Summary: Mr X complained the Council decided he does not have eligible needs under the Care Act 2014. There was no fault in the way the Council assessed Mr X’s needs and the Ombudsman cannot question the merits of its decision.

The complaint

1. Mr X complained the Council decided he is not eligible for support, but he believes he does meet the eligibility criteria under the Care Act. He feels the Council do not understand his lack of support and have wrongly referred him to services he cannot use or does not feel comfortable using.

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What I have investigated

2. I have considered the assessment which took place on 8 November 2018. I have not looked into the later assessment on 31 May 2019 as this took place after Mr X brought his complaint to the Ombudsman and does not form part of his complaint.

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The Ombudsman’s role and powers

3. 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

4. As part of the investigation I have considered the following:
• The complaint and the documents provided by the complainant’s representative.
• Documents provided by the Council and its comments in response to my enquiries.
• The Care Act 2014
• The Care and Support Statutory Guidance (Updated 26 October 2018)
• The Care Act Factsheets (Updated 19 April 2016)
5. I wrote to Mr X’s representative and the Council to give them an opportunity to comment on draft decision. I considered any comments they made before making a final decision.

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What I found

6. Sections 9 and 10 of the Care Act 2014 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.
7. After assessing the total extent of a person’s needs, the council should consider which are eligible needs under the Care Act 2014. The guidance says councils must consider whether:
• The adult’s needs are due to a physical or mental impairment or illness.
• The adult’s needs mean they cannot achieve two or more specified outcomes.
• As a consequence of being unable to achieve those outcomes there is, or is likely to be, a significant impact on the adult’s wellbeing.
8. Eligible needs are those that meet all the above conditions.
9. The specified outcomes referred to above include:
• maintaining personal hygiene;
• managing food preparation;
• maintaining a habitable home;
• maintaining significant relationships; and
• accessing the community.
10. 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”.
11. Where the 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.

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Needs assessment

12. Mr X has dyslexia, learning difficulties, depression and anxiety. He wears an orthopaedic boot as a result broken ankle some years ago.
13. The manager of the housing scheme where Mr X lives raised concerns to the Council about Mr X’s ability to look after himself on 17 July 2018. This resulted in the Council referring the matter to a social worker.
14. Mr X’s advocate contacted the Council on 7 September 2018 to seek a needs assessment.
15. A social worker (the assessor) carried out an assessment on 8 November 2018. This considered whether Mr X had eligible needs across the range of outcomes set out in the Care Act.
16. Mr X told the assessor he would like to move home to help him feel comfortable and safe from both verbal and physical abuse. He said he feels vulnerable and thinks this will improve his well-being.
17. The assessor noted Mr X uses a crutch to mobilise because of a previous fractured ankle, which Mr X said has not healed properly. He said he is in discomfort and is depressed about the situation.
18. Mr X said he finds it difficult to deal with post or correspondence because of his mental health problems and dyslexia. He will sometimes leave it for a week before dealing with it.
19. Mr X told the assessor he can’t clean his home because he finds it physically hard to get back up. He has no motivation to clean but takes the rubbish out weekly. He said he is out most of the time because of the condition of his home.
20. Mr X said he wishes to manage his money himself. The assessor noted Mr X was in rent arrears because he chose not to pay for services he did not use and because of the condition of his home when he moved in.
21. Mr X told the assessor he does not eat properly. He finds cooking difficult and will graze on fast food instead. He buys food when he is out but only keeps limited food in the house. He feels depressed about eating and lacks motivation. He told me he suddenly feels upset and cries when eating out.
22. Mr X said he has no difficulty using the toilet, but he does not use his shower. He doesn’t feel like washing at home but instead has a weekly strip wash. He wears shirts for two or three days before washing and does not wear underwear. He sometimes showers at a shelter. He told me he has a strip wash when he feels he needs it.
23. He said he needs new clothes, but he does not have spare money. He feels he does not wear the right clothes for the weather. He told me he fears getting into more debt and buying clothes causes him anxiety and depression.
24. Mr X said he was not in contact with family and has no friends. He said he has no enjoyment in life. He told the assessor he is lonely and has no one to talk to. He is scared to meet new people. He feels things will go wrong and he feels uneasy. He told me he feels trapped, isolated and scared. He needs support in order to meet new people and socialise.
25. Mr X said he would like to go swimming, but fees are an issue. He does not feel he could work or volunteer, but training would be of interest to him. However, he feels uncomfortable about going on courses.
26. The assessor decided Mr X is not eligible for adult social care. Although it was noted he does struggle to look after himself at times because of low motivation, he generally manages to maintain his home, personal care, nutritional intake and safety to a reasonable standard. Mr X was told he can ask for support with correspondence from the manager of the housing scheme and he already uses an advocacy service to help with doctor’s appointments. He was told he should continue to see his GP about his mental health issues and that money advice services can help him to manage his money. He was given details of organisations to help him socialise and learn skills.
27. Mr X told the assessor he disagreed with the decision and he did not want to use the services suggested. His assessment was amended to reflect his views, but the opinion of the assessor did not change.

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What happened next

28. Mr X’s advocate complained to the Council on Mr X’s behalf on 22 January 2019. He asked for the decision to be reviewed because he does have eligible care needs.
29. The Council responded on 6 February 2019. It said the assessor had told Mr X how he can get help and support for his needs and he can contact the Council for another assessment if his needs change.
30. Mr X’s advocate wrote back to the Council on Mr X’s behalf on 8 April 2019. He said the support suggested by the assessor was not suitable and Mr X did not feel the extent of his pain, depression and dyslexia had been considered. He said he feels he received no current help or support.
31. The Council replied on 29 April 2019. It said it had highlighted the areas where Mr X could seek help. It said his GP could support him about his pain and depression and advocacy services or his housing scheme manager could help with his dyslexia. The Council said the outcome remained Mr X did not have eligible needs for a funded service and his assessment outlined where he can get support for the needs he has. It said the fact Mr X did not want to use the support did not mean the Council would fund a service for him.
32. Mr X remained unhappy with the Council’s response as he felt he did have eligible needs and the options the Council suggested were not useful to him. His advocate brought Mr X’s complaint to the Ombudsman on 23 May 2019.

Response to my enquiries

33. The Council told me Mr X expressed his needs in his assessment, but his opinion differs with the views of the assessor.
34. The Council said it can decide on how it meets any eligible needs and first it will look towards the person, their family, friends and the voluntary sector before providing a funded service. It told me needs identified as part of an assessment do not mean those needs must be met by a funded service. There are other ways in which the Council can perform its duty.
35. The Council said Mr X’s needs were to attend health appointments. It also said he wanted support with bills and correspondence. The Council said it cannot provide support workers for such needs through adult social care and Mr X has been signposted to advice and support services.

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Analysis

36. The Council told a suitably qualified officer to carry out the assessment and it covered the full range of outcomes set out in the Care Act. Mr X, with the support of his advocate, gave his views about each relevant outcome and the assessor then came to a professional judgement on whether Mr X could meet them. There was no fault in this process and Mr X was fully involved in it.
37. The assessor decided Mr X could meet his own needs to a reasonable degree and does not have eligible needs on two or more outcomes under the Care Act. Mr X may disagree with the decision, but this was a conclusion the assessor was entitled to reach. We cannot question the merits of a decision where it is made without fault.
38. The records I have seen from the Council show Mr X had a further assessment by telephone with a new assessor on 31 May 2019. The outcome was that Mr X does have eligible needs, which will be met with community support at home. He was referred for further assessment. This does not affect my view of the complaint, as I have only investigated the assessment which took place on 8 November 2018.

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Final decision

39. I have completed my investigation. There was no fault in the way the Council assessed Mr X’s needs and the Ombudsman cannot question the merits of its decision.

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Investigator's decision on behalf of the Ombudsman