Summary: The Council was at fault when it reduced Ms A’s housing related support without first asking her if she wanted a social care assessment. During this investigation, it offered her a social care assessment and a payment of £150. This is a partial remedy. It will also apologise and ensure officers from Sensing Change send key documents to customers in their preferred format, making a record when they have done so.

The complaint

1. Ms A complains Suffolk County Council (the Council) reduced her care package. She also complains it did not send her a copy of her assessment, review or care and support plan.

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The Ombudsman’s role and powers

2. 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)
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)
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)

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How I considered this complaint

5. I considered:
• The Council’s response to Ms A’s complaint
• The complaint to us
• Records described later in this statement
• The parties comments on a draft of this statement.

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What I found

6. Supporting People was funding to provide housing-related support services to people to help them maintain their housing. The government scrapped the scheme, but continues to provide funding for housing support to councils. Some, including this council, continue to commission housing-related support. Councils had powers to charge people for supporting people services, but those charges were also scrapped when the government ended Supporting People.
7. A council must carry out an assessment for any adult with an appearance of need for care and support, applying national criteria to decide if a person is eligible for care. (Care Act 2014, section 9)
8. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2)

9. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
10. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)
11. A person can take their personal budget as money, and use it to arrange care to meet the needs and outcomes specified in their care and support plan. This is called a direct payment.
12. People have to pay a charge for most long-term care and support services that a council provides under the Care Act 2014.
13. Intermediate care is a structured programme of care provided for a limited time to help a person maintain or regain the ability to live independently. Reablement is a type of intermediate care which has a focus on helping the person regain skills and reducing their needs through providing services in the home. Intermediate care is free for up to six weeks. (Care and Support Statutory Guidance, paragraphs 2.12 to 14)
14. Sensing Change provides the Council’s social work service for people living in Suffolk who have sight and hearing loss. Sensing Change carries out social care assessments and care and support plans, rehabilitation, equipment and sensory support (including short and long-term support to maintain independence.)

What happened

15. Ms A has sight loss and anxiety and lives in her own home. The Council told me Ms A received 6 hours of support a week from 2002 until September 2018. A support worker from Sensing Change provided this support.
16. A short-term enablement (reablement) plan dated March 2014 said ‘Ms A has a support worker from Sensing Change, funded by supporting people. She currently has 2 visits a week for correspondence, shopping and a walk to the post office. She has a history of anxiety and is isolated in the community…. Long term goal is to make more links with others to reduce isolation and improve mental wellbeing. Ms A currently has support from her supporting people support worker. Their criteria do not include ongoing social support…. She currently has a support worker twice a week however all her needs can be met in one three hourly session a week. Longer term Ms A would benefit from having a volunteer or befriender to increase social stimulation.’
17. Although the enablement plan suggested Ms A’s support should reduce to one session a week of three hours, for reasons which the Council could not identify, Ms A continued to get six hours a week.
18. Sensing Change told me that Ms A uses braille and information is provided to her in braille on request. There is no information on file saying Ms A wanted to receive information verbally, but Sensing Change told me its staff would have explained any written information to her orally.
19. The Council carried out a review in June 2018. The review described the activities Ms A did with her support workers:
• They guided her round the shops to buy food
• They supported her at the bank and post offices to help with finances and bills
• They read all her letters and highlighted any bills to pay
• They supervised household chores and gardening as she could not see to clean
• They supported her at medical and dental appointments.
20. The review recommended Ms A’s support should continue at six hours a week as it helped lower Ms A’s anxiety and reduced her panic attacks.
21. One of Ms A’s support workers took a leave of absence following an incident with Ms A. And Ms A did not want to work with the support worker when she returned to work. The Council did not replace the three hours of support this worker provided with an alternative and so when the support worker went on leave, Ms A’s support reduced to three hours a week. The records suggest there were/are no additional support workers within Sensing Change that could provide any additional hours.
22. In November 2018, a family support practitioner visited Ms A to review her support hours. Ms A said she was managing to do all her shopping in three hours and managed health appointments independently and agreed to the reduction in hours. The family support practitioner said she would review Ms A again in February 2019 and told her to contact Sensing Change for an assessment of need if anything changed.
23. In November 2018, a family support practitioner spoke with Ms A’s representative to explain Ms A did not require six hours of support as she could get her shopping done in three hours.
24. Ms A made a complaint. Sensing Change’s complaint response said:
• It had been providing a support service to Ms A for 20 years
• The previous review was in June 2018: the outcome was that support was appropriate and remained at six hours
• The support plan would have been explained to Ms A verbally at the time
• All customers would be receiving new care and support plans in the New Year
• Ms A said her support worker had not addressed a letter and accused her of ‘exploiting her vulnerability’. It later transpired that the recipient received the letter. Ms A was angry and the support worker had to withdraw to seek advice
• Sensing Change decided to withdraw the support worker for employee welfare reasons. Another support worker carried out the other three hours of support
• Sensing Change offered Ms A the original support worker, but Ms A refused. There was then a review and Ms A agreed the reduction to three hours was acceptable.
25. A social care practitioner carried out a review in March 2019. Ms A said:
• She did not agree with the support hours being reduced from six to three hours, despite the Council having recorded she had agreed
• She had been getting six hours a week for over 20 years
• Three hours did not give her enough time to complete supervised housework.
• The support worker had sometimes been late due to traffic, reducing her time to two hours
• She wanted to spend time outside, putting flowers on her mother’s grave and going for coffee
• She was happy with her current support worker
• She had not received previous assessments, reviews or correspondence in braille.
26. The social care practitioner said she would speak to her manager about getting the three hours reinstated. Ms A stressed the importance of social support for her emotional wellbeing.
27. The practitioner noted Ms A was not receiving adult social care services and that if she wanted support, Sensing Change may have to assess her to confirm she met adult care services’ eligibility criteria (see paragraph eight.)
28. A reablement plan starting March 2019 said:

“Ms A has a support worker once a week to assist her to access the shops and local amenities, assist with correspondence and letter writing and support her to the dentist. This is essential as Ms A is registered as blind and ideally needs a specially trained sensory support worker who is a trained sighted guide to support her.

Ms A explained that having 3 hours support does not give her time to complete "supervised housework." Ms A commented that she has not had the time to purchase a new hoover and carpets or bed and sideboard for upstairs. Ms A said that at present, she is having to prioritise managing correspondence and doing the shopping.

Ms A said she would like to be able to spend time out in the community, put flowers on her Mum's grave and go for a coffee somewhere. Having social time contributes to Ms A's mental wellbeing and she told us that she fears going back to where she was in the 90's/00's, which was a bad time for Ms A and additional mental health support was required. Ms A is prescribed medication to help manage the effects of anxiety and has previously attended group therapy.

Ms A reiterated the importance of her needs associated with her emotional and mental wellbeing. Ms A has previously looked into services in the community which provide a more structured approach (day services for example), but feels these do not cater for her needs. A suitable charity-run service which was identified previously, unfortunately closed down. Ms A confirmed that she would prefer community-based support from a support worker.

Ms A also raised the issue of her not receiving any written correspondence regarding her past assessments/reviews and that this is required by law.

Ms A would like to access the community more. Her mental and physical health is under stress due to having a visual impairment and she needs specialist support to get out and about. Ms A experiences anxiety when she leaves home. Ms A cannot see to read peoples facial expressions or see where they are. She is unaware of objects that maybe in her path due to her visual impairment.

No support is available at present within the in house support work service. Ms A declined a home visit to discuss the options available to her to meet her support needs. Options include seeking support via a care agency, a personal assistant via a direct payment or seeking assistance from the local volunteer befriending service. Ms A raised concerns about where the increase in support would come from and if this would mean a new service provision and having to contribute to the cost of her support.

29. The social care practitioner wrote to Ms A with a braille copy of the reablement plan and a summary of the agreed actions:
• Look at availability within the Sensing Change support service to enable Ms A to access the community twice a week.
• Feedback to support work service
• Seek alternative support to enable Ms A to access the community twice a week
• Support to fill out a financial assessment for social care services (if this was pursued)
30. Sensing Change said during this investigation that its service standards were not met and offered Ms A £150 to reflect this. It said there was no evidence Ms A received copies of documents in braille (aside from those set out in the previous paragraph), though its practice was to do this if a customer asked.

Was there fault?

31. The Council has not been providing Ms A with services under the Care Act framework described in paragraphs seven to 13. The plans describing the services to Ms A are called reablement plans, but, as reablement is a short-term service to prevent or reduce care needs, and Ms A has been receiving the same support for 20 years, I do not see how Ms A’s support can be reablement. The support was funded through Supporting People and the legacy funding.
32. It did not matter which legal framework the Council was providing services under until September 2018 because Ms A was happy with the support she was receiving. Then there was an unplanned reduction in Ms A’s support hours because one of her support workers was off work. The records show Ms A initially agreed to the reduction, then changed her mind in November 2018, when her representative contacted the Council to complain. I consider the Council should have offered a social care assessment to confirm Ms A’s eligibility for care services in November 2018 when she said she was unhappy with the reduction. The threshold for an assessment (anyone who may need care and support) is low. The failure to offer a social care assessment to determine Ms A’s eligibility was fault.
33. The Council offered Ms A a social care assessment during this investigation. The records indicate she refused this, possibly because of concerns about having to pay a charge. Councils are entitled to charge for long-term care and support services they provide under the Care Act and so there is no fault in officers advising Ms A she would also need to have a financial assessment.
34. The Council did not keep a record of sending copies of letters and documents in braille or of having explained such documents to Ms A verbally. The failure to keep a record was fault and caused confusion for Ms.

Agreed action

35. 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 Sensing Change, I have made recommendations to the Council.
36. I recommend the Council, within one month of my final decision:
• Apologises to Ms A
• Pays her £150 to reflect the avoidable distress caused by the failure to offer her a social care assessment before reducing her support hours
• Ensures staff send documents to clients of Sensing Change in their preferred format, making a record of when they have done so.
37. I will require evidence of compliance. The Council has accepted my recommendations.
38. Ms A has now decided she wants a social care assessment and, at the time of writing, the parties are due to speak to arrange a convenient date to meet.

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Final decision

39. The Council was at fault when it reduced Ms A’s housing related support without first asking her if she wanted a social care assessment. During this investigation, it offered her a social care assessment and a payment of £150. This is a partial remedy. It will also apologise and ensure officers from Sensing Change send key documents to customers in their preferred format, making a record when they have done so. It should take these actions with a month of my final decision.

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Investigator's decision on behalf of the Ombudsman