Council did not clearly explain her elderly mother’s care home charges or that constant 1 to 1 care would be added on top of the standard weekly fee, leading to an unexpected bill of over £56,000.
The Ombudsman found the Council at fault for failing to spell out the real total cost and charging period, and for not securing a suitable alternative nursing home.
What happened
In March 2024, Mrs Y, who had previously lived at home supported by her family and a private carer, was admitted to hospital. On 1 April 2024 she was discharged from hospital to Care Home 1 on a “discharge to assess” basis, with the Council funding this placement for what was described as an intended six-week period.
On 22 April 2024 a social worker contacted Mrs Y’s other daughter, Mrs Z, to discuss a Care Act assessment and the Council’s charging policy, telling her that because Mrs Y’s savings were above the upper capital limit, she would have to pay the full cost of her care after the assessment.
Care Home 1 then reported that Mrs Y was unsettled, and extremely distressed and noisy if left alone, at risk of falls from trying to get out of bed, and at risk of malnutrition because she was not eating or drinking, and said it could not meet her needs, asking the Council both to move her to a nursing home and to fund 1 to 1 supervision until that move happened.
The social worker visited on 25 April 2024, reviewed the placement and completed a care assessment, agreeing that Care Home 1 could not cope and that Mrs Y should move to another placement.
The assessment record notes that the social worker spoke with both daughters, Miss X and Mrs Z, about Mrs Y’s wellbeing and about financial charges, confirming there was no charge at that time for Care Home 1, that there would be a free “settling-in” period at the eventual new home, and that funding and charging would be discussed again after a review there.
The Council agreed with the home to fund 1 to 1 care from 29 April to 3 May 2024, later extending this funding to 9 May 2025 (a date the narrative presents as an extension of the same 1 to 1 arrangement).
On 10 May 2024, the social worker returned, completed an NHS Continuing Healthcare Checklist and a Mental Capacity Assessment, finding that Mrs Y lacked capacity to decide where she should live and recording a best interests recommendation that she should move to a nursing placement.
Meanwhile, on 3 May 2025 the local NHS ICB agreed to fund NHS-Funded Nursing Care (FNC) for Mrs Y, once she moved to a nursing home. [This meant she was eligible for a contribution to the cost of the registered nurse nursing input it was acknowledged that she should be getting. It does not automatically mean one cannot be cared for in an ordinary care home]
The Council continued to fund 1 to 1 care while searching for a nursing home, and in early June 2024 Care Home 1 requested a meeting to resolve the situation.
By that stage the Council had approached over a dozen nursing homes; all were either full or declined to take Mrs Y, so the Council suggested she could perhaps return home with 1 to 1 care and a robust support package.
Miss X and Mrs Z rejected this suggestion, insisting that a nursing home was more appropriate. They were of the view that there was only one way to meet the need.
Miss X says they were repeatedly told that Mrs Y would not need 1 to 1 care once in a nursing home because “there would be more staff”.
The Council did not manage to find any suitable nursing home before Mrs Y was re-admitted to hospital in early August 2024.
On 2 August 2024 the Council wrote to Miss X confirming Mrs Y’s assessed weekly charge for Care Home 1 was £4,118.94. Miss X queried this, saying they had been told Mrs Y would pay only the standard care home fee, not extra 1 to 1 care.
On 29 August 2024 the Council issued an invoice for £43,543.08 covering 30 April to 13 July 2024, which Miss X again disputed because they had only expected to pay the home’s weekly rate. A second invoice on 23 September 2024, covering 13 July to 7 August 2024, brought the total to £56,333.58. Mrs Y died in September 2024.
Miss X continued to challenge the charges, relying on a July 2024 email from the social worker that referred to further “funding” for 1 to 1 care and expressed no reason why it could not be agreed, and said the family had never been told Mrs Y would personally be charged for that 1 to 1 care.
On 6 November 2024 a finance officer discussed the matter with her and then wrote confirming that, although the use of the terms “funding” and “funded” had been unclear and there were lessons to be learned, the Council would uphold the charges because Miss X had been told Mrs Y would need to pay the full cost of her care; the officer offered to remove charges for the notice period 3 to 7 August 2024 and issue an amended invoice, which Miss X says she never received.
When Miss X asked for a breakdown, the Council confirmed the residential placement was £758.94 per week and that 1 to 1 care was charged at £20 per hour for 24 hours a day, totalling £3,360 per week.
In early January 2025 Miss X made a formal complaint, arguing that if the family had known the true weekly cost of over £4,000 they would have arranged cheaper private care and that the Council should pay the 1 to 1 care costs.
In its complaint response the Council said Care Home 1 had quickly recognised Mrs Y needed extra support to feel safe and served notice, and that the only way it could keep her there until a new placement was found was by providing constant 1 to 1 supervision. It confirmed that the initial period at Care Home 1 had been intermediate (discharge to assess) care and so free, but that after the care needs assessment Mrs Y, as someone with savings above the capital threshold, became liable for the full cost from that assessment point. The Council also said its records showed Miss X had been involved in discussions about attempts to settle Mrs Y, including 1 to 1 care. [No mention appears to have been made of the FNC funding eligibility decision that had been agreed.]
The Council explained that its charging policy and statutory guidance normally prevented it from entering contractual arrangements for a person’s residential care, except where that person lacked capacity and had not lawfully authorised someone else to manage their finances. Because Mrs Y lacked capacity and had not appointed an attorney, the Council had entered a contract with Care Home 1 and paid the home while Miss X applied to the Court of Protection for deputyship, saying that every effort had been made to secure better-value care and that 1 to 1 support was unavoidable to keep Mrs Y safe.
It accepted that it would have been better if Miss X had been given the actual cost of the package, not just told that Mrs Y would pay in full, and said it was reviewing its processes, but maintained that the charges were correct and that Mrs Y’s estate remained liable for the full amount.
What was found
The Ombudsman found fault in the Council’s failure to clearly inform the family at the outset how much Mrs Y would be charged, for what exact period, and that 1 to 1 care costs would be added to the standard care home fee. It also found service failure in the Council’s inability, despite efforts, to secure an alternative nursing home placement, concluding this too amounted to fault.
The investigation noted that the Council had led the family to believe Mrs Y would receive six weeks of fully funded “discharge to assess” care and then a non-chargeable settling-in period at a new home, but in fact invoiced from 30 April 2024, four weeks after the move to Care Home 1, so she did not receive the full six weeks free as described.
The Ombudsman decided the Council’s poor communication meant Mrs Y and her daughters were denied the chance to make properly informed decisions or explore other options and that the shock of receiving a bill of over £56,000, including 1 to 1 charges at more than four times the standard weekly rate, caused significant distress and uncertainty for the family.
However, the Ombudsman accepted that Mrs Y did need residential care and that 1 to 1 support was necessary to meet her needs until a suitable nursing home could be found, and considered it likely she would also have needed 1 to 1 support even in a nursing home. On that basis it did not require the Council to fund the 1 to 1 care costs but found it should pay the cost of the first six weeks at Care Home 1 as discharge-to-assess care, so that Mrs Y’s estate would only be responsible for care home charges from 13 May 2024 onwards.
By way of remedy, the Council agreed to apologise to Miss X, cover the first six weeks of Care Home 1 fees, and pay Miss X £500 to recognise the shock and distress caused. It also agreed to remind relevant staff of the need to give full information about adult social care charges and the cost of whole packages at the time care is arranged, and to ensure they keep complete records of the advice and information they provide.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
This is an indefensible evaluation by the Ombudsman, in our view, on the basis of community care law, FNC law and CHC.
It has been the law since community care law began to be shaped by judicial review decisions that if there is only one way to meet the needs, then the Council must pay and only charge a sum that it has lawful authority to charge. Cost is not a determinant of free NHS Continuing Health Care status, but if no nursing home will accept a person who is eligible for Funded Nursing Care, as this woman had been regarded since May, there is no way that it can be correct that she was not assessed for Continuing NHS Healthcare via the Decision Support Tool mapping exercise with respect to the totality of her health and social care needs. Qualifying within that framework would have underpinned a legal right to totally free care.
Whilst nothing is said about that in this report, and we have to acknowledge that this means that the woman’s estate would still have had to have paid social care charges (with the FNC element being paid by the NHS) in any nursing home where she might have been placed), it also means
a) that it is arguable that the rates on offer from Essex, for nursing care homes, cannot have taken market sustainability into account, if none on Essex’s framework would take the resident on; The investigator’s conclusion that ‘as the Council was unable to identify a nursing home that could meet Mrs Y’s needs it is likely, on the balance of probabilities that Mrs Y would also have needed 1 to 1 support in a nursing home’ overlooks that the problem was likely to have been the rates being offered being arbitrarily low.
b) that exploration of spot purchasing attempts by Essex, for any rate that would have assured an appropriately skilled placement, let alone a better rate than £4K a week, should have been evidenced. There is no evidence basis for the investigator’s assumption that she would have needed 1:1 care in a nursing home, and it is beyond jurisdiction for an Ombudsman’s investigator to make social work judgments up, as they go along. The right thing to do would have been to explore the sufficiency of the rates being offered, and why nobody referred this woman for a CHC assessment under the Care Act Assessment Regulations, in our vie, because this woman potentially had a good chance of getting CHC on the basis of the domain of ‘behaviour’ at priority level;
c) that the relatives who would be authorising payment of the charges from the woman’s own money, once deputyship had been awarded, should have been enabled to consider the alternatives, acting in the best interests of the person with the needs and the money to be spent upon those needs;
d) that since one can buy a very large amount of care for £4K a week – (160 hours at £25 an hour), especially with the benefit of a good care plan that informs how to structure any plan for care at home, and use the benefit of live in care on what’s called a daily average basis, they should have been told that care at home would have meant that the value of the woman’s house could not then be considered, which would have made a big difference to the charges.
The Ombudsman also found fault in the Council’s inability to secure a suitable nursing home for Mrs Y. Under sections 18 and 24 of the Care Act, once a local authority has determined that an adult has eligible needs, it must meet those needs, and it must prepare a care and support plan that specifies how the needs are to be met.
The duty to meet needs is not merely a target duty owed to the population as a whole; when triggered by an individual eligibility determination it becomes an enforceable duty owed to that person. Public law therefore requires the authority to take all reasonable steps to identify and arrange services capable of meeting those needs appropriately, suitably and in a manner that respects the person’s dignity, physical and mental health, and suitability of living accommodation, all of which are aspects of wellbeing under section 1.
Where no suitable provider can be found despite reasonable efforts, the authority may lawfully offer an alternative such as care at home provided that alternative is itself objectively capable of meeting the assessed needs and does not impose disproportionate burdens on family members who are under no legal obligation to provide care.
If the Council genuinely believed that the ‘at home’ option could meet needs, it should have explained that view transparently, set out the proposed package in a care plan, and afforded the family a proper opportunity to challenge that determination. If the Council’s professional conclusion was that only nursing home care was suitable, then its failure over months to locate a vacancy left it in breach of its core statutory duty. Public law does not permit an authority to say that a duty has been discharged merely because providers have declined to accept the placement; an interim solution is required, and even this one ought to be able to weighed against alternatives, Market failure of the kind happening here triggers the authority’s residual obligation to commission at a rate sufficient to secure provision or, in extremis, to provide services directly. The Ombudsman’s finding of service failure here reflects that principle and the fact that Mrs Y remained without the nursing care the Council had itself determined she required until she was readmitted to hospital.
The Council’s decision that nursing home care was required appears to have been taken in consultation with the family, which is consistent with the statutory requirement. However, once the search for a nursing home failed and the Council began to contemplate a return home, any revision of that best interests decision would have required renewed compliance with section 4 Mental Capacity Act consultation, transparent reasoning about why the alternative was now thought suitable, and proper regard to the daughters’ concerns about their mother’s emotional and psychological wellbeing. The record here suggests the Council may not have re-opened the assessment or revised the care plan in a procedurally compliant way before proposing the home option, and if so that would have constituted a further breach of both the Mental Capacity Act and the Care Act planning duty in section 25.
Families and advocates should understand that they are entitled to see a written care and support plan before services commence, from the Council and not just the care provider, to receive a written record of any financial assessment setting out the weekly charge and the basis on which it has been calculated, and to be told at the outset if costs will be backdated or if charges for additional elements such as 1 to 1 support will apply.
If that information is not forthcoming, it is open to the family to ask the Council in writing for the plan and the financial assessment, citing section 25 and section 17 respectively, and if necessary to escalate via the statutory complaints procedure or, where the issue concerns legality or procedural fairness, by way of a referral to the Monitoring Officer under section 5 of the Local Government and Housing Act 1989. Where the authority’s offer appears insufficient or where no suitable provider can be secured, the family should press the authority to explain in writing why it considers the offer lawful and why it has not been able to meet the duty to secure provision, as that explanation will be necessary both for accountability and, if required, for any subsequent legal challenge.
The Ombudsman’s conclusion that the Council should have made the charges more transparent at the outset reflects a well-established public law principle that procedural fairness demands clear, prior information where a statutory function will lead to financial or any other significant wellbeing consequences for an individual.
The duty in section 17 of the Care Act 2014 to carry out and provide a written record of a financial assessment, and the overarching duty in section 1 to promote wellbeing by enabling people to participate as fully as possible in decisions affecting them, both required the Council to spell out the full weekly cost, the cumulative exposure over time, and the point from which charges would start to accrue. Using loose language such as “funding” and “funded” without clarifying that the estate would bear the cost once eligibility had been determined fell short of the standards mandated by the Care and Support Guidance, which states at paragraph 8.16 that the written record should explain how the assessment has been carried out, what the charge will be and how often it will be made.
That guidance further emphasises that information should be provided in a manner the person can easily understand. The failure here denied Mrs Y and her family a genuine opportunity to explore alternatives, such as a privately arranged package at a potentially lower cost, and so amounted to a breach of the statutory requirement to provide intelligible information.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Essex County Council (24 023 221) report. If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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