Summary: We uphold Mr X’s complaints about a delay in responding to his request for assistive technology for his wife Mrs X and a delay in reviewing her care and support plan. The fault caused avoidable distress and financial loss. The Council will apologise, identify a suitable respite placement for Mrs X, reimburse Mr X for items he has bought and make a payment to reflect his avoidable distress and time and trouble.

The complaint

1. Mr X complains for his wife Mrs X that Sheffield City Council (the Council) delayed in responding to his request in August 2018 for assistive technology (‘AT’) (equipment to help someone be more independent at home). He has suffered financial loss because he has bought equipment meantime and wants the Council to reimburse the cost.
2. Mr X also complains the Council delayed in reviewing Mrs X’s care and support plan. He said this meant Mrs X did not get planned respite care and so he had to return £30,000 of her unused direct payment to the Council. He would like the Council to identify an appropriate respite provision for Mrs X.

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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, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I considered Mr X’s complaint, the Council’s responses to his complaint and documents described later in this statement. I discussed the complaint with Mr X. The parties received a draft of this statement and I took comments into account.

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What I found

Relevant law and guidance

6. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
7. Eligible needs are set out in national criteria. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2)

8. Councils have a duty to meet a person’s eligible needs that are not being met by an unpaid carer. (Care Act 2014, section 18)
9. The Care Act 2014 sets out what councils may provide to meet a person’s needs, including care and support at home and goods and facilities. (Care Act 2014, section 8)
10. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs. (Care Act 2014, section 26)
11. There are three ways in which a personal budget can be used, including as a direct payment (a direct payment is money a person gives to a council to meet agreed needs).
12. Statutory Guidance explains a council should review a care and support plan at least every year, on request or in response to a change in circumstances. The purpose of a review is to see how a care and support plan has been working and to decide if any revisions need to be made to it. The council should act promptly after receiving a request for a review. (Care and Support Statutory Guidance, Paragraphs 13.19-21 and 13.32)

What happened

13. Mrs X has physical disabilities, uses a wheelchair and has a visual impairment. She is eligible for social care services and the Council has been giving her a direct payment for several years. Mr X arranges Mrs X’s care and uses the direct payment to pay for it.
14. Mr X asked the Council to review Mrs X’s care and support plan in August 2018. He said the reasons for requesting a review were:
• He could not find a suitable placement in Sheffield for Mrs X to have respite care. He and Mrs X had looked at some care homes, but none were suitable as they were for people who were more disabled than her and would not accept pre-booked respite periods.
• He wanted permission to use some of the unspent direct payment to buy AT for Mrs X.
15. Mr X complained in October 2018 about the delay in starting a review. The Council apologised for the delay.
16. In November 2018, a social worker asked Mr X to email her with the equipment he and Mrs X wanted to buy. Mr X responded with a list of products and the reasons why Mrs X needed them. Mr X said Mrs X had not been able to spend all her direct payment because of hospital admissions and because she was not able to find suitable respite. He asked the Council if he could use some of the unspent direct payment to buy a home hub with smart light switches and voice control speakers and a front door camera, smart door lock and smart central heating controls. The total cost for the equipment he wanted was £775. Mr X said this was less than three per cent of the unspent direct payment he was returning to the Council.
17. Mr X also told the Council that he was not getting respite care and he wanted this issue addressed as part of the review. The social worker acknowledged Mr X’s email. The Council started a review of the care and support plan around November 2018, the exact date is unclear from the case notes. There is documentation dated January 2019 which set out Mrs X’s needs and her personal budget. She required assistance from two carers with personal care. She also needed help with most other daily tasks including medication, meals and drinks, practical tasks, support to access the community and to stay safe. This document noted Mr X found supporting Mrs X difficult at times and needed regular breaks from caring to ensure his own well-being. Mr X told me he had not seen a copy of this document and that it was not implemented.
18. No action appears to have been taken on the case until a team manager visited Mr and Mrs X in May 2019 to discuss AT and respite care. The team manager told Mr and Mrs X they could only use the direct payment to ‘meet an identified wellbeing need’. The note of the meeting said “Respite discussed and the need for something suitable for Mrs X. Cost discussed and funding level. Explained that we would look at Mrs X’s support needs in the first instance, funding would be considered after.”
19. The outcome of the meeting was the team manager was going to allocate the case to a social worker to “start again. To look at technology request as well as support planning.”
20. A social worker referred Mrs X to the Council’s prevention and reablement team at the end of May. The reason for the referral was for advice about suitable AT, such as equipment to open the front door or turn lights on and off. A worker from the prevention and reablement team visited Mrs X and drew up a plan. This noted Mr X had provided a list of equipment that might be suitable for Mrs X to use to control lights, heating and to answer the front door. The plan said the prevention and reablement team was going to liaise with another team to find out whether the equipment would meet Mrs X’s needs. The worker from the prevention and reablement team spoke to Mr X at the end of July saying she had discussed the case with colleagues and looked at various options available.
21. Mr X complained to the Council about the lack of action. The Council responded to his complaint about AT in August 2019. It acknowledged there had been delays in responding to his request. It said it had referred Mrs X’s case to the reablement team which had specialist knowledge about assistive technology and the Council would tell him what its decision on funding for assistive technology was in September.
22. An Occupational Therapist (OT) from the prevention and reablement team visited Mrs X at the end of August. Mrs X showed the OT how she was already using equipment in the home and they discussed the AT Mrs X wanted. The OT visited Mrs X again in September and referred her to an AT company. A specialist from the AT company visited Mrs X in November and December.
23. The OT visited Mrs X again in December and there was further discussion about the sort of equipment Mrs X might use.
24. The Council did not tell Mr and Mrs X about its decision on whether he could use some of Mrs X’s direct payment for AT. So he complained to us. He had also complained to the Council in October 2019 about the delay in reviewing Mrs X’s care and support plan. The Council did not respond until we prompted it to in January 2020, although one of the Council’s officers was in regular contact with Mr X about progress on its complaint response.
25. The Council’s response to Mr X’s complaint about the failure to review Mrs X’s care and support plan said:
• Mr X asked for a review in August 2018 and a council officer contacted him in November. This was an unacceptable delay at the beginning.
• This wait was normal at the time due to internal changes to working. Waiting times had now reduced.
• Support planning had been ongoing and was taking much longer than expected. On top of the delay in allocating a worker, there was a two-month delay because of staff absence
• Most of the delay was due to not agreeing the respite part of Mrs X’s care and support plan and in particular due to council staff providing incorrect information. Staff had wrongly told Mr and Mrs X they were only entitled to funding of up to £481 a week (the cost of residential care) for respite.
• The Council was willing to fund appropriate respite care which would meet Mrs X’s needs. Funding would be flexible.
• The Council would be issuing guidance to staff and managers about respite funding. This would minimise the risk of recurrence.

Comments from the Council

26. The Council accepts it took too long to respond to Mr X’s request for assistive technology and reviewing the care and support plan. It says the wait was normal and due to internal changes to working and high levels of demand. The Council also says waiting times have now significantly reduces as a result of changes to ways of working.

Was there fault?

27. There was fault by the Council and I uphold both complaints.

Complaint 1: The Council delayed in dealing with a request for AT

28. Mr X asked the Council to fund AT in August 2018. At the time of writing, funding has still not been agreed. Mr X identified the AT he thought was suitable. The Council then prevaricated by referring Mrs X to a different team which then referred her to a private company. While referring Mrs X to other internal and external services was not in itself fault, taking so long to agree a relatively small amount in cost terms was fault. I see no reason why the Council could not have completed the process within about three months of Mr X’s request.

Complaint 2: The Council delayed in reviewing Mrs X’s care and support plan. He said this meant Mrs X did not get planned respite care and so he had to return some of her unused direct payment to the Council. He would like the Council to identify an appropriate respite provision for Mrs X.

29. Mr X asked the Council to review Mrs X’s care and support plan in August 2018. The Council appears not to have started a review until November and the documents dated January 2019 (which set out Mrs X care needs and personal budget) was never issued to Mrs X. The care and support planning process is not yet finished at the time of writing. Taking months to properly complete a review a care and support plan was not a prompt response as required by Care and Support Statutory Guidance and was fault.
30. In addition, the Council has not revised or made changes to the care and support plan despite Mr X’s stated concerns about the lack of suitable respite provision. Mrs X’s care and support plan noted Mr X needed regular respite care. The care and support plan indicates Mrs X has an eligible need for replacement care to meet her care needs when Mr X has a break. This has not been achieved because of the Council’s delay, provision of incorrect information about funding and a failure to identify suitable placements for Mrs X to have respite.
31. Mrs X has a direct payment with which in theory she or Mr X could have used to fund respite care. They told the Council they had not been able to find anywhere suitable for respite care in Sheffield and eventually paid back some of the direct payment because they could not find a way of using it. The Council accepted it provided incorrect information about funding for respite care. This was fault. There is no evidence the Council identified a suitable respite service for Mrs X and this means Mr X has not had a break for at least 18 months. The failure to support Mr and Mrs X with identifying an appropriate provision after they asked for assistance was fault. The Council has a duty to meet Mrs X’s eligible unmet needs and one of the identified eligible needs in the care and support plan has not been met. The Council failed to act in line with section 18 of the Care Act 2014.

Did the fault cause injustice?

32. Mr X has paid for some of the AT equipment himself. So Mrs X has not suffered injustice in that she has received the benefit of that equipment. However, Mr X is out of pocket.
33. Mr X has not had a break from his caring role for at least 18 months. This has caused avoidable distress.

Agreed action

34. To remedy the injustice described above, the Council will, within two months:
• Apologise
• Fund the items set out in Mr X’s original proposal for AT
• Reimburse Mr X for the items of AT he has already bought
• Pay Mr X £2000. This is a case where the impact on Mr X has been exceptional in that it has been both severe and long term. This figure is in line with our Guidance on Remedies for exceptional cases.
• Identify and arrange suitable respite for Mrs X, consulting with Mr and Mrs X about the available options.

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Final decision

35. We uphold Mr X’s complaints about a delay in responding to his request for assistive technology for his wife Mrs X and a delay in reviewing her care and support plan. The fault caused avoidable distress and financial loss. The Council should apologise, identify a suitable respite placement for Mrs X, reimburse Mr X for items he has bought and make a payment to reflect Mr X’s avoidable distress and time and trouble.
36. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman