Summary: Ms D complains the Council decided to reduce her homecare package, even though her needs have not reduced. As such, Ms D says she no longer has the amount of support she needs. The Ombudsman did not find fault with the way the Council reached its decision.

The complaint

1. The complainant, whom I shall call Ms D, complained the Council decided to reduce her care package from 24 to 17 hours, even though her needs have not reduced and the contents of her most recent needs assessment/review was virtually unchanged from her previous one.
2. Ms D says the reduced support package will not be enough to meet her needs and the Council failed to explain:
• How the 17 hours will be enough to meet her needs, and
• Why it believes her needs can now be met by 7 hours less than before.

Back to top

The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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)

Back to top

How I considered this complaint

6. I considered the information Ms D and the Council provided to me. I also interviewed two officers from the Council who have been involved in this case. I shared a copy of my draft decision statement with Ms D and the Council and considered any comments I received, before I made my final decision.

Back to top

What I found

7. Ms D’s needs assessment said she has to pace herself each day, as relatively small activities can leave her very tired. Ms D has limited mobility and is unable to stand for long. Ms D has specific dietary needs, which means she has to eat fresh foods. She lives at home with her husband and three children, who are in their teens. Ms D does not have to pay a contribution towards her care package and receives DLA (Low Care and High mobility). Ms D uses this for buying dietary supplements; a vehicle loan and wheelchair maintenance. Ms D receives support from a personal assistant (PA) from Monday to Friday.
8. The Council told me it arranged a care review in October 2018, following an alert that more than £6,000 had accumulated in her direct payments account between February 2017 and March 2018. It said that this indicated that Ms D was not using all her available support hours.
9. However, Ms D told me this amount had accrued due to difficulties with recruiting and retaining staff, and had accumulated over a three-year period. She said she only accrued £1,682 during the above 12 months period and was using all the 24 hours of PA support in October 2018 when the assessment took place.
10. The care review included a review by an OT. The care review said, amongst others, that:
• Personal care: A PA provides support to Ms D with personal care, bathing and dressing.
• Domestic tasks: Ms D is unable to complete domestic tasks independently. Ms D’s PA makes a packed lunch for the children in the evening and supports Ms D to cook the family meal at night. The PA helps Ms D with cleaning and hoovering, and with laundry when she cannot do this herself. Her husband also does some laundry at weekends.
• Accessing the community: Ms D does not go out alone as she does not feel safe crossing roads and managing any risks. As Ms D relies on others to accompany her, she can often feel very isolated, spending much of the time during the day on her own. If needed, Ms D will access the local shops with her PA to get fresh groceries. The PA also supports with (hospital) appointments for her and/or her children, if needed. The records indicate that Ms D often feels too tired to be able to attend local groups or activities in the community.
• Being a Parent. “I need support to look after my children 1 – 2 times a week”. Assistance with parenting is provided though domestic assistance and community hours as available. One of her children has severe asthma and his bedroom and living areas have to be dusted and hovered daily to prevent an attack.
• Ms D’s husband works full time and has his own health conditions. He returns around 6pm and Ms D said he is often exhausted by the time he returns home.
11. Following the care review in October 2018, the Council made the following changes to Ms D’s support package:
• Personal care: The Council has continued to allocate one hour each morning, for support with personal care.
• Domestic support: The Council has reduced this from 45 minutes per day (3.75 hours a week) to one hour per week. The Council says that:
1. The Care Act Guidance (6.106f) says (maintaining a habitable home): “councils should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe”. At times, the Council has provided more support with this as needed. It only needs to provide support to ensure the person is safe. This support is therefore to do a thorough clean of the bathroom and kitchen once a week to keep them to a habitable standard. Furthermore, PAs have to clean up as they carry out support with personal care etc.
2. It is not unreasonable to expect the husband and the three teenage children to provide some support with keeping their own house clean, such as cleaning, hoovering and laundry.
• Support with meal preparation:
1. Ms D continues to receive 30 minutes support at lunch time, to prepare her lunch using fresh ingredients and provide some other assistance.
2. The support plan used to include 1.5 hour/day support with family meal preparations. This has now been reduced to 30 minutes per day. The Council says that:
1. Thirty minutes is sufficient to assist Ms D with preparing dinner. If needed, Ms D’s husband will only need to serve the food when he returns from work.
2. The support plan will no longer include support with preparing a packed lunch. The Council believes that although Ms D says two of her children have issues with food, her children should be able to prepare their own school lunch with support from their parents. The Group Manager has also signposted Ms D to the Council’s Children’s Services, if she considered they need support in their own right. However, Ms D has turned down this offer.
3. Access to the local community. This has changed from 45 minutes per day (3.75 hours per week) to 6 hours per week. This will include support with attending (medical) appointments for Ms D or her children. Mr D has said his wife is not entitled to free hospital transport.
12. Furthermore, the Council has said that:
• Ms D’s condition varies from day to day. She does not have to use her personal budget in the above manner; she can use it flexibly. For instance, Ms D could move her hours around if needed or could access the ‘meals at home’ service and use the 30 minutes saved to meet alternative needs.
• Ms D can keep a six weeks surplus of her Direct Payments in her Direct Payment Account, should she need this for contingency hours.
• With regards to all the needs put forward in relation to the children (asthma, eating disorder etc), the Council proposed a referral to children service so they can assess the children’s needs and identify any support they could provide to assist with the situation.
13. Ms D is very unhappy with the seven hours reduction in her care plan. She says that:
• Her needs have not reduced and the contents of the 2018 assessment was very similar to the one in 2017.
• Her husband is unable to provide an extra two hours a week of support to do domestic tasks. Her husband suffers from stress, anxiety, depression, Irritable Bowel Syndrome, and joint pain in his knees, back and shoulder. He works from 7am till 6pm and also provides care support to her when he is at home.
• The Council has failed to appreciate that her children have their own health care needs and are therefore not capable of doing as many basic domestic tasks as healthy children of the same age.
• She cannot prepare her children’s school lunch, in the morning. Two of her children have issues/problems with regards to food and they are therefore unable to make their own lunches, while being supervised by her. As such, Ms D told the Council that she needs PA support with this aspect of her role as a parent.
14. The Council offered to carry out a carer assessment. However, Mr D initially turned down this offer. Since then, Mr D completed a carer assessment in May 2019, which resulted in a one of payment of £150. Furthermore: Mr D is eligible for respite care funding to offer him a break from his role as Ms D’s carer, if he would want this. The assessment highlighted a request from Mr D to have support for his wife at the weekend, to enable him to leave the house and do more things with his children or for himself. As such, Mr D should explore this further with the Council, for instance a sitting service at the weekend.
15. The Council told me it aims to maximise the independence of its clients. As such, it referred Ms D to its Reablement Service to look at ways of promoting her independence in terms of accessing the community (for instance by bus), cooking and pacing herself. The service called Ms D in January 2019. However, Ms D said she did not feel the service was suitable for her:
• Ms D said she declined the offer, because she did not believe that she would be able to achieve more independence. She told me she participated in a rehabilitation course in 2014, which did not help her but increased her symptoms. She is already aware and uses equipment that can help her. Ms D also told me her physiotherapist said that “her global pain and fatigue severely limit her ability to carry out household tasks” and that she has “limitations in her standing tolerance”. Ms D said she discussed this with the reablement team, who agreed it would not be suitable for her.
• However, the Council said at interview, that it does not have any record that said the reablement team agreed with Ms D’s view. While it accepts that Ms D has limitations, they do not accept that 12 weeks of reablement support would not be able to identify areas, further equipment and ways of doing things that would have benefits for her.
16. The Council also offered a reassessment in February 2019. However, Ms D declined this because she was satisfied the assessment document accurately reflected her situation. She could therefore not see a reason to complete a further assessment.
17. The Council confirmed to me that, where there is a disagreement with clients about a reduction in care package, the Council will carry out a review after three to six weeks to assess how the reduced package is working.

Assessment

18. This is a decision for the Council to take on the merits of the case. The Ombudsman cannot substitute his judgement on what would be right for what a council has decided. He must consider whether there was fault in the way the Council reached its decision. I found that the Council carried out an assessment that captured Ms D’s needs. It considered the information and arguments Ms D provided, and used relevant guidance to come to a view as to how Ms D’s eligible needs should be met.
19. As such, I found there was no fault in the way through which the Council made its decision. Without fault, I will not question the merits of that decision (see paragraph 4 above).
20. The Council has said it will review with Ms D how her revised care package is working.

Back to top

Final decision

21. For reasons explained above, I decided not to uphold Ms D’s complaint.

Back to top

Investigator's decision on behalf of the Ombudsman