Summary: There is no evidence the Council was at fault in its assessment of Mr X’s social care needs, except in its failure to consider his need for someone to accompany him to medical appointments. The Council now agrees to reconsider its assessment on that point in the light of the Care Act.

The complaint

1. Mr X (as I shall call the complainant) complains that the Council has sought to reduce his Direct Payment budget and has not taken into account other information about his needs.

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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. 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

3. I considered all the information provided by the Council and by Mr X. I spoke to Mr X. Both Mr X and the Council had an opportunity to comment on an earlier draft of this statement and I took their comments into account before I reached a final decision.

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What I found

4. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person's needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:

1. The needs must arise from or be related to a physical or mental impairment or illness.

2. Because of the needs, the adult must be unable to achieve two or more of the following:

Managing and maintaining nutrition;

Maintaining personal hygiene;

Managing toilet needs;

Being appropriately clothed;

Being able to make use of the adult's home safely;

Maintaining a habitable home environment;

Developing and maintaining family or other personal relationships;

Accessing and engaging in work, training, education or volunteering;

Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and

Carrying out any caring responsibilities the adult has for a child.

3. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult's well-being.

Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.

5. In relation to “Making use of necessary facilities or services in the local community including public transport and recreational facilities or services”, Section 6.106 of the Care and Support Statutory Guidance 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”.
6. Section 27 of the Care Act 2014 gives an expectation that local authorities 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, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.
7. Everyone whose needs the local authority meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning, with the final amount of the personal budget confirmed through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be an amount enough to meet the person’s care and support needs.

There are three main ways in which a personal budget can be administered:

As a managed account held by the local authority with support provided in line with the person’s wishes;

As a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes;

As a direct payment. (Care and Support Statutory Guidance 2014)

8. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They provide independence, choice and control by enabling people to commission their own care and support to meet their eligible needs.

What happened

9. Mr X has received Direct Payments from the Council for some time to help meet his assessed needs. He has employed a Personal Assistant (PA) and his daughter to help him. In 2017 he complained to the Council that his social worker wanted to reduce his level of support and he did not believe she had properly taken into account all his needs. The Council agreed to allocate a different social worker.
10. The social worker visited Mr X on 31 August 2017 to complete a fresh assessment. When he received the proposed new support plan Mr X complained to the social worker and her manager that his daily needs had not been taken into consideration and he wanted the Council to contact his GP and the hospital. The manager discussed the support plan with the social worker. She noted she was satisfied all the information provided by Mr X had been included.
11. Following discussions with Mr X’s GP the Council agreed to reduce Mr X’s weekly Direct Payment from £365 to £202 but as Mr X continued to be concerned about the reduction in his Direct Payments, the reduction did not take place. Mr X met the Council with his daughter and a representative in February 2018 to discuss his needs further.
12. In response to Mr X’s continued concerns the Council offered a further assessment at an assessment centre, and help with possible assistive technology to meet his medication needs and falls risks. Mr X decided he did not want to attend the assessment centre so the social worker arranged for an Occupational Therapist (OT) to carry out a functional assessment. The OT recommended some aids to assist Mr X at home. The social worker sought more information from Mr X’s GP about his medical conditions and their impact on his social care needs.
13. Mr X was admitted to hospital for some time and it was not until October that a fresh appointment could be made for an assessment to discuss his care and support plan.

The complaint

14. In November Mr X complained to the Council about the proposed new care and support plan and the intended reduction in his Direct Payments. He said he had been told in 2017 that his budget would be reduced but it had not been. He said his health had deteriorated considerably and yet the Council expected him to manage with less money. He sent copies of medical information with his complaint.
15. The team manager responded to Mr X in December. She said the proposed reduction in his Direct Payments had not gone ahead because at each contact Mr X had requested that further evidence was considered. When he was given the proposed care and support plan and DirectPayment agreement he had refused to sign it. She said the Council had since been working with him to ensure the plan and budget met his needs.
16. The manager also referred to the medical information Mr X supplied and said the social worker had taken it into account, where there was evidence that as a result of his medical needs he required more support for meal preparation and for eating and drinking. The social worker had also taken into account his hospital admissions and increased his hours because of his swallowing problems.
17. Mr X complained again to the Council in January. In February the social worker sent him the care and support plan and letter of agreement to the Direct Payments to sign. The support plan said, ‘(Mr X) would like to be accompanied to his medical appointments due to his memory concerns and fear of falling’. The plan said however that Mr X should ask a friend or family member to accompany him to medical appointments: ‘Medical appointments are counted as a health need and not a social care need’.
18. A service manager replied to Mr X’s complaint in February. He said the reduction proposed was from £356 to £329 a week. He said a member of the Direct Payments support team would be able to explain to him how the budget was calculated to provide him with the support required. He said otherwise Mr X should contact the Ombudsman.
19. Mr X did not sign and return the care plan and letter of agreement. He replied to the service manager that he would complain to the Ombudsman.
20. Mr X complained to us about the Council’s proposed reduction in his Direct Payments and said the social worker had not taken into account his many medical conditions. He said the threat of a reduction in his care had caused him considerable anxiety.
21. The Council says a full re-assessment was completed in relation to Mr X’s needs and his requests to obtain further evidence were all completed and included in this assessment. It says the social worker gathered information regarding his discharge needs after his hospital admissions. She adjusted the assessment and care and support plan accordingly to evidence any increase in areas of his needs.
22. The Council says in accordance with the Care Act, the budget is now worked out to cater for the hours that Mr X is assessed as requiring to meet his needs, rather than identifying a budget and fitting the hours into the figure. It has provided a detailed breakdown of the hours required.

Analysis

23. The Council has assessed and reassessed Mr X at his request when he has asked for more information to be taken into account. It was not fault for the Council to reach a different view on the hours required to support his needs once it had considered all the relevant information.
24. It is not the role of the Ombudsman to decide on Mr X’s social care needs but to investigate whether the Council has arrived at its decision properly. There is no evidence of fault in the way it has done so, except in one respect. The Council says it was not a social care need for Mr X to be accompanied to health care appointments, but the statutory guidance says councils “should consider needs for support when the adult is attending healthcare appointments”.

Agreed action

25. Within one month of my final decision the Council will reconsider the support Mr X requires for being accompanied to medical appointments.

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Final decision

26. There was fault which caused injustice to Mr X in one aspect of the complaint as identified at paragraph 24 above. The agreed action in paragraph 25 will remedy any consequent injustice.

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Investigator's decision on behalf of the Ombudsman