Purpose of the policy
This policy sets out the Council’s approach to managing appeals and complaints relating to Care Act financial assessments, charging decisions and invoices.
The policy ensures that individuals are provided with a clear, fair and transparent process to challenge decisions, in accordance with statutory duties and good administrative practice.
Scope
This policy applies to:
- Adults who have been financially assessed under the Care Act 2014
- Representatives acting on behalf of an adult
- All Adult Social Care staff involved in financial assessment, charging, appeals and complaints
The policy covers:
- Financial assessments
- Care Act charging decisions
- Requests for reassessment
- Financial appeals
- Escalation to the Council’s complaints procedure
- Referral to the Local Government and Social Care Ombudsman
Legal and regulatory framework
This policy is underpinned by:
- Care Act 2014
- Care and support (Charging and Assessment of Resources) Regulations 2014
- Care and Support Statutory Guidance
- Local Authority Social Services and NHS Complaints Regulations 2009
- Human Rights Act 1998
- Equality Act 2010
Key principles
The Council will apply the following principles when managing Care Act financial appeals and complaints.
Transparency and clarity
Individuals will be provided with clear, accessible explanations of:
- How charges have been calculated
- The regulations and guidance applied
- The reasons for decisions at each stage
All decisions and outcomes will be confirmed in writing using plain language.
Proportionality and early resolution
The Council will seek to resolve concerns at the earliest and least formal stage possible, avoiding unnecessary escalation where matters can be resolved through explanation, correction or clarification.
Right to challenge and representation
Individuals have the right to:
- Challenge financial assessments and charging decisions
- Be supported by a representative, advocate or appropriate person
- Submit additional evidence at any stage
Reasonable adjustments will be made to ensure accessibility.
Lawful and consistent application of the care act
All financial decisions will be:
- Made in accordance with the Care Act 2014 and accompanying regulations
- Consistent with Care and Support Statutory Guidance
- Applied fairly and consistently across cases
Any discretion will be exercised apropriately and recorded with rationale.
Ability to pay and risk of hardship
The Council will have due regard to:
- The individual’s overall financial circumstances
- Disability-related expenditure
- Risk of financial hardship
- Wellbeing and human rights considerations
Particular care will be taken where individuals are vulnerable.
Fairness, independence and objectivity
Wherever possible, appeals will be considered by officers not previously involved in the case. Decisions will be evidence-based and subject to senior management oversight.
Distinction between appeals and complaints
- Financial appeals related to the application and outcome of financial charging decisions.
- Complaints relate to concerns about process, conduct, delay or maladministration.
This distinction ensures compliance with public law principles and Ombudsman guidance.
Learning and continuous improvement
Themes and outcomes from appeals and complaints will be monitored and used to:
- Improve practice and guidance
- Inform training and quality assurance
- Strengthen consistency and fairness in decision-making
Financial appeals and complaints process
Stage 1 - Local resolution
The Council will first attempt to resolve concerns informally through:
- Telephone contact
- Written correspondence
- Face-to-face discussion, where appropriate
This stage focuses on clarification, explanation or correction of errors.
Outcome
- Issue resolved or;
- Progression to Stage 2
Stage 2 - Financial review or reassessment
Where concerns remain, a formal financial review or reassessment will be undertaken.
Individuals must normally request a review within 28 days of the notification letter, setting out:
- The grounds for the request
- Any additional supporting evidence
The Council will acknowledge the request and confirm next steps. Where further information is required, this must be provided within 14 days of request.
The review will:
- Reconsider financial information
- Check correct application of the Charging Policy
- Consider disability-related expenditure and hardship
The review will be completed by a Senior Finance Office, not previously involved where possible.
Outcome
Written confirmation of a revised or upheld decision will normally be provided within 14 days, or as soon as reasonably practicable.
Stage 3 - Formal financial appeal (Financial Risk Panel)
If the individual remains dissatisfied, a formal appeal may be submitted within 28 days of the Stage 2 decision.
- Head of Service
- Assistant Director
- Finance Officer and/or Legal Advisor
The panel will consider:
- Compliance with legislation and statutory guidance
- Whether policy has been applied correctly
- Financial circumstances, risk and hardship
- Use of discretion and overall fairness
The appeal process will normally be completed within 28 days of receipt of a completed appeal submission.
Outcome
- A final financial appeal decision issued in writing
- Clear rationale for the discussion
Important financial position during appeal
During stages 2 and 3:
- The individual will continue to be charged their original contribution while the review/appeal is ongoing
- If the contribution is revised:
- Any increase or reduction will be backdated
- Any overpaymenrs will be refunded
Where a recommendation is made to waive or amend charges, this will be subject to senior management ratification.
Stage 4 - Statutory complaint
If the individual remains dissatisfied after the financial appeal process, they may raise a complaint under the Council's statutory complaints procedure.
This stage considers:
- Process
- Conduct
- Delay
- Administrative fairness
Oversight sits with Executive Director of Adult Social Care.
Stage 5 - Local government and social care ombudsman
If all local stages are exhausted, the individual may refer the matter to the Local Government and Social Care Ombudsman for independent review.
Responsibilities
- Adult Social Care Finance Teams: Implementation of assessments and reviews
- Senior Officers and Panel Members: Decision-making and governance
- Executive Director of Adult Social Care: Oversight of complaints and assurance
Policy review
This policy will be reviewed:
- Every three years from date of publication, or
- Earlier if required due to legislative or guidance changes