Summary: The Council has not properly considered all Mrs Y’s needs in its proposal to reduce a lunchtime visit from 90 minutes to 30 minutes, neither has it demonstrated that all required tasks can be met within the 30-minute timeframe

The complaint

1. Mrs X complains about the Council proposal to reduce her mother’s lunchtime call from 90 minutes to 30 minutes. Mrs X does not believe that all Mrs Y’s needs can be met with 30 minutes.

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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. 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. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on draft of this document.

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What I found

Relevant legislation

5. The Care Act 2014 sets out local authorities’ duties in relation to assessing people’s needs and their eligibility for publicly funded care and support. Under the Care Act 2014, local authorities must:

• carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care
• focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve
• involve the person in the assessment and, where appropriate, their carer or someone else they nominate
• provide access to an independent advocate to support the person’s involvement in the assessment if required
• consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

6. Eligibility determination must be made after the needs assessment.
7. Councils still have the power to meet needs that are not considered eligible in order to help maintain wellbeing and independence. Councils should consider risk factors which can include physical safety.
8. The Act gives local authorities a legal responsibility to provide a care and support plan. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
9. 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.
10. The personal budget must always be an amount enough to meet the person’s eligible care and support needs. It can be administered by the Council, by a third party, or as a direct payment.

What happened

11. Mrs Y is elderly. She is mostly bedridden and lives downstairs in her own home. She has a urostomy bag and a colostomy bag. She also has an open wound which has not healed. A district nurse attends regularly to dress the wound. Mrs Y relies on carers to meet her needs. Mrs X says more recently Mrs Y’s health has deteriorated with several visits to hospital by ambulance. Mrs X is Mrs Y’s only informal support. She lives some distance away but visits at least once a week to help with shopping, some domestic chores and provide support with finances.
12. Mrs Y has received home care services since 2012. The Council commissioned Mrs Y’s care until 2018, after which she transferred to direct payments to allow her to remain with her long-standing Care Provider. Mrs Y is very happy with the service she receives
13. The lunchtime visit has always been 90 minutes. During the visit carers empty both the urostomy and colostomy bags as well changing any soiled bedding/clothing, check medication has been taken and prepare a hot meal, sometimes cooked freshly from scratch as Mrs Y has specific dietary requirements.
14. Whilst Mrs Y eats her meal carers clean the kitchen and other areas used.
15. I have seen a copy of Mrs Y’s care and support plan completed in 2017, this records Mrs Y to be a vegan and required meals prepared from fresh ingredients. Mrs X says pre-packed meals are unsuitable due to Mrs Y’s specific health and dietary needs. The assessor concluded “carers to continue to prepare culturally tailored meals”. 90 minutes was allocated for the lunchtime visit.
16. The support plan also records the support Mrs Y needs to manage her urostomy bag. Without support she is at risk of infections. At that time Mrs Y was able to manage her colostomy bag.
17. The Council reviewed Mrs Y’s care in December 2018. I have seen a copy of this document. Mrs Y’s needs remained the same. The assessor recorded recommended changes to the previous care plan, “It is also noted that the package of care can be reduced. it is appropriate to explore further options of providing meals. I have found that Wolverhampton city council offer a meals on wheels service that covers [Mrs Y home area] therefore this option will be explored with [Mrs Y] and her daughter [Mrs X]. From an OT assessment it has been established that the length of carecalls could possibly be reduced…”. The Council proposed to reduce the midday visit to 30 minutes during which the carers would “support with transfers, hot drink, urostemy and colostomy emptying, laundry tasks and domestic cleaning tasks”.
18. Mrs X said she was unhappy with the proposed changes saying it would make her mum ill.
19. Mrs X says the Council told her Mrs Y’s meals could be batch cooked and frozen to reduce cooking time. It allowed one-hour weekly for a carer to batch cook meals for the week. Mrs X says even if this was done, carers could not defrost a meal, supervise Mrs Y eating and attend to all her personal care needs in 30 minutes.
20. The Council says most of the lunchtime call is used to prepare a freshly cooked meal. A social worker and occupational therapist (OT) have assessed the care provided to Mrs Y and concluded the necessary care can be delivered within the reduced timeframe. Batch cooking twice weekly means that means can be heated up rather than cooked from scratch.
21. The Council discussed the proposal with the Care Provider. I have seen a copy of the notes of this conversation. The Care Provider acknowledged the time taken to cook fresh meals daily, and this could not be completed in the proposed reduced hours. Batch cooking the meals may make this possible. Carers would need to prepare fresh chapati, which takes 10 – 15 minutes. That leaved 15 minutes to complete all other tasks.
22. The Council says it offered Mrs Y the option of a having a freshly cooked hot meal delivered daily, which met her dietary requirements. Mrs Y declined this offer saying she could not be sure of all ingredients used, and this could adversely affect Mrs Y.
23. I have seen a copy of a care and support plan completed in April 2019. This shows Mrs Y’s needs remain the same as 2017/8. It proposes a lunchtime visit of 30 minutes from carer. The tasks to be completed are listed as:

• Carer to support [Mrs Y] with emptying catheter and colostomy bag.
• Carer to support [Mrs Y] with her transfers (If required)
• Carer to prompt [Mrs Y] to have her medication in order to maintain her health and wellbeing.
• Carer to prepare [Mrs Y] a meal of her choice.
• Carer to clean kitchen area after use.
• Carer to ensure [Mrs Y] is wearing her pendant alarm at all times.
• Carer to ensure [Mrs Y] is comfortable and safe before leaving.
• Carer to ensure the property is secure and the key is replaced in the key safe.

24. Once a week, the proposed lunchtime visit would be 90 minutes to enable carers “…to batch cook meals of choice for the week”, in addition to completing the usual tasks.
25. The Council says it has not implemented the proposed reduction in lunchtime visits whilst the complaint is ongoing. The original support plan remains in place.

Analysis

26. It is not the Ombudsman’s role to decide if a person has social care needs, or what services they should receive from the Council. The Ombudsman’s role is to establish if the Council has assessed a person’s needs properly and acted in accordance with the law.
27. Needs assessments should consider a persons’ physical and psychological needs. It must consider how a person’s needs may change or fluctuate and consider how this impacts on their wellbeing.
28. From the evidence I have seen Mrs Y’s needs remain unchanged since at least 2017. She is vulnerable and is dependent on others to meet her needs. The Council proposes to reduce Mrs Y’s lunchtime visit not because her needs have reduced but because it believes her needs can be met in a more cost-effective way. Cost can be a relevant factor in deciding between suitable alternative options for meeting needs. However, that does not mean choosing the cheapest option. The Council can consider best value, but it cannot make decisions based only on financial considerations.
29. In considering a cheaper alternative the Council should able to demonstrate that this new arrangement will meet Mrs Y’s assessed needs. Batch cooking meals is not an unreasonable suggestion. Mrs Y’s specific dietary requirements could still be met. However, it needs to demonstrate all Mrs Y’s other needs can be met within the proposed 30-minute lunchtime visit. The Council says reheating a meal and preparing a chapti would take 10-15 minutes, that leaves 15 minutes to complete all the tasks set out in paragraph 23 above. It is difficult to see how this could achieved without compromising Mrs Y’s dignity and wellbeing.
30. Mrs Y has complex medical and social care needs. I note that despite having such needs it appears she has not been referred for an NHS Continuing Care Assessment. The Council may wish to consider this.
31. It is my view the Council has not properly considered all Mrs Y’s needs in its proposal to reduce a lunchtime visit to 30 minutes, neither has it demonstrated that all required tasks can be met within a 30-minute timeframe.

Agreed action

32. The Council will within four weeks of the final decision:

• reassess the time needed to complete all the tasks required at the lunchtime visit, and provide a breakdown of this to this office
• apologise to Mrs X for the time and trouble she has been put to pursuing this complaint with the Council and the Ombudsman.

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Final decision

33. There is evidence of fault in this complaint. The above action is a suitable way to settle the complaint.
34. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman