A council was at fault for incorrectly charging a man for care he received in the wake of a leg amputation, the local government and social care ombudsman has found.
The watchdog found that North Somerset council’s ‘enablement’ service, which was offered to the man, ‘Mr Y’, should have qualified under the Care Act 2014 as ‘intermediate care’.
The act defines intermediate care as services that enable an adult to regain the ability to live independently in their own home.
Statutory guidance stipulates that where councils provide intermediate care and reablement support to people who need it, the first six weeks must be offered free of charge. Mr X was charged at a flat weekly rate for support he received in a care home after leaving hospital, as well as being billed for full care costs from day one.
The ombudsman’s report concluded that North Somerset’s enablement service was not materially different from an existing reablement service, save for being delivered in a care home setting rather than in people’s own homes.
“Simply referring to intermediate care by another name does not allow the council to charge for it,” said Michael King, the local government and social care ombudsman. “Intermediate care, where people are receiving support with the intention of returning home, cannot be charged in this initial period.”
North Somerset council agreed to repay £722.40 to Mr Y and reduce an invoice payable to the authority for care costs by £1,887. The council also said it would review its adult care charging policy to ensure compliance with the Care Act.
Following his amputation, North Somerset decided Mr Y needed ‘residential enablement’, including emotional support, to regain his independence. The council said it had explained its care-charging processes, including that its enablement service incurred a fixed weekly charge of £120.40.
From June 2016, Mr Y spent 14 weeks in a care home, one of a list the local authority provided to he and his son, ‘Mr X’, that charged within what the council was willing to pay. In December, after the men did not return a financial assessment form sent by the council, it invoiced Mr Y for the full cost of care, prompting a complaint from Mr X.
“He told the council the family believed enablement was a stepping stone to Mr Y returning home and that the council would pay for it,” the ombudsman’s report said. “Mr X explained they would not have agreed to Mr Y moving to the care home if the family had known there would be a charge.”
The council subsequently provided information to the ombudsman regarding a bed-based intermediate care recovery service provided in its area, jointly funded by it and the NHS and delivered free of charge for six weeks.
The authority said however that its enablement service, as used by Mr Y, did not fall under ‘intermediate care’ because it was “utilised by service users who have been assessed as requiring permanent residential or nursing care”. It told the ombudsman that Mr Y, who is now living at home without a support package, was deemed unsuitable for intermediate care having refused a prosthesis and being assessed as having limited potential for further rehabilitation.
The watchdog concluded North Somerset had “used two conflicting definitions of enablement – one where the individual is assessed as requiring permanent residential or nursing care and another where the individual receives help to prepare to live at home”.
The ombudsman said the council’s definition of ‘enablement’, as used on its website, was essentially the same as bed-based intermediate care.
Its report said that Mr X and Mr Y had been caused anxiety because of North Somerset charging for enablement care, “when that care is intermediate care under the Care Act 2014”.
North Somerset did not accept that it had provided intermediate care under the ‘enablement’ name, but conceded that Mr Y should have been offered the alternative recovery programme. It acknowledged publishing misleading information and said it would be reviewing its enablement service, which the ombudsman concluded needed to be “clearly distinguishable from intermediate care under the Care Act”.
A council spokesperson said: “The council recognises the findings of the ombudsman report and is in the process of implementing all the recommendations within agreed timescales. We have already refunded the family and apologised for any faults identified in the report.”