Summary: Mr C has complained that the hours of support he receives per week, has not been enough to meet his needs. The Ombudsman has not upheld Mr C’s complaint.

The complaint

1. The complainant, whom I shall call Mr C, complained to us that the amount of support hours he receives (22.5 hours a week) is not enough to meet 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. 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. 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)
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, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I considered the information I received from Mr C and the Council. I also considered the information I obtained from a telephone conversation with Mr C’s care provider. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received before I made my final decision.

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What I found

6. Mr C has cerebral palsy and a learning difficulty. He lived with his father and stepmother in 2018, before he moved out to live independently in December 2018. Before Mr C moved out, his care and support plan said that:
• Nutrition: Mostly met by his parents. Mr C advised he could prepare some things for himself but found this very difficult. He said he would need support with preparing a hot meal in the evening, once he moves out. An OT assessment should be carried out to determine his skill levels.
• Maintaining a habitable home environment: Mostly met by his parents. When he would move out, he would need some assistance and encouragement to carry out household tasks. Mr C was receiving some support from his care provider to develop his skills within this area, in preparation of moving out. An OT assessment should be carried out to determine his skill levels.
• Develop and maintain relationships: It was very difficult for Mr C to develop relationships with his peers. He does not show a lot of interest or effort in this area. Instead, he prefers to interact and spend most of his time with his paid support workers. Mr C does not have any close friends and struggles in social situations. His care provider supports him with a range of social activities and tries to develop his skills in this area.
• Access and engage in work, training, education or volunteering. Mr C is a student at a local college, where he was studying Monday to Wednesday.
• Access to community and use of facilities: Mr C said he wanted to access a wider array of facilities and activities within his community, but lacked the energy and confidence to do this alone. Mr C was currently receiving support with volunteering (two hours a week), and support with socializing on Saturdays. He also attends an activity centre on Fridays.
• Summary: Mr C was receiving 12 hours of support per week. All involved with Mr C felt he was doing extremely well and the hours remained appropriate. There was a concern around his emotional health and wellbeing and he was urged to access counselling through his GP or college.
7. According to his social worker, Mr C’s support package at this time was generous and geared towards supporting him to be as independent as possible. However, the social worker felt that he was not making any effort to make friends. Mr C did a lot of activities supported on a one to one basis in the community, when he did not need support with this (such as going to the cinema). It appeared that Mr C mostly wanted support from paid care workers for company and companionship. This meant he was unwilling to try and do things independently. There was a concern that increasing his support hours would increase his dependency on formal staff.
8. Mr C made a complaint to the Council in August 2018. He asked the Council to increase his support package from 12 to 15 hours a week. Mr C was receiving 7 hours a week of support in the community to enhance his relationships with his peers and engage in more activities in the community, and 5 hours to develop his independence around household task in preparation for moving out in the near future. Mr C wanted more support with household tasks, meal preparation, community activities and to attend medical appointments.
9. In response to the complaint, the Council organised a meeting with Mr C and his advocate on 5 September 2018. The record of this meeting states that:
• Mr C said he was tired and in pain most days, due to his cerebral palsy. He said he did not feel he had the support he needed to “live his life and do the things he should be doing”, but he coped.
• Mr C’s social worker said that his support was not meant to be long term. It was about developing a social network for him and build up his confidence and skills. Mr C did not need support from his carers with some of the activities he wants to do in the community.
• Mr C said he would use the additional three hours for help within the house, such as help with choosing breakfast and household tasks. He also said he has social skills and confidence to go out and interact with people, but needed help with getting out.
• The meeting agreed there would also be a functional skills assessment by an Occupational Therapist (OT), after which the Council would review Mr C’s care package.
10. Following the meeting, the care provider reported back to the Council that: it believed Mr C did not have the confidence or skills to do anything independently in the community. He does not make any efforts to speak to others when he is out or build relationships with peers; he is rude to peers who want to speak to him. Nevertheless, the 12 hours a week were sufficient. Mr C would be better off in shared accommodation, but he does not want that.
11. The Council agreed that, once Mr C had moved out in December 2018 to live independently, he would receive 25.5 hours of support a week:
• ½ hour in the morning with breakfast (7 days a week)
• 1 hour a week with his evening meal (x 7 days)
• 15 hours per week support with leisure activities, household tasks and pursuing an employment opportunity.
• The care package would be reviewed after three months.
12. Mr C’s care plan said he should be encouraged to go out of his comfort zone and engage with his peers when attending social events. Mr C should be more willing to try and build a social network to become less dependent on his care workers.
13. Mr C moved into a rented property in December 2018. He told his social worker at the end of January 2019 that he wanted more support in the evening. However, his social worker believed that one hour was enough. The evening support Mr C was receiving was to encourage him to do as much as possible himself.
14. An OT assessment took place in February 2019. Before the assessment, the OT obtained information from Mr C’s social worker and his care support agency:
• Mr C said he did not plan his meals and would use whatever was available. He could not do tasks that involve two hands. Making lunch made him tired.
• The OT concluded that Mr C would benefit from support with planning cooking in advance. He also advised Mr C to buy some equipment that could enable him to prepare some of his cooking, before his carer arrives. The OT also advised Mr C to consider buying a dishwasher.
• Mr C’s care provider agreed with the OT’s suggestions and that one hour in the evening was enough.
15. The OT made another visit in March 2019, to assess what support care workers should provide to Mr C to encourage and enable him to try and do as much of his meal preparation as possible. At the assessment, Mr C confirmed he did not buy any of the equipment the OT had recommended two months ago. The OT recommended that: Mr C should change his cooker to an electric hob, he should buy equipment for one-handed people, and he could eat microwave meals. The OT concluded Mr C did not need extra support and could be independent with his breakfast.
16. The social worker discussed the outcome of the OT assessments with Mr C. The social worker explained to Mr C why the evening call would not increase. However, Mr C did not agree that he could be independent with breakfast and he refused to accept the suggestions the OT had made. Instead, Mr C said he would make a complaint.
17. Mr C made a complaint to the Council in April 2019. He said that:
• He needed more support, because he was now living independently and would soon stop with college, resulting in a need for more support at home on Monday to Wednesday.
• He was unable to do many things that people thought he could do.
• He needed someone to remind him what he needs to do and where he needs to go.
• He needed support with planning meals and shopping, as he forgets things very quickly.
• He was worried about spending a lot of time on his own, as he struggled to go out and socialise. He said that thinking about how to cope alone, was making him very tired, ill, overwhelmed and stressed.
• He was unhappy with his care package and wanted another care review by someone else.
18. In response, the Council reallocated his case to a different social worker to progress a review of his care. The new social worker discussed the support Mr C felt he needed and how his support was currently being provided. Mr C said he would like 6 more hours a week for social support, as he felt too vulnerable to access the community alone. The new social worker concluded that, although Mr C felt he should have more support, his current package enables him to get out and about. He sees people daily and has opportunities for emotional support. More social support by carers would increase his dependence on them. As such, the package should remain at 22.5 hours a week.
19. The Council also organised a meeting with Mr C in June 2019, to discuss his concerns about his care support. The record of the meeting states that:
• A GP had diagnosed Mr C with Glandular Fever, which can leave a person very fatigued. Mr C said the Council were not meeting his needs. He was feeling drained and overwhelmed every day. As such, he would need more help with managing and organising letters and bills, and staying on top of things. Mr C said he does not go outside on his own, resulting in isolation.
• In addition to two visit per day, to help him with getting up, his dinner and other things he could not manage, Mr C was also getting 12 hours support a week from “Circles Network” on Thursday (cleaning and paperwork); Friday (Food shopping) and Saturday (Social – cinema; snooker; bowling).
• The Council suggested prioritising, time tabling and pacing techniques to deal with his fatigue.
• Mr C did not seem interested in exploring internships, further training or volunteering.
• The Council asked Mr C to explain what type of support he thought the Council was not currently providing. However, Mr C struggled to explain what the Council could do to make things more manageable for him. At this meeting, Mr C did not suggest anything specifically and only said he was struggling and needed more help.
• The Council explained it cannot approve more hours if these can’t link in with specific tasks he needs support with. It asked Mr C how the Council could help him to link up with people to make friends and do things with. However, Mr C could not provide an answer.
20. The meeting concluded that
• Mr C had adequate support that he could use flexibly. Mr C failed to explain why he needed extra support and in which areas.
• Mr C has chosen not to continue with education. He should think about work experience and/or volunteering opportunities, which could assist him with socialising as well.
• CBT or counselling could help Mr C to open up his perspective about his situation and allow him more insight before exploring further changes to his support.
21. The care plan says that all involved with Mr C felt he was doing extremely well and that the amount of hours remained appropriate. However, it was felt that Mr C could do more himself to enhance his social network outside of his paid support. However, to do this, Mr C would have to show willingness for this to happen. Mr C would continue to receive 22.5 hours of support a week.
22. Mr C was unhappy with the outcome of his complaint and referred his complaint to the Ombudsman in July 2019.
23. Since then, the Council has carried out another care review in October 2019, which concluded that Mr C was receiving the amount of support he needed to meet his needs in terms of daily living, access to his community and socialising. Furthermore, Mr C had spoken to his GP about medication for depression and he was thinking about counselling.
24. The Council says that:
• There is a lot of resistance from Mr C to promote his independence and not be reliant of services. Whenever suggestions are made about how he could do things independently, this results in a complaint to the Council.
• Mr C’s care provider has supported Mr C for a long time. The Council involves them as part of any review and support planning, because they know Mr C’s situation very well.
• Mr C is able to link into groups to allow increased opportunities to make friends and networks in a more organic way without relying on his workers.
• If Mr C wants to consider an electric wheelchair, to help him with accessing the community, he can ask his GP to refer him to the wheelchair service to assess his eligibility.
• Mr C has yet to confirm that he wants the Council to refer him to his GP for CBT or counselling.
25. Mr C’s care provider told me that he only socialises with his care workers. As such, they believe that Mr C wants to increase his hours so he can socialise more. Mr C is receiving support with bill payments, cleaning, shopping, encouraging him to eat healthy etc. Mr C goes to some social activities but only ends up talking to his care workers. They have encouraged Mr C to pursue more volunteering / work opportunities, which could help him with any issues related to isolation. However, Mr C is not interested or motivated to do that.
26. Mr C told me that he needs 5 hours of support a day, Monday to Friday. He is with his family at the weekend. He needs support with shopping, medical appointments, and bills. He does not have the strength or stamina to go out into the community on his own, because he gets very exhausted when travelling. He struggles to walk more than 10 minutes, and cannot use his wheelchair independently. He does not have anxiety, so there is no need for him to go to counselling. People with cerebral palsy struggle to interact with people and have a conversation with them.

Assessment

27. I did not find fault with the way through which the Council has reached its decision that Mr C’s care support is enough to meet his needs.
28. Mr C’s care support is geared towards trying to make Mr C as independent as possible. The Council has regularly reviewed his needs and actively engaged with Mr C to be able to listen and consider his arguments for increasing his hours. It has also carried out two OT assessments and involved Mr C’s care support workers in his care reviews.
29. The records showed that all professionals involved with Mr C’s care support (two social workers, an Occupational Therapist, and his care support agency) felt that Mr C has been receiving the amount of support he needs; none have raised concerns about a lack of support.
30. Without fault, I will not question the merits of the Council’s decision (see paragraph 3 above).

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Final decision

31. For reasons explained above, I did not uphold Mr C’s complaint.

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Investigator's decision on behalf of the Ombudsman