London Borough of Newham (19 015 171)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 17 Feb 2021

The Ombudsman's final decision:

Summary: There was fault by the Council. It failed to properly address Miss B’s needs as a carer for both her elderly parents for around 21 months. In this time, Miss B did not have a single day off from caring for her parents, she was unable to meet friends, or have any time for herself. The Council has agreed to apologise to Miss B and pay her £5,000 in recognition of the impact on her of its failings. It will also review what went wrong in this case, identify lessons learned and implement any changes needed to ensure that these faults do not recur.

The complaint

  1. Miss B complains that the Council:
    • Failed to meet her needs as a carer until May 2018, after assessing those needs in June 2016. So, she missed out on opportunities for respite and was left stressed and distressed by her caring role;
    • Took too long to respond to her subject access request and still has not provided all the relevant records; and
    • Has not adequately addressed her complaint or remedied the injustice arising from its fault.
  2. As a result, Miss B did not have the support she was entitled to. During this time, she cared for her parents without any time away. She developed depression and anxiety as well as other physical conditions. Miss B tells me that her doctor has concluded her health problems have been caused by the stress of her caring role.

Back to top

What I have investigated

  1. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
  2. Having considered the information we have to date and spoken to her representative, I have decided that Miss B had good reason not to complain to the Ombudsman sooner. She was unable to spare time and energy to progress this because she did not have adequate support as a carer for her parents, and for much of the time she had a reasonable expectation that matters were progressing. I have exercised discretion to investigate Miss B’s complaints about events from June 2016.
  3. I have not investigated Miss B’s complaint about the subject access request for the reasons set out below.

Back to top

The Ombudsman’s role and powers

  1. 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)
  2. 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)

Back to top

How I considered this complaint

  1. I considered the information provided by Miss B’s representative. I considered the information provided by the Council including the carers assessment I also considered the law and guidance set out below. Both parties have had the opportunity to comment on a draft of this statement. The Council agreed to my recommendations and I have considered any comments from the parties before reaching my final decision.

Back to top

What I found

The law and guidance

  1. Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
  2. Where the local authority is carrying out a carer’s assessment, it must include in its assessment a consideration of the carer’s potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)
  3. Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
  4. Where the local authority is carrying out a carer’s assessment, it must include in its assessment a consideration of the carer’s potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Back to top

What happened

  1. Miss B lived with her parents who I have called Mr and Mrs H. Her elderly father, Mr H had vascular dementia, had multiple strokes, and suffered from chronic kidney disease and diabetes. Miss B’s mother, Mrs H has severe arthritis and requires knee replacement operations in both knees. They required constant care during all hours of the day and for all their daily needs including dressing, eating, and using the toilet, and all domestic chores such as grocery shopping and cleaning.
  2. The Council became involved in June 2016. The Council first telephoned and then visited to assess the situation. It completed a carers assessment for Miss B in June 2016. The assessment found that Miss B provided all the care and support to her father except personal care, which was provided by a friend. She was unable to work, study or take part in any activities. Miss B could not leave her father alone with her mother, as she could not care for him.
  3. The assessment says Miss B is not willing or able to continue to provide the same level of care and support. At that time, Miss B said her mother’s health was also deteriorating and she was worried about providing care to both. Miss B had no help from her family. She was isolated and stressed.
  4. The social worker (SW) concluded that Miss B met the criteria for services and she would like to return to study and work, she would like some support for her father and to access the community, and would like direct payments to pay the friend for personal care for her father.
  5. The Council says it explored Telecare for Miss B’s father and arranged a visit to look at independent living equipment to ease Miss B’s caring role. It says it also referred Mr H to the enablement team to look at care for him. The Council’s intention was to ease Miss B’s caring responsibilities by supporting her father. However, it did not follow up on Miss B’s needs at that time.
  6. Mrs H’s health was deteriorating. The Council offered Mrs H a needs assessment in September 2016 which she refused. But On 1 November 2016, an emergency care package was implemented. The Council funded 21 hours of care for Mrs H weekly but did not explicitly review or assess Miss B’s needs as carer. The care package did not significantly lessen the burden as she could not leave either her mother or father alone. Miss B still had no time to see to her own needs, or to work or study.
  7. The Council reviewed Miss B’s needs as a carer in July 2017. This noted that Miss B does not really have a break or a life of her own. The Council decided that a carer’s break sitting service and direct payments would enable Miss B to get a break. The Council also agreed a direct payment to Miss B to pay for massage therapy at £854 per annum. The Council’s records note that Miss B could not get a break when her father had a sitting service because she had to care for her mother. The Council’s case note describes Miss B as being at breaking point.
  8. The Council failed to process the direct payments properly due to an administrative error. These were not made until April 2018 and have been in payment continuously since then. The Council says that payments should have been backdated to 22 December 2017. Miss B says she did not receive a backdated payment.
  9. The Council again reviewed Miss B’s needs as a carer in May 2018. At that time, Miss B said the strain on her was very similar to the previous assessment and she needed an increase in the sitting service.
  10. However, there were further problems with the direct payments. Miss B could not access her direct payments from September to December 2018.
  11. In response to her complaint to it:
    • The Council acknowledged that it did not pay the correct amount of her direct payment for Miss B’s massage therapy. It should have paid £854 but only paid £366. It paid the balance to Miss B. This meant that she could not pay for her massage therapy from September to December 2018. The Council offered to pay her £250 for the inconvenience this caused her.
    • It said this was a systems error and it made additional manual checks while it was resolving this. It has also formed a direct payments group to oversee improvements to this process. This means that people waiting for direct payments are allocated to a team to oversee and the same data system is used for all direct payment requests. The Council has confirmed that no other service users had delayed or incorrect direct payments.
    • The Council told Miss B that there was no record of carers assessment in June 2016 and she would not have been entitled to direct payments from then as a support package would need to have been approved by its panel.
  12. The Council has offered to pay Miss B £693. This is made up of £250 in recognition of the time and trouble the Council put her to when she had to chase it for her direct payments, plus a further £250 for the period she had no support, and a payment of £193 for support that she could not take that year. The Council says it has made this payment, but Miss B says that although the Council offered her this, it has not paid it.
  13. Miss B’s father sadly passed away in May 2020.

Fault and Injustice

  1. There was fault by the Council causing an injustice to Miss B. The Council failed to properly support Miss B or meet her needs as a carer to her two parents.
  2. The Council assessed Mr H’s needs in June 2016. It says that it assessed Miss B’s needs at the same time. It did refer Mr H for some help intending that this would take some of the burden from Miss B. But the Council failed to properly address Miss B’s needs as a carer, despite noting that she was not willing or able to continue to provide the same level of care and support; that she could not leave her father at any time as her mother’s health was also deteriorating; that she was isolated and stressed; and deciding that she met the eligibility criteria for support.
  3. The Council knew that Miss B’s situation had deteriorated when it had to arrange an emergency care package for her mother later that year. Although the care for Mrs H may have reduced Miss B’s caring burden in some ways, it did not significantly do so, as she could not leave either her mother or father alone. The Council did not do anything to ensure that the care allowed Miss B to take a break from caring or to meet her needs and outcomes assessed earlier that year. That is to allow Miss B to return to work or study, or to take a break and make friends. In fact, Miss B still could not take a single day off from caring for her two parents.
  4. The Council says it accepts that it should have followed up on Miss B’s needs sooner than July 2017. Although it agreed to provide a sitting service and direct payments for Miss B to get some massage therapy, the Council did not actually meet these needs until April 2018. This means that Miss B did not get any time for herself or a proper break from caring for almost two years after her needs were first identified (June 2016 to April 2018). This is despite the Council finding her to be isolated, stressed and struggling to sustain her caring role at every assessment it made.
  5. There was also fault by the Council when Miss B could not access her direct payments, meaning she could not access the much-needed massage therapy between September and December 2018.
  6. The Council has acknowledged that it should have followed up on Miss B’s needs sooner. It has offered to make her a payment of £693. However, it seems to me that Miss B is likely to have needed a similar provision to meet her needs and to give her a break from her caring responsibilities from June 2016, or at least from September 2016, when the Council found her mother to be in need of a care package too. The Council cannot say that it should have followed up her carer’s needs sooner and then not take account of the impact of not doing so, especially as it found she met the eligibility criteria for support. Miss B was without proper support for around 21 months. In addressing Miss B’s complaint, the Council should also take account of the cumulative impact on Miss B of not receiving the appropriate support sooner, and that the direct payments and sitting service are worth more to her than the cost of these to the Council. The Council’s offer is not sufficient and it does not appear to have grasped the impact on Miss B. Its failure to properly address her complaint is further fault.

Back to top

Agreed action

  1. When we have evidence of fault causing injustice we will seek a remedy for that injustice which aims to put the complainant back in the position they would have been in if nothing had gone wrong. When this is not possible, we will normally consider asking for a symbolic payment to acknowledge the avoidable distress caused. But our remedies are not intended to be punitive and we do not award compensation in the way that a court might. Nor do we calculate a financial remedy based on what the cost of the service would have been to the provider. This is because it is not possible to now provide the services missed out on.
  2. The Council has agreed that within a month of this decision it will show the Ombudsman it has:
    • Apologised to Miss B that it did not properly address her needs between June 2016 and April 2018 (when payments and services actually began);
    • Paid Miss B £5,000 in recognition of the distress and frustration it caused her and the significant impact of the missed support for this sustained period;
    • Ensure that it has paid the full amount of the direct payments due to Miss B from July 2017 to date; and
    • Shared this decision with the relevant staff.
  3. The Council will also within three months of this decision show the Ombudsman it has reviewed what went wrong in this case, identified lessons learned and implemented any changes needed to ensure that these faults do not recur.

Back to top

Final decision

  1. I have completed my investigation. There was fault by the Council causing Miss B injustice.

Back to top

Parts of the complaint that I did not investigate

  1. There is no reason why Miss B cannot complain to the Information Commissioner about the subject access request and so I would expect her to do so. I have not investigated that part of her complaint.

Back to top

Investigator's decision on behalf of the Ombudsman

Print this page

Privacy settings

LGO logogram

Review your privacy settings

Required cookies

These cookies enable the website to function properly. You can only disable these by changing your browser preferences, but this will affect how the website performs.

View required cookies

Analytical cookies

Google Analytics cookies help us improve the performance of the website by understanding how visitors use the site.
We recommend you set these 'ON'.

View analytical cookies

In using Google Analytics, we do not collect or store personal information that could identify you (for example your name or address). We do not allow Google to use or share our analytics data. Google has developed a tool to help you opt out of Google Analytics cookies.