Summary: Ms X complains the Council has failed to meet her care needs. The Council failed to explain that her assessed charge needed updating, which caused unnecessary distress and contributed to her reluctance to accept the support on offer. The Council has agreed to apologise, waive any assessed charge for 12 months and take action to assess Ms X’s needs under the Care Act, which it last did in 2017.

The complaint

1. The complainant, whom I shall refer to as Ms X, complains the Council:
• has failed to meet her eligible social care needs
• is asking her to contribute more than she can afford to pay towards the cost of her care
• has failed to provide her with six months of free care which it promised her
• has failed to provide her with an independent advocate

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What I have investigated

2. I have investigated the actions of the Council and Pennine Care NHS Foundation Trust (Pennine Care) in relation to Ms X’s social care needs.

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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. 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)
5. 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

6. 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

What happened

7. Ms X has a history of mental health problems. In 2017 she received a diagnosis of autism spectrum disorder.
8. The Council’s social care services for adults with mental health problems are delivered by Pennine Care’s Community Mental Health Team on its behalf. In April 2017 Pennine Care assigned Care Coordinator B to work with Ms X. In August 2017 the Council assessed Ms X’s needs under the Care Act and identified an indicative personal budget.
9. The Council says Care Coordinator B completed a care plan in August 2018. The document it has provided is headed “My wellbeing and recovery plan”. It says Ms X did not want mental health services from the Community Mental Health Team and had no involvement in producing the plan. The plan does not identify or address Ms X’s social care needs.
10. Pennine Care’s records show that by December 2018 it was planning to use Ms X’s indicative personal budget to provide support workers to go with her on trips to London to attend therapy sessions organised by the NHS. This followed failed attempts to get NHS funding for the same purpose.
11. According to Pennine Care’s records Ms X did not want anything to do with the Community Mental Health Team, including Care Coordinator B.
12. On 18 January 2019 Pennine Care left a message asking if Ms X had thought any more about using an agency, which specialises in supporting people with autism, to access the London based therapy.
13. On 11 February Ms X asked Social Worker D if she knew about her £6,000 personal budget for support to go to London for therapy. She said she would not be able to go to London for therapy with a stranger. She also said she could not afford the support as her financial assessment said she would have to pay £166 a week towards the cost of her care. Ms X said she had not received confirmation of her personal budget from the Council.
14. In March Pennine Care assigned Care Coordinator C to work with Ms X. Social Worker D said Care Coordinator C could help Ms X apply for funding for support to travel to London for therapy. Social Worker D arranged to visit Ms X on 10 April with Care Coordinator C to discuss the application.
15. Ms X could not make the appointment on 10 April because of a hospital appointment. She told Pennine Care it was too far for her to travel to London. She said she could hardly get out of the house and spent most of the time indoors.
16. Pennine Care rearranged the appointment for 23 April but Ms X did not receive a letter confirming this. Social Worker D said she would send her another appointment letter so they could complete her support plan and apply for funding for the support she had asked for. Ms X said she did not want to meet with Social Worker D or Care Coordinator C, or anyone from the Community Mental Health Team. She said she wanted support with her autism so the Council should complete her support plan. Social Worker D said she would pass the message on to senior management [I have seen no evidence this was done]. When Ms X said she did not have an Advocate, Social Worker D said two agencies could provide advocacy but Ms X said neither agency was independent.
17. On 30 April Social Worker D received a message saying Ms X wanted to meet to complete her support plan. The message said Ms X could not travel to London.
18. On 8 July Care Coordinator C called Ms X after receiving a message. Ms X said she had not accepted appointments as she was not bothered about her personal budget because she could not pay for care in the long-term. Care Coordinator C offered a further appointment but Ms X suggested there was no point as she was not under the Community Mental Health Team and did not want its support. She said she had been refused advocacy and refused to accept Care Coordinator C’s claim this had been arranged.
19. When the Council replied to Ms X’s complaint in July it said:
• Adult Care Services had closed her case as it could not progress with developing a care and support plan to apply for funding for support services to meet her assessed needs, which would have been the next step after the indicative budget stage;
• her named worker in the Community Mental Health Team had proposed a meeting as she had been discharged from Adult Care Services;
• the Community Mental Health Team had proposed using her budget to help her travel to London but could have supported her in applying to use it to pay for support within her local area;
• the Council had agreed to waive her financial contribution of £166.40 a week for six months;
• an Advocate could be appointed to support Ms X with any meeting with the Community Mental Health Team.
20. On 8 August Ms X called Care Coordinator C, who confirmed Ms X had been allocated to her. Ms X disputed this. Care Coordinator C pointed out Ms X had been offered three appointments to complete a care and support plan. Ms X said she did not want a personal budget as she did not want to pay the contributions in the long term.
21. Pennine Care arranged for Ms X to be assessed by an independent psychology service in Lancashire. This avoided any need for support travelling to London. Later in August, the Council told Ms X her case was still open to Care Coordinator C at Pennine Care. It said it had assessed Ms X’s needs which identified needs under the Care Act and produced a personal budget. It said Care Coordinator C would be in contact to complete her support plan. Ms X e-mailed the Council saying she did not have a Care Coordinator and was not under the Community Mental Health Team. She said Care Coordinator C did not want to know, refused to speak to her and on the one occasion she spoke to her did so in “clipped tones and was hostile”. She copied her e-mail to Care Coordinator C. Ms X later told the Council she wanted to progress her personal budget. She also said she wanted to sort out her financial assessment and asked who she should contact about this.
22. On 22 August Ms X called Care Coordinator C. They mainly spoke about health services. However, Ms X disputed that Care Coordinator C was her Care Coordinator. She said she did not have a care and support plan and could not access her indicative budget. Care Coordinator C told Ms X they had not been able to complete a care and support plan as she had refused to meet. She offered to make an appointment to discuss her “concerns” but Ms X said she did not want anything to do with the Community Mental Health Team. She said she needed an Advocate. When Care Coordinator said an Advocate would be provided under the Care Act, Ms X said this was not true. Ms X ended the call.
23. On 20 September Ms X wrote to the Council, largely complaining about NHS services. She said she had an assessment for social care in 2017 which did not go anywhere as she could not afford to pay £166.40 a week for the cost of her care. She said she could not understand why she was referred to Adult Social Care after her autism assessment and then never heard from them again. She said she wanted to see someone from Adult Social Care as she was not under the Community Mental Health Team. She said she wanted an Advocate.
24. On 25 September Care Coordinator C noted Ms X did not meet the threshold for the Community Mental Health Team.
25. On 26 September Ms X wrote to the Council. She said the Council had been wrong to tell her MP she had a named worker. Ms X said Care Coordinator C refused to speak to her. She said Care Ordinator C and Social Worker D were victimising her and did not want anything to do with her.
26. Social Worker D and Care Coordinator C had a meeting with Ms X on 23 December to discuss her concerns. They mainly discussed health services. However, Ms X said she wanted to discuss her social care budget and how to access it. She said a financial contribution was ok if it was worked out fairly. She said she wanted a meeting with Senior Management.
27. On 27 January 2020 Ms X had a meeting with two Senior Managers at Pennine Care. In addition to discussing health services, Ms X said she could not afford to pay £166.40 a week for her social care. Ms X said she did not want to be under Care Coordinator C. But the Managers did not want to allocate someone else to work with her. The record of the meeting includes these actions:
• “To be closed from Bury Services to access her funding for adult care”
• “Before [Ms X] left the building, she had changed her mind and decided that she would like to have an assessment.”
28. On 3 February Care Coordinator C wrote to Ms X offering three dates to assess her needs with Social Worker E. She said they would arrange for support from and Advocate. The Council says Ms X did not respond.
29. The Council says the financial assessment which said Ms X had to contribute £166.40 is no longer relevant. It says a financial assessment completed in March 2018 identified a provisional contribution of £40.50 a week. It says the figure is provisional, as Ms X has not responded to requests for information about disability related expenses.

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

30. Under the Care Act there is a clear process to be followed. Assess someone’s needs for care and support. Decide whether the person has eligible needs for support under the Care and Support (Eligibility Criteria) Regulations 2014. If so, the person should be given an indicative personal budget. There is then a duty to produce a care and support plan which sets out their desired outcomes, how the needs will be met and the final personal budget. The Care and Support Statutory Guidance (Statutory Guidance) says the planning process should be person-centred and:
• “The person must be genuinely involved and influential throughout the planning process, and should be given every opportunity to take joint ownership of the development of the plan with the local authority if they wish, and the local authority agrees. There should be a default assumption that the person, with support if necessary, will play a strong pro-active role in planning if they choose to. Indeed, it should be made clear that the plan ‘belongs’ to the person it is intended for, with the local authority role being to ensure the production and sign-off of the plan to ensure that it is appropriate to meet the identified needs.”
• “The guiding principle therefore is that the person be actively involved and is given every opportunity to influence the planning and subsequent content of the plan in conjunction with the local authority”.
31. The last time Ms X’s needs were assessed under the Care Act was in August 2017. It is therefore not clear what Ms X’s social care needs have been during the period covered by my investigation. Pennine Care decided what Ms X should use her indicative personal budget for before discussing it with her. That did not comply with the requirements of the Statutory Guidance. That is fault for which the Council is accountable.
32. When the Council wrote to Ms X in July 2019 it said the Community Mental Health Team could have supported her in applying to use her personal budget to pay for support within her local area. But that is not reflected in the Team’s records of its contact with Ms X, which repeatedly mention supporting her to attend therapy in London. It appears the attempts to produce a care and support plan ended, at least until February 2020, after the Team sourced therapy closer to home.
33. The Council says the financial assessment which said Ms X had to pay £166.40 a week was superseded by another assessment in March 2018. It is unclear why the Council failed to explain that when it wrote to Ms X in July 2019. Ms X has repeatedly said she was concerned about accessing her personal budget because she could not afford to do so in the long-term (i.e after the charge had been waived for six months). I have seen no evidence of anyone clarifying the financial contribution with her or pointing out that she needed to provide more information to complete a financial assessment. That is fault for which the Council is accountable. This suggests a lack of joined up working between Pennine Care and the Council over such matters. The Council needs to take action to address this.
34. There has been no assessment or review of Ms X’s needs under the Care Act since 2017. It therefore needs to reassess her needs. I cannot simply ask the Council to pay Ms X her indicative personal budget, as she would like. Given the problems Ms X has experienced, the Council should lead on the assessment of her needs and the development of any care and support plan. It is not clear whether Ms X will be prepared to work with the Council. However, at her request, the Council has agreed that she can record the assessment.
35. The evidence does not support the claims that:
• Ms X has not had a Care Coordinator;
• Care Coordinator C refused to speak to her or failed to return calls;
• Care Coordinator C and Social Worker D have victimised Ms X.
36. Although Care Coordinator C and Social Worker D have, at times, been critical of Ms X, that does not amount to victimisation. It appears Ms X has been reluctant or unwilling to work with the Community Mental Health Team from the start.
37. The faults I have identified have caused unnecessary distress to Ms X and put her to the time and trouble of pursuing her complaint. This warrants an apology and financial redress. The Council has offered to waive the charges for her care for 12 months.

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Agreed action

38. 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 Pennine Care, I have made recommendations to the Council.
39. The Council has agreed to:
• within four weeks:
1. write to apologise to Ms X for the time and trouble she has been put to and the distress she has been caused, and offering to waive her assessed charges for 12 months;
2. take action to assess Ms X’s social care needs under the Care Act and for her to record the assessment;
• within eight weeks;
1. work with Pennine Care to identify the action they need to take to ensure more joined up working over matters relating to financial assessments, so legitimate concerns do not go unanswered.

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Final decision

40. I have completed my investigation as the Council has agreed to take the action to remedy the injustice it has caused.

Parts of the complaint I did not investigate

41. I have not investigated Ms X’s concerns about Pennine Care’s failure to meet her health care needs, as these fall within the remit of the Parliamentary and Health Service Ombudsman. We decided not to carry out a joint investigation. At Ms X’s request, an Assistant Ombudsman reviewed that decision in February 2020 but did not alter it.

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Investigator's decision on behalf of the Ombudsman