Summary: Mrs X complained about the Council’s failure to carry out a proper care needs assessment and other related issues. We have found the Council was not at fault.

The complaint

1. Mrs X complains about the Council’s response to her request for adult care support. In particular, she complains:

• the Council’s care assessment in July 2019 was inadequate and incorrect.
• the Council failed to provide mobility aids.
• her social worker did not provide enough support in applying for re-housing or in accessing financial help from charities.
• her social worker made unnecessary safeguarding enquiries.
• the Council repeatedly ignored her request for communications by email only and arranged meetings without her consent.

2. Mrs X says the Council’s failure to provide support has had a detrimental impact on her mental well-being.
3. Mrs X is represented by her partner, Miss Y, in making this complaint.

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What I have investigated

4. I have investigated events up to February 2020, when the Council ended its social work involvement in this case.

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The Ombudsman’s role and powers

5. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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)
6. 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)
7. 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

8. As part of my investigation I have:

• considered the complaint and documents provided by Miss Y;
• made enquiries of the Council and considered its response;
• considered the relevant law and statutory guidance; and
• sent my draft decision to both parties and invited comments on it. Any comments received were taken into consideration before I reached my final decision.

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What I found

Relevant law

Care needs assessment

9. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Adult safeguarding

10. Section 42 of the Care Act 2014 and the Care and Support Statutory Guidance set out the Council’s safeguarding duties. A safeguarding duty applies where a council has reasonable cause to suspect that an adult:

• has needs for care and support;
• is experiencing, or at risk of, abuse or neglect and
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

11. If the section 42 threshold is met, the Council must make enquiries.

Duty to make reasonable adjustments

12. The reasonable adjustment duty is set out in the Equality Act 2010. It applies to any body which carries out a public function. It aims to make sure a disabled person can use a service as close as it is reasonably possible to get to the standard usually offered to non-disabled people. When the duty arises, the body is under a positive and proactive duty to take steps to remove or prevent obstacles to accessing their service. If the adjustments are reasonable, they must be made.

What happened

13. I have set out below a summary of the key events. It is not meant to show everything that happened.
14. Mrs X is a young woman who suffers with several physical and mental health problems, including osteoarthritis and anxiety. She lives with her partner, Miss Y who is also her carer.
15. In July 2019, Miss Y contacted the Council to request a social care needs assessment on behalf of Mrs X. Mrs X required help with the following areas of difficulty:

• Anxiety.
• Managing health conditions, including her arthritis and her need for possible knee surgery.
• Support to get active, particularly with weight loss and mobility.
• Support for Miss Y in her role as carer.

16. A social worker, Officer J, carried out this assessment. Also in attendance was Mrs X’s GP. Mrs X did not participate verbally in the assessment, but provided a letter setting out what she needed. Miss Y spoke on behalf of them both during the assessment.
17. Mrs X had a number of potentially eligible social care needs. However, the couple advised the Council they were able to meet these needs (such as dressing and washing) themselves and did not want external support for personal care needs. The assessment confirmed that Miss Y was happy to continue to support Mrs X.
18. In terms of Mrs X’s other requirements, Officer J made a number of referrals to other agencies because they were health related rather than social care needs:

• Falls and Community Therapy service.
• Mental health services.

19. Officer J also carried out a carer’s assessment for Miss Y. Miss Y was awarded a one off payment of £150 to acknowledge her caring responsibilities. This was in line with the Council’s policy on providing support for carers.
20. Officer J also assisted Miss Y in applications for discretionary benefits and housing. Both have been the subject of separate complaints and investigations by the Ombudsman. I will not reinvestigate these matters.
21. Following Officer J’s referral to mental health services, an appointment was made for a mental health assessment at Mrs X’s home on 12 August 2019. This had been cancelled by Miss Y because Mrs X had anxiety about the visit. Officer J was contacted by Mrs X’s GP as two other health related home visits for Mrs X had been cancelled by Miss Y. The GP made a safeguarding referral to the Council as she was concerned about Mrs X’s well-being and lack of access to support she needed.
22. The Council carried out a preliminary safeguarding assessment and decided it was necessary for Officer J to carry out a home visit the following day with a member of the safeguarding team. Officer J called Miss Y to advise her of this. Miss Y told Officer J she needed at least a weeks notice of a home visit. A date was arranged for the following week.
23. Officer J and the safeguarding officer visited Mrs X at home. Mrs X did not engage but Miss Y spoke on her behalf.
24. Mrs X was offered another visit from the Mental Health Assessment team but this was declined by Miss Y. Miss Y explained the issues Mrs X has engaging with new people. She was only prepared to see one particular psychologist (“the Psychologist”) with whom Mrs X had trust and was on her waiting list.
25. Officer J told Miss Y that they remained concerned about her restricting Mrs X’s access to services and this required a follow up visit from the safeguarding team.
26. In September 2019, Officer J was contacted by Mrs X’s GP. Miss Y had emailed the surgery reporting a potentially serious medical issue on behalf of Mrs X. The GP tired to talk to Mrs X on the phone but was told by Miss Y this was not possible. She carried out a home visit, but was not allowed into the property. She raised another safeguarding alert with the Council.
27. Shortly afterwards, a safeguarding professionals meeting took place. Concerns were raised about Mrs X’s non-engagement with services and the impact of this on her mental health. It was agreed that they would await the outcome of the assessment visit from the Psychologist, due to take place in October 2019.
28. Following her visit, the Psychologist confirmed she had no safeguarding concerns.
29. In December 2019, Officer J was contacted by a member of the Falls and Community Therapy team to say they had been unable to contact Mrs X. Officer J advised him to contact Miss Y in writing as this was their chosen contact method.
30. Officer J’s manager (Manager D) tried to call Miss Y to discuss the non-engagement issue. Manager D recorded that Miss Y had previously indicated she could be contacted by phone.
31. A further professionals meeting took place on 15 January 2020. Outcomes were:

• Mrs X and Miss Y to be offered a home visit by the Head of Service to respond directly to official complaints made.
• There was no role for mental health services because main issues raised by Mrs X were around pain management and mobility. These matters were the responsibility of the NHS.

32. Miss Y declined the home visit by the Head of Service. Because there was no further role for social work support, the case was closed.

The complaint

33. Miss Y first complained to the Council in November 2019. The Council replied the following month. I have summarised the main, relevant points below:
1. The safeguarding investigation was justified due to concerns raised by both the GP surgery and the ambulance service.
2. Mrs X’s medical history was provided by Miss Y and Mrs X during the assessment. It was not possible to obtain confidential medical information about her medical history without their consent
3. The Council acknowledged Mrs X’s request for all contact to be made via Miss Y and via email. The Council considered it had complied with this request except in certain occasions when it was necessary to speak to Mrs X directly because of safeguarding issues.
4. Officer J made several referrals and request for support from other departments and agencies.
5. The Council had acted appropriately in its attempts to offer support to Mrs X’s mental health needs.
6. Officer J offered appropriate support with housing issues.
7. Manager D took the view Miss Y was able to discuss matters over the phone and was the best way to try and resolve the outstanding issues and complaints.
8. An appropriate, timely referral was made to the Falls and Community Therapy Team by Officer J, prior to her having closed the case and no longer being Mrs X’s social worker.
34. Dissatisfied with this response, Mrs X complained to the Ombudsman.

Analysis

35. I will consider each of Mrs X’s separate complaints (summarised at paragraph 1 above) in turn.

The Council’s care assessment in July 2019 was inadequate and incorrect

36. The law requires local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how it impacts on their wellbeing and the results they want to achieve.
37. It is not the Ombudsman's role to decide what, if any, care and support a person needs. That is the Council's role. The Ombudsman's role is to consider if the Council has followed the correct process for establishing a person's needs and if it acted correctly when this process was complete.
38. Miss Y participated in the assessment on behalf of Mrs X. This was at Mrs X’s request. I am satisfied, the assessment considered their views and Officer J’s observations from her visit. They were clear they did not want anyone to help with Mrs X’s personal care needs. This was because Miss Y was willing to continue in her role as Mrs X’s carer. Because of this, Officer J correctly carried out a carer’s assessment. A payment was made to Miss Y because of this assessment in accordance with the Council’s policy.
39. The assessment recognised that Mrs X still had need for other support services. Officer J therefore made several referrals to other departments/agencies.
40. Mrs X also complains about inaccurate and incomplete medical information on the assessment.
41. When this matter was raised by Miss Y, Officer J contacted Mrs X’s GP. The surgery was unable to release confidential medical information without Mrs X’s consent which she did not give.
42. The assessment records Mrs X’s health conditions as severe arthritis, IBS, Chrohn’s and mental health anxiety”. Mrs X had provided Officer J with a hand written letter setting out the issues that affected her. Miss Y provided more information verbally. The GP was also present at the assessment.
43. I am satisfied Mrs X was given sufficient opportunity to inform the assessment process about her medical history, the difficulties she faced and the support she needed. The records show Officer J responded appropriately to Miss Y’s objection to incomplete medical history being included in the assessment. She contacted the GP surgery, but was told the information could only be disclosed with Mrs X’s consent. This was not forthcoming, so Officer J could not take the matter any further.
44. I am also satisfied with the action taken by Officer J after the assessment by making referrals to other services and contacting her GP.
45. Officer J also demonstrated her commitment to supporting Mrs X’s mental health issues by arranging for her to be visited by her preferred therapist at home.
46. Mrs X does not agree with the outcome of the assessment, but I cannot question a decision just because someone disagrees with it. I must consider if there was fault in the way the decision was made. The Council assessed Mrs X’s needs in line with the Care Act and Statutory Guidance. The assessment is detailed and set out Mr X’s needs and how these may be met. There was no fault in the process.

The Council failed to provide mobility aids

47. The assessment recorded Mrs X’s request for several disability aids – a wheelchair, grab rail and an external ramp.
48. Miss Y also explained Mrs X required help to deal with the underlying causes, for example, pain management for her arthritis and support to lose weight and become more active. The assessment correctly identified this was the responsibility of the NHS rather than the Council’s social care function. Because of this Officer J made an immediate referral to the NHS Falls Team with a request for Occupational Therapy and Physiotherapy assessments.
49. However, there was a long waiting list for these assessments. Mrs X was not given an appointment until five months later. While I acknowledge this was a long time, because this was an NHS-led service, I do not criticise the Council for this delay. Office J made the referral immediately after her assessment and so there was no fault.
50. I understand from the Council’s response to my enquiries that an occupational therapy assessment took place in January 2020 and mobility aids were offered to Mrs X.

Mrs X’s social worker did not provide enough support in applying for re-housing or in accessing financial help from charities

51. From the case records, I can see that Officer J offered the following support to Mrs X and Miss Y:

• Liaised with the Council’s Local Welfare Team. Her intervention led to provision of a cooker, as washing machine, a double bed, bedding and a sofa.
• Provided assistance in arranging for the delivery and installation of these items.
• Made requests on their behalf for an additional food parcel.
• Liaised with the housing department to provide information about their status on the housing register.
• Offered her support in any grant applications made by Miss Y, if the organisation concerned required input from a social worker.

52. In her response to the Ombudsman, Officer J has explained she uses a “strength-based approach” when offering support to her clients. She therefore encouraged Miss Y to make her own applications. To do it for them could lead to clients being disempowered and being reliant too reliant on the service.
53. I do not criticise Officer J for this approach. There was no fault.

Mrs X’s social worker made unnecessarily safeguarding enquiries.

54. I also find no fault in the Council’s decision to make safeguarding enquiries. The Council took into consideration the referrals it had received from both the ambulance service and Mrs X’s GP. I am satisfied there were genuine concerns about Mrs X being prevented from accessing services she required. Miss Y has strongly denied the ambulance service made a referral, but the records confirm this happened.
55. It was the Council’s role to weigh up the information it had, to apply the correct law and guidance to assess the risk. The Ombudsman cannot question the merits of a decision if there is no fault in the way the Council has reached that decision.

The Council repeatedly ignored her request for communications by email only and arranged meetings without her consent.

56. The reasonable adjustment duty aims to ensure a disabled person can use a service as close as it is reasonably possible to get to the standard usually offered to non-disabled people. Therefore, the Council needs to ensure its services are accessible to everyone.
57. The Council complied with Mrs X’s requirement for all communication to be via Miss Y because of her anxiety issues. The Council also, wherever possible, complied with Miss Y’s request that communication was by email rather than by phone. I have noted Miss Y’s reasons for this. She told the Council she did not trust what the Council said to her and would then change its mind. For this reason, she wanted a written record of what was being said. She has also explained that a phone call would distract her from her caring responsibilities.
58. There were a few occasions when the Council tried to contact Miss Y by telephone. Miss Y considers they were breaches of the relevant equality legislation and amounted to disability discrimination. I disagree.
59. The Council has explained that there were occasions, for example, during the safeguarding enquiries, that it was necessary to speak directly to Mrs X. I have also noted that the Manager tried on several occasions to speak to Miss Y by phone. I do not criticise the Council for this. I understand by this time Miss Y and Mrs X had lost all faith in the Council, but the manager was making best endeavours to try and resolve the situation and offer support to the couple.
60. I have found no evidence Mrs X was prevented from accessing any Council services because of the Council’s actions.
61. For these reasons, I do not find fault with the Council actions.

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Final decision

62. The Council acted without fault when responding to their request for adult care support. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman