Summary: Ms X complains that the Council did not assess Ms Y’s needs properly and significantly reduced her support without reason. She says Ms Y was distraught about this. The Ombudsman finds the Council was at fault causing Ms Y significant distress, time and trouble. It has agreed to pay Ms Y £1200, reinstate her support hours and complete a fresh assessment. It will also take action to prevent similar problems in future.

The complaint

1. The complainant, whom I shall refer to as Ms X, is a case worker from a mental health charity. She complains on behalf of Ms Y that the Council:
• Did not properly consider Ms Y’s needs when it assessed her.
• Significantly reduced her support without good reason.
2. Ms X says the support plan now compromises Ms Y’s wellbeing, dignity and choice, and does not leave enough time for essentials, increasing the risk to her health. Ms Y is distraught and would like the Council to reinstate the 33 hours she previously received.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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, section 30(1B) and 34H(i), as amended)
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). In this case, Ms Y consented to Ms X complaining on her behalf.

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How I considered this complaint

6. I considered information from the Complainant and from the Council.
7. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

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What I found

8. Sections 9 and 10 of the Care Act 2014 (the Act) say councils must assess the needs of an adult who appears to need care and support. The council must do this regardless of whether it thinks the person has eligible needs and regardless of the person’s finances.
9. The statutory guidance says a council must consider “the total extent of a person’s needs” before it considers the person’s eligibility for care and support and what types of care and support can help to meet those needs. This must be “regardless of any support being provided by a carer”. The assessment must include “looking at the impact of the adult’s needs on their wellbeing and whether meeting those needs will help the adult achieve their desired outcomes”. Councils must give people a record of their needs assessment.
10. After establishing the “total extent of needs”, the council should consider which are eligible needs under the Act. The guidance says councils must consider whether:
1. The adult’s needs are due to a physical or mental impairment or illness.
2. The adult’s needs mean they cannot achieve one or more specified outcomes.
3. As a consequence of being unable to achieve one or more of the ten specified outcomes there is, or is likely to be, a significant impact on the adult’s wellbeing.
11. Eligible needs are those that meet all of these conditions (a-c). The ten outcomes referred to in b) above include:

• maintaining nutrition,
• maintaining personal hygiene,
• using the home safely,
• maintaining a habitable home,
• developing and maintaining personal relationships, and
• making use of facilities or services in the community.

12. The guidance says: “being unable to achieve these outcomes” includes being able to achieve them with assistance or achieving them without assistance but where “it takes significantly longer than would normally be expected”.
13. When a council decides someone has eligible needs, it must produce a care and support plan explaining how to meet them. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support is available locally.
14. Councils should conduct a review of a care and support plan at least every 12 months. As well as the duty to keep plans under review generally, councils must conduct a review if the adult or a person acting on the adult’s behalf asks for one.
15. Where a council is meeting some needs, but not others, the care and support plan should clearly set out which needs it will meet and which needs it will not. It should explain this decision. The council should give the person a personal budget to meet the eligible needs identified in the care and support plan. The council must ensure eligible needs are met but it does not have to provide services directly. The personal budget must always be an amount enough to meet the person’s care and support needs. The detail of how the person will use their personal budget will be in the care and support plan.
16. The statutory guidance says:
• “At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising”.
• local authorities “should take a holistic approach” to considering the needs to be met. They should make “comprehensive provisions” to accommodate fluctuating needs, and detail contingencies for sudden changes or emergencies.
• “Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high quality, coordinated assessment”.
• “Where the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise”.
• “The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life”.
• “Consideration of the needs to be met should take a holistic approach that covers aspects such as the person’s wishes and aspirations in their daily and community life, rather than a narrow view purely designed to meet personal care needs”.
• Reviews must not be used to “arbitrarily reduce” a person’s personal budget.
17. The guidance provides examples of how local authorities should consider each outcome. It says “local authorities should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments”.
18. The Act also places a duty of promoting individual wellbeing on local authorities. It sets out nine areas of wellbeing as:
• Social and economic wellbeing
• Personal dignity
• Physical, mental and emotional health
• Protection from abuse and neglect
• Domestic, family and personal relationships
• Personal control
• Individual contribution to society
• Suitability of living arrangements
• Work, education, training and recreation.
19. The Ombudsman’s complaint factsheet on assessments says the Ombudsman normally considers that it is reasonable for an assessment to take between four and six weeks from the date of the initial request.

What happened

20. Ms Y has degenerative health conditions and disabilities which cause her considerable pain and significant difficulties with mobility, continence, and daily living activities. She also has mental health conditions which cause her difficulties in accessing the community and dealing with people she does not know and trust.
21. Following an initial assessment in 2017, the Council provided Mrs Y with 21 hours per week to help her get out of bed, washed, dressed and organise meals and drinks for the day. Ms Y said she needed help to access the community and social and leisure activities. Ms Y says the Council advised her that she would have to make separate referrals for assessments of her social care needs relating to her physical disability and those relating to her mental health. Ms Y asked several times for an assessment of her social care needs relating to her mental health.
22. In October 2017, the wheelchair service assessed her wheelchair needs and advised Ms Y that she should not remain seated in a wheelchair all day. It recommended an assessment for a riser recliner armchair “to enable transfers and reduce pain on transfer”. It said it would “benefit fatigue and pain and pressure care management”.
23. In November, Ms Y asked if the Council could help with funding a riser recliner chair and bed. She also asked for an assessment to include her social care needs relating to her mental health such as those around accessing the community.
24. In January 2018, Ms X wrote to the Council and asked for an urgent review of Ms Y’s care plan. She said her needs for aids and adaptations within the home may have been overlooked. She asked the Council to consider providing a riser recliner armchair as a matter of urgency. She also asked it to consider 2-3 hours per week to support her to access the community as she was isolated and lonely.
25. Less than one week later, the Council left a voicemail message. This advised that Ms Y was already on the list for an urgent referral to an occupational therapist (OT) and for a review of her care needs.
26. In March 2018, Ms Y complained to the Council. She said that despite being on the list for an urgent referral she had not had any contact. She asked for dates for the OT assessment and review of care and support needs. The Council responded a few days later and apologised. It said the delay was due to a lot of urgent referrals and loss of experienced staff. It said it would allocate an OT to assess her within two weeks but may not be able to assess her social care needs at the same time. The Council also agreed to assess her needs relating to both mental health and physical disability.
27. On 23 April, the OT completed an assessment and agreed to order an armchair, not a riser recliner. Ms X’s records note Ms Y told the OT that pushing herself up out of a chair caused pain to her back, neck, wrists and shoulders. The OT said because Ms X could get out of a chair in the shower, she must try this chair first. Ms X explained that she did not push up to get out of the shower chair but pulled herself using grab rails. Ms X’s records also note the OT initially said Ms X’s need for a height adjustable bed so she could raise her head to assist with breathing difficulties, was a health need. A week later, the OT ordered some equipment including an armchair and a bed. The OT also referred Ms Y to the local council for an adaptation to her home. Ms X says the Council did not provide a copy of this assessment.
28. In May, an assistant practitioner (AP) visited to review Ms Y’s care plan; APs are trained to assess, support and review people’s needs. Ms Y asked for more hours because she needed to shower more often. The assessment notes Ms Y’s difficulties, support needs and desired outcomes. The AP noted that because of her dog, Ms Y had chosen to stay at home rather than go to hospital when she had pneumonia. She also noted Ms Y’s anxiety and depression had an impact on her ability to access the local community. She noted this was likely to have a significant impact on her “social wellbeing, emotional wellbeing and mental health”. Ms X’s record of this meeting notes that the AP confirmed this was not an assessment to identify Ms Y’s social care needs relating to mental health.
29. On 30 May 2018, Ms X telephoned the OT; the Council records note she said the chair was “of no use to her” and she found it uncomfortable.
30. The AP contacted the mental health team manager who suggested a joint assessment.
31. On 12 June, the AP and an OT visited to review Ms Y’s needs and equipment. The OT observed Ms X use the armchair. In response to concerns raised, the OT advised Ms Y and Ms X that the Council had not refused to give Ms Y a riser recliner chair. She said she was continuing to assess Ms Y’s needs to identify the correct chair. Council records note the OT acknowledged Ms Y needed a riser chair because she had a functional need to stand. She also acknowledged a recliner chair would support Ms Y’s legs but said this was a health need. Ms X’s records note the OT advised that Ms Y’s need to have her legs raised is a health problem therefore “not part of her remit or funding pot”. However, the OT arranged a trial of a riser recliner armchair. The AP increased Ms Y’s support from 21 hours to 27 hours to enable her to shower more often, three times a week. Ms X says the Council did not provide Ms Y with a written record of this visit. The Council records note the AP and OT advised Ms Y the Council would not provide 24 hour support following her discharge from hospital after an operation. They said this would be an NHS responsibility. Ms Y also asked about support to attend hydrotherapy; the AP advised the Council was unlikely to fund this also that the Council would not provide support to attend medical appointments.
32. On 21 June, the armchair was replaced with a riser recliner chair.
33. On 26 June, the AP spoke to the mental health team manager. He said they were unlikely assess Ms Y because when people have both physical and mental health needs, they would assess both. The OT visited Ms Y to review the riser recliner chair. Ms Y advised the OT that while the chair helped in some respects it was not entirely comfortable and she had some problems with it causing her pain. The OT arranged a table to use with the chair and noted to review in a couple of weeks.
34. Following further discussion with the mental health team and Ms X, and her manager, the AP advised Ms Y she would visit to discuss support to access social activities. She said if there were any unmet needs in this area, she would discuss with her manager to find out whether funding would be agreed.
35. In July the AP and a practice consultant assessed Ms Y and agreed to allocate six hours per week for support to access the community, to be reviewed after three months.
36. On 8 August 2018, the OT contacted Ms Y because the AP said she was having problems with the chair. The OT visited the following week and decided to trial a different chair. She contacted a supplier with the measurements to arrange for this.
37. The additional six hours for accessing the community began on 13 August.
38. On 28 September 2018, the OT trialled another chair for Ms X. It was more suitable, so she recommended the Council provide one for her.
39. On 2 November, the Council confirmed it had approved and ordered a new chair.
40. A meeting to review the additional six hours was planned for 15 November. The AP rescheduled the meeting to 27 November. On 14 November, the AP sent Ms Y a brief email to advise the six hours had ended with immediate effect. Ms Y misunderstood this and replied “Thank you”. As Ms Y had not understood, she continued paying her personal assistants to provide this support for a further two weeks before she realised it had ended. The Council said she would have to pay this herself, from her benefits.
41. On 27 November, the AP and a social worker visited to reassess Ms Y’s care and support needs. Ms Y gave a detailed account of how she had used the additional six hours and Ms X says they agreed she had used these appropriately. Ms Y said the only issue now was she had no support to attend medical appointments. Ms X’s records note the AP and social worker advised she should speak with her GP as this was a “health issue”. The assessment also noted Ms Y’s fluctuating abilities and noted “it is essential this is factored in to her support package”. The assessment noted the areas of wellbeing significantly impacted were personal dignity, physical and mental health and emotional wellbeing, control over day to day life and social wellbeing. It noted that Ms Y needed support to get out and about once a week and needed “specialist one-to-one support to do this safely”. A discussion was planned for 4 December to discuss the existing personal budget and support hours with “management”.
42. The next day, the AP advised Ms X that the team manager would review Ms Y’s care and support plan the following week. Ms X asked that he considered that Ms Y had made full use of her 33 hour plan. She said she had a two year wait for treatment for a mental health condition, a one year wait for an adaptation, and was waiting for an electric wheelchair for use outside. She asked that the 33 hours be reinstated. Without this, she said Ms Y felt her needs relating to her mental health were not being met.
43. On 4 December, the manager agreed to add six hours for a further four weeks until the outcome of the re-assessment.
44. On 20 December, the OT visited to review Ms Y’s morning routine. Her records note that Ms Y said she was having a bad day while she was in the bathroom. The OT noted details about Ms Y’s routine and the difficulties she had. She noted the outcome that Ms Y remained eligible for support but that her needs could be met and managed “in a time efficient way”. The OT recommended a revised care plan to be trialled for three weeks and then reviewed. This reorganised the individual tasks completed by the personal assistant and limited it to those in the care plan. It based this on the assumption that this had been a bad day for Ms Y. The OT did not record any discussion with Ms Y or Ms X about what a bad day would mean in terms of impact and how her needs might vary. The support plan gave clear information for those providing care and was detailed about what support Ms Y needed and what wasn’t covered by the care and support plan. Ms Y’s hours would be reduced to just under 21 hours.
45. Just before Christmas, the Council offered Ms Y a meeting to discuss the new care plan. She told the Council she could not leave her home without support and asked for a home visit but was then unwell and the meeting could not go ahead. The Council sent Ms Y the new care and support plan on 8 January 2019. Ms Y complained and said the support provided was unfair. She had not been able to give her personal assistants enough notice of the change in hours which left her at risk of an employment tribunal. She said the chair had still not been delivered and that the new care plan:
• assumed she would not use the toilet more than once.
• allowed insufficient time to cook meals; she did not always want ready meals.
• did not allow time for batch cooking, previously suggested by the OT.
• failed to include time for wiping down three times and creaming at each pad change as recommended by the tissue viability nurse.
• said she should be left in the bathroom in her soiled state while the personal assistant stripped the bed and cleaned the mattress.
• did not allow time for her to recover between activities as recommended by her pain management adviser.
• meant her trusted personal assistant would now need to take another job to make up her hours and would therefore not be as flexible when she needed extra help or to attend health appointments.
• did not allow for attending health appointments; she would not be able to go.
46. On 9 January 2019, the Council responded to Ms Y’s complaint and said the chair was due for delivery imminently. A social worker had been allocated at Ms Y’s request and had completed a reassessment. The outcome was a reduction from 33 hours to 20.45 hours to take effect from 14 January.
47. On 10 January 2019, the new chair was delivered to Ms Y; she was happy with this. Ms Y emailed the Council; she restated her concerns about the new care plan, asked for a new team to consider her needs, and said the new care plan also:
• did not account for her social care needs relating to her mental health
• dictated when she should eat, how long this would take, when she should shower and how long. She said she could not eat on demand and needed to build up to showering and getting dressed to allow time for the pain to ease.
• allowed no personal choice.
• Allowed no time for the time it takes for the personal assistants to strip soiled clothes and give a bed wash and clean clothes. This was needed in the morning and sometimes in the evening.
• Allowed no time for personal assistants to hoover and dust floors and surfaces to reduce irritation to her lungs; she had owned her dog for seven years so before she got so unwell.
48. On 11 January, Ms X brought Ms Y’s complaint to the Ombudsman.
49. A care and support plan dated 14 January, shows Ms Y was to get 1 hour 45 minutes daily support to help with washing, dressing, medication and meal preparation. Also, 30 minutes daily for evening support to get to bed, and four hours weekly for supported activities in the community. This was to be topped up to 27 hours per week from 14 January to 11 February so that Ms Y could give enough notice to her personal assistants. The Council responded to Ms Y’s further complaint and said both workers were experienced and undertook the review in line with the Care Act 2014. It said direct payments are flexible and helpful for fluctuating conditions. It said there was no reason to transfer her case and it would be reviewing her care plan in four weeks. It signposted her to the Ombudsman if she was not satisfied with this response.
50. Ms Y subsequently advised the Council that she had cancelled an operation and a urology appointment due to the lack of support available. Ms X provided evidence of this. She said she was devastated, stuck in the house 24 hours a day and scared of being left in wet/soiled pads for hours on end. She was also worried that she was bound to get pneumonia more often. She said the reason for having personal assistants in the first place was because they could do more in the way of cleaning. She said “Life isn’t worth living” and she was a “prisoner in my own home”. The social worker advised her that there would be no change to the care plan.
51. On 11 February, Ms Y’s support was reduced to 19 hours and 45 minutes.
52. On 21 March, the social worker and practice consultant visited Ms Y to review her care plan. They agreed to add an extra 15 minutes daily for showering and said they considered she had enough time to be flexible with good and bad days. They said Ms Y had four hours each week to access the community but she said she uses this on personal care and other tasks. The OT said the reduction was due to time previously spent on non social care activities like medical appointments and deep cleaning. They said the Council would support only basic hygiene; wiping down the kitchen and bathroom. Cleaning due to lung condition would need to be paid for privately or Ms Y could speak to her GP to see if health support was available. They also said the Council no longer provided support for gardening, or attending medical appointments, and she would have to pay for this privately. She could also ask her GP about support to attend medical appointments. They said she should arrange delivery of her prescriptions by the pharmacy and the Council could provide one-off support to set up direct debits to deal with bill payments. They discussed Ms Y’s needs in detail and said she needed to be flexible with her care routine to deal with fluctuations in mobility. They also said they considered she had enough support for times when she was unwell and needing bed care.
53. Ms X says the review still did not consider:
• the time it takes to clean Ms Y, dispose of the soiled pad, dry and apply cream, to help with a clean pad, and dress her.
• the time she needs to rest between activities due to her breathing problems.
• for personal assistants to get towels from the drier and wrap around Ms Y.
• the time for batch cooking.
• that the dog and cleaning are important for her wellbeing.
• that Ms Y needs help with making medical appointments and paying bills due to problems with concentration. Not everything can be managed with direct debits.
• support to attend medical appointments from a known and trusted person. She needs an average of two hours per week for this.
54. Ms X provided a step by step breakdown of the new care plan with details of tasks that were missing and would need more time. The Council has not responded to these specific points. She says the reduced support has resulted in missed showers, no help with additional toileting needs or access to the community, and an increase in depression, anxiety and pain. This has also increased Ms Y’s morphine intake. Ms Y has missed physio and urology appointments and an operation. She says this contrasts with the situation at the review in November 2018 when Ms Y’s mental and physical health had improved since the increase to 33 hours.
55. Ms X says Ms Y was not provided with a written care plan or records of the assessments and reviews she engaged in on 23 April, 23 May, 25 July, 27 November and 20 December. Ms X also reports that Ms Y is approximately £50 worse off each week following changes to the Council’s charging policy for her care. She also has a reduced benefit payment because she has a spare bedroom. She says despite this, Ms X is now expected to pay privately for cleaning her house, gardening, chiropody, and support to medical appointments which she cannot afford.

Was there fault which caused injustice?

56. It is not the Ombudsman’s role to decide if a person has social care needs, or if they are entitled to receive services from the Council. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law.
57. Ms Y contacted the Council in November 2017, asking for a riser recliner chair and help with accessing the community. The Council took over five months to complete an OT assessment, and over eight months to consider her needs around accessing the community. This despite being flagged as urgent and at least ten assessment or review visits from the OT, AP and social worker. It was over one year before she got the riser recliner chair that she needed and over eight months before she got support to access the community. Given the Care Act’s focus on prevention and early intervention, this is too long. This was fault by the Council and caused Ms Y significant and avoidable distress. It also meant she was without services to meet needs, which were eventually identified as eligible needs, for a considerable time. There is enough evidence to suggest that, on the balance of probability, these needs would have been identified as eligible had she been assessed within 28 days.
58. When the Council identified Ms X’s needs around accessing the community as eligible, it put in place a temporary arrangement to meet those needs and ended the arrangement without review or assessment. It had identified eligible needs and having done so, it needed to ensure these needs were met. It is unclear why the Council felt only a temporary arrangement was warranted. If it expected the needs to have been reduced or ended by three months of support, it should have made this planned outcome clear in the care and support plan. It needed a review and a reassessment to identify any significant change in needs. The Council has now included this support in the care and support plan but has reduced it to four hours; I saw no reasoning for this. It should not use a review to arbitrarily reduce the support. The Council was at fault in ending support for accessing the community without reason. When it decided to reduce the amount of support for this, it should have clearly set out how it came to this decision. This caused Ms Y significant and avoidable anxiety, stress and uncertainty.

For the most part, the Council’s assessments were well considered and contained the information needed to make a sound decision about Ms Y’s care and support needs. They contained much detail, recognised the importance of fluctuating needs and contingencies, and demonstrated a clear understanding of the Care Act process in general. This is good to see. However, there was insufficient consideration of the difference between a good day and a bad day. This meant it was not clear that the time saved on good days would be enough to cover the extra needed on the bad days. The OT overheard Ms Y say it was a bad day but she did not know what Ms Y referred to and did not ask. Ms Y has multiple difficulties; she says this referred to her continence, but it was not a bad day with her mobility. Those assessing should have taken specialist advice on the impact of Ms Y’s specific health and mental health conditions or have been suitably trained in these conditions. This was fault and meant Ms Y’s care and support plan was based on incomplete information. We do not know what this would have looked like if it had been based on the full information so cannot say whether Ms Y would have received more support. However, we can say this caused Ms Y significant and avoidable stress, anxiety, uncertainty and confusion because she did not understand how the Council had decided on the support she needed.

59. Some of the changes the Council made to Ms Y’s support were understandable and the reasoning behind it not wrong. It is right that care needs should be met in the most cost effective and efficient way. However, it did not consider Ms Y’s complaint about the revised care and support plan in detail. It did not look at what she, and Ms X, said point by point and state why it did not agree. She said it had not allowed for her to be wiped down three times and creamed at each pad change as advised by the tissue viability nurse. It should have looked at this and taken advice from the tissue viability service if necessary. Ms Y said she needed time to recover between activities, this too needed further consideration and potentially advice from the physiotherapist who advised her. Ms Y said having her dog in the house really mattered to her. The Council failed to properly consider the impact on her of not having the dog, or not keeping the house clear of dog hair and dust. It should not fetter its discretion by taking the position that it will not provide certain support regardless of the circumstances. This also applies to the refusal to provide support to medical appointments. The Care and Support statutory guidance to the Care Act states that local authorities should consider needs for support when the adult is attending healthcare appointments. This was fault and caused Ms Y significant and avoidable distress because she complained and the Council did not fully address her concerns.
60. Throughout the process, the Council tried to dismiss various needs as “health needs” and even tried to separate mental health related social care needs. The Care Act 2014 is clear that assessments should be holistic and local authorities should work together with the NHS where there are health needs. Even so, supporting a person to medical appointments is a social care need. The Council did not consider whether Ms Y needed the support she requested; it just dismissed her request. If it accepts that she needs support to access the community on account of her mental health, then it seems likely she will need support to attend medical appointments. Ms Y should not be expected to use the support she receives to access the community for social and leisure purposes, to attend medical appointments. The Council needed to fully consider her needs in this area and it failed to do so. It was at fault here and this meant Ms Y has had to pay privately for support, or her personal assistant has done this without payment. This caused her further distress and some financial loss.
61. If the Council believed Ms Y had needs which were the responsibility of the NHS, it should have arranged a coordinated assessment. Alternatively, if it believed her needs were of the level that she might be eligible for continuing healthcare, it should have completed a checklist assessment. If this supported this view, it should then have referred for a full health needs assessment. At the least it should have consulted with those professionals who had advised Ms Y on aspects of her care. The Council is responsible for identifying all social care needs whatever the underlying cause and ensuring that eligible needs are met. Ms Y should not have been affected by any gap between health and social care. The Council was at fault in the way it dealt with this and this caused Ms Y further anxiety, stress and uncertainty. She was also caused significant and avoidable time and trouble in bringing her complaint. Although she has help from Ms X in this, she has found this difficult.

Agreed action

62. To remedy the injustice identified above, I recommended the Council:
1. Apologises to Ms Y detailing the faults identified above and the action the Council is taking to avoid similar faults in future.
2. Pays Ms Y £1,200 for the distress, loss of service and time and trouble.
3. Reinstates the 33 hours of support pending a fresh and full assessment which considers the specific issues raised by Ms Y and Ms X.
4. Completes a coordinated assessment with the NHS.
5. Takes advice from relevant professionals regarding the impact of Ms Y’s health conditions and the impact on her care needs.
6. Ensures staff understand when its specialist health and social care Continuing Health Care (CHC) service should be involved, reminding all staff and providing a clear flow chart setting out the procedure.
7. Consider how it deals with cases where people have complex health and social care needs and ensures joint assessments. It will do this as part of its operational review of joint working with CHC health staff.
8. Ensure staff are aware that:
1. the Council must ensure eligible needs are met and must not change this without a reassessment.
2. challenges to an assessment must be considered and responded to fully.
• Completes recommendations a) to c) within four weeks of the final decision, and the remainder within eight weeks.
• Provides the Ombudsman with evidence of the actions taken. Suitable evidence would include:
1. A copy of the apology letter
2. Confirmation of the payment and reinstated support hours
3. A copy of the completed assessment.
4. A copy of the flowchart and evidence of the reminder to staff.
5. Details of relevant work planned within the operational review of joint working with CHC health staff.

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Final decision

63. I have completed my investigation and uphold Ms X’s complaint that the Council:
• Did not properly consider Ms Y’s needs when it assessed her.
• Significantly reduced her support without good reason.
64. The Council has agreed to complete the actions detailed above and I am satisfied this will put right the injustice it caused as far as possible.

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Investigator's decision on behalf of the Ombudsman