Staffordshire County Council (18 005 920)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 02 Jan 2019

The Ombudsman's final decision:

Summary: Ms X complains the Council failed to carry out all the actions it agreed to a take following her previous complaint, making both her mental health and physical health worse. The Council has not completed all the actions it agreed to take. This has caused unnecessary distress to Ms X. The Council needs to take action to remedy the injustice it has caused.

The complaint

  1. The complainant, whom I shall refer to as Ms X, complains the Council failed to carry out all the actions it agreed to a take following her previous complaint. She says this made both her mental and physical health worse.

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The Ombudsman’s role and powers

  1. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
  2. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)
  3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)

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How I considered this complaint

  1. I have:
    • considered the complaint and the documents provided by Ms X;
    • discussed the complaint with Ms X;
    • considered the comments and documents the Council has provided in response to my enquiries; and
    • shared a draft of this statement with Ms X and the Council, and invited comments for me to consider before making my final decision.

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What I found

  1. Staffordshire and Stoke on Trent Partnership NHS Trust (the Trust) does adult social care assessments, and produces care and support plans for the Council. Because of paragraph 4 above, the Council is accountable for the Trust’s actions. I therefore refer to the Council in this statement.
  2. When investigating Ms X’s previous complaint we found that, despite identifying eligible care needs, the Council did not produce a care and support plan explaining how it would meet them. This left Ms X without any care for up to two years. We issued our final decision on 9 May 2018 when the Council agreed to:
      1. within four weeks apologise to Ms X for its failings, and pay her £750 for the distress it had caused and the time and trouble it put her to in pursuing her complaint;
      2. within six weeks assign another officer to reassess Ms X’s needs and put in place a care and support plan for meeting her eligible care needs;
      3. within six weeks work with the NHS to resolve an issue of funding for meals at a respite facility.
  3. The Council also agreed within eight weeks to consider what action it needs to take to ensure assessments and care and support plans meet the requirements of the Care and Support Statutory Guidance including:
        1. eliminating unnecessary delay over assessments, care and support planning and decisions on personal budgets;
        2. ensuring assessments adequately identify care needs;
        3. providing estimated personal budgets as the basis for care and support planning;
        4. providing people with copies of their assessments and care and support plans; and
        5. ensuring care and support plans include the final personal budget.
  4. We asked the Council on 8 June if it had sent the apology and made the agreed payment.
  5. On 13 June a Neighbourhood Manager wrote to Ms X inviting her to a meeting “to discuss the allocation of a new Social Worker and how we move forward”. This was because in April an Area Manager had decided the Neighbourhood Manager should visit Ms X “before we agree to change the [Social Worker] as there is no real basis for this and is a repeated pattern by” her.
  6. The Council says it sent an apology to Ms X on 14 June. On 19 June the Council told us it would arrange for a cheque to be sent to Ms X.
  7. On 3 July Ms X confirmed she had received the Council’s cheque but not the apology. The Council said it would send another apology to Ms X. It also agreed to sort out an Advocate for Ms X for her meeting with the Neighbourhood Manager.
  8. Ms X met the Neighbourhood Manager on 2 August. The Neighbourhood Manager agreed to appoint another Social Worker to assess Ms X.
  9. The Social Worker visited Ms X on 20 August to assess her. The assessment says Ms X cannot achieve these outcomes “within a reasonable timescale and without significant pain, distress, anxiety, or distress to yourself or others”:
    • manage and maintain nutrition;
    • maintain personal hygiene;
    • manage toilet needs;
    • maintain a habitable home environment;
    • make use of the home safely;
    • develop and maintain family or other personal relationships;
    • access and engage in work, training, education or volunteering;
    • make use of necessary facilities or services in the local community, including public transport and recreational facilities or services;
    • carry out any caring responsibilities for a child.
  10. However, the assessment says Ms X is not seeking work. Nor does she have any caring responsibilities for a child. The assessment says Ms X:
    • needs help twice a day managing continence;
    • cannot independently shower or wash safely and cannot use a bath;
    • is reluctant to accept care in her home but would like help accessing bathing facilities in a care home because of her physical limitations;
    • needs someone with her to remain safe when accessing the community;
    • is entitled to free care under Section 117 of the Mental Health Act 1983.
  11. The assessment resulted in an indicative personal budget of £205 a week. The Council produced an indicative support plan which says;
    • Ms X cannot maintain dignity and respect due to the lack of access to suitable bathing facilities;
    • her physical health has impacted on her emotional wellbeing and she suffers from acute periods of anxiety, stress and low mood;
    • her personal care needs are neglected due to her inability to maintain them independently;
    • her social and economic wellbeing is compromised by her inability to access the community unsupervised;
    • Ms X feels a direct payment for a personal assistant to support her would give her control over her day to day life and how her needs are met.
  12. The indicative support plan provides for a personal budget of £86.63 a week to:
    • employ a personal assistant for four hours (direct payment of £41.88);
    • pay for four weeks of respite care a year;
    • cover the costs of being an employer and managing a direct payment account.
  13. The Social Worker sent Ms X’s indicative support plan to the Council’s Brokerage Team. On 10 September the Social Worker received this message: “declined request - no change in need and not social care eligible”. Ms X says it is not correct to say her needs have not changed. She says since having a fall in October 2017 she has had no use of her right arm.
  14. On 20 September the Social Worker e-mailed Ms X’s Advocate. She said Ms X had asked for a meeting on one of three dates in October, including 16th, which was the only date the Social Worker was available. She asked the Advocate to check if this was OK with Ms X. She said the Council had turned down Ms X’s request for support as the offer of a disabled facilities grant (DFG) was still open if she wanted to have her home adapted to meet her needs. She said the Council would not reconsider its position unless Ms X’s needs changed significantly. She said she sent the assessment agreed by Ms X, with a section amended as requested by the Advocate.
  15. Ms X says she understood there would be another meeting to agree the assessment.
  16. On 21 September the Social Worker told the Advocate she had made the amendments asked for before sending the assessment to the Brokerage Team. She said she sent it off because the Area Manager had said they needed to reconsider the requests for support because of the Ombudsman’s recommendations. She said they could meet to “complete the assessments and resubmit” if Ms X was still unhappy. Alternatively, she said Ms X could complete a self-assessment.
  17. Ms X has previously raised objections to a DFG because:
    • she may have had to repay £6,000 (if she sold her home);
    • a disabled wet room would devalue her home by £6,000;
    • handymen working for the company which would have installed the wet room had stolen her property in the past (ring inherited from her mother) so she did not trust the company;
    • her home is jointly owned with her ex-husband (who was abusive to her), so she would also need his consent for disabled adaptations.
  18. With regard to the service improvements identified in paragraph 7 above, the Council says it is looking at ways to digitalise the system to ensure timely assessments take place, which automatically alert its Brokerage Team to arrange any service required to meet assessed needs. It says this will mean front line workers (e.g. Social Workers) can use electronic devices for assessments. However, it says it cannot fully eliminate human error.
  19. Ms X says she has recently had three falls while trying to deal with her own personal care (dress and wash), which have made her condition worse, as she can no longer grip with her left arm.

Is there evidence of fault by the Council which caused injustice?

  1. Despite agreeing to apologise and pay Ms X £750, the Council did not do this until after we sent a reminder. That was fault by the Council. The Council is aware of Ms X’s problems with anxiety and that any delays are likely to distress her.
  2. Despite agreeing to assign a new Social Worker to reassess Ms X and put in place a care and support plan within six weeks, the Council took five weeks to invite her to a wholly unnecessary meeting with the Neighbourhood Manager. That was fault by the Council which caused unnecessary delay and distress to Ms X. It appears the Council invited Ms X to a meeting because it was reluctant to appoint another Social Worker. But it had no choice, having already agreed to do this.
  3. Rather than six weeks, it took the Council nearly 15 weeks to reassess Ms X’s needs and produce an indicative care and support plan. That was fault which caused further distress to Ms X.
  4. Having identified eligible care needs the Council has a duty to produce a care and support plan. The Council has produced an indicative care and support plan but has not agreed a final plan. The Council has not therefore completed the actions it agreed to take. That is further fault by the Council. The Council has allowed the process to stall following the response from its Brokerage Team.
  5. The Council appears to have questioned whether Ms X has eligible care needs, without having any basis for doing so. The Council has identified eligible needs in a number of areas, including personal hygiene and accessing the community.
  6. It also appears the Council is only prepared to meet Ms X’s need for help with personal hygiene if she accepts a DFG. If that is the case, it needs to be reflected in the care and support plan. However, I have seen no evidence of the Council addressing Ms X’s objection to a DFG. It needs to do so before deciding that is the only option it is prepared to support. It also needs to give consideration to Ms X’s mental health as well as her physical health needs. Furthermore, Ms X has other eligible needs, including accessing the community, which the Council is not meeting because it has not put any support in place. The indicative personal budget would have met that need, as well as the need for help with personal hygiene.
  7. It is unclear from the indicative support plan what need the proposed respite funding was intended to address. It is also unclear why the Council has turned this down. The Council needs to address this lack of clarity and also “work with the NHS to resolve an issue of funding for meals at a respite facility” as it agreed to do.
  8. With regard to the service improvements identified in paragraph 7 above, the Council’s response is inadequate as it does not address all the issues it agreed to address. The Council needs to reconsider its response.

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Agreed action

  1. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the Trust and the Council, I have just made recommendations to the Council.
  2. I recommend:
    • within four weeks the Council’s Chief Executive writes to Ms X apolgising for the fact that she has had to complain again, the distress it has caused her and the failure to complete a care and support plan;
    • within four weeks the Council pays Ms X £500 for the distress she has been caused and the trouble she has been put to, and a further £350 so she can make her own arrangements for care until the Council agrees a care and support plan with her;
    • within six weeks the Council agrees a care and support plan with Ms X which meets her eligible care needs;
    • within eight weeks the Council reconsiders its response to the service improvements identified in paragraph 8 above and consider what it needs to do to make sure care and support planning does not end when the Brokerage Team does not accept an indicative care and support plan.

The Council has agreed to do this.

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Final decision

  1. I have completed my investigation as the Council has agreed to take the action I recommended.

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Investigator's decision on behalf of the Ombudsman

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