Summary: Mr X complains the Council refused his request for medication to be allowed as disability related expenditure, refused to provide him with a copy of a letter his doctor had sent, and failed to properly deal with his request for help with the cost of a support worker to help him make telephone calls and write letters. He also complains the Council failed to implement evening support calls and provided false and defamatory information to a care agency. We find some fault with the Council’s actions. We have made recommendations.

The complaint

1. Mr X complains the Council:
• Refused a request for over-the-counter medication to be allowed as disability related expenditure (DRE).
• Refused to provide him with a copy of the letter his doctor had provided to the Council which he said supported the DRE request.
• Failed to properly deal with his request for help with the cost of a support worker to help him make telephone calls and write letters.
• Has not implemented evening support calls even though he was told by the social worker it would be arranged.
• Provided false and defamatory information. This is in relation to information recorded by his allocated worker and shared with a care agency.

Mr X says he has been left with a package of care which does not meet his needs and that he is paying for items which he feels he needs because of his ill-health.

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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 provided by Mr X.
6. I made enquiries with the Council and considered the information it provided.
7. I sent a draft decision to Mr X and the Council and considered their comments.

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What I found

Legislation, guidance and policy

8. The Care Act 2014 is the legislation that sets out local authorities’ powers and duties in respect of social care. The Care Act 2014 is accompanied by a guidance document entitled Care and support statutory guidance. This provides guidance for local authorities on how to meet their statutory duties under the Care Act.
9. Councils must carry out an assessment for any adult who appears to have a need for care and support. Decisions made by councils about whether someone’s needs are eligible for care and support must be made based on an assessment. (The Care Act 2014)
10. The purpose of an assessment is to identify the person's needs, how they impact on the person’s wellbeing, and the outcomes the person wishes to achieve in day-to-day life. Assessments provide a full picture of the person’s needs. The local authority must involve the person being assessed in the process as they are best placed to judge their own wellbeing. (Care and Support Statutory Guidance, Sections 6.5, 6.9, 6.12, 6.13, and 6.30)
11. The statutory guidance states that following their assessment, individuals must be given a record of their needs assessment. (paragraph 6.98)
12. The Council’s policy notes it will allow disability related expenditure when the service user shows evidence of a reasonable expense caused by their disability. It is a cost they must meet because of their disability.

What happened

13. Mr X has received care and support since 2016. Mr X lives in a sheltered retirement accommodation complex.
14. In February 2018, Mr X’s care plan noted he received 45 minutes of personal care support Monday to Friday. This included preparing breakfast and hot drinks. Mr X also paid privately for support with cleaning and shopping.
15. In March 2018, the Council completed an assessment of Mr X’s care and support needs. The assessment noted Mr X had limited movement in his right arm and hand and could not write. It also noted Mr X did not use the phone as it causes him significant stress and illness. The assessment highlighted Mr X asked others to make calls and write letters on behalf and had struggled to find regular and reliable support with it. The assessment also highlighted Mr X could not manage personal care at weekends.
16. The assessment did not comment on whether Mr X was struggling with personal care in the evenings.
17. At the end of March 2018, Mr X asked the Council to arrange weekend support visits. The Council’s records showed his allocated worker was trying to source weekend care.
18. In April 2018, the Council’s records noted there was a decline in Mr X health as he was losing weight, not eating, and having frequent continence accidents. Mr X’s allocated worker checked to see if the care provider had capacity for weekend morning care visits. She also checked for capacity for evening care visits due to Mr X’s decline in well being and the increase support with continence care.
19. At the end of April 2018, Mr X’s allocated worker noted they had potentially found a contact for Mr X for letter writing support.
20. In May 2018, Mr X’s allocated worker tried to find weekend and evening care support for Mr X to support him with personal care and nutritional support.
21. At the end of May 2018, Mr X’s sheltered retirement accommodation warden told the Council Mr X was distressed and wanted increased care. The warden also noted Mr X was calling for out of hours help for non-urgent issues.
22. In June 2018, Mr X’s warden again told the Council Mr X continued to call on neighbours and paramedics and that this behaviour increased at weekends when he did not have care visits.
23. The Council completed a new assessment of Mr X’s needs in June 2018. The assessment noted Mr X did not use his phone and that he could not write due to an injury to his right arm.
24. The assessment also noted that Mr X had increase in calling on the warden, paramedics, and neighbours at weekends. It also noted Mr X had many possessions in his home and items on the floor which are a trip and slip hazard. The assessment highlighted there was a risk of:
• Self-neglect of own care and home environment.
• Falls in home due to slip and trip hazard.
• Losing his tenancy if Mr X continued to call on out of hours service, neglect his home environment, and continued behaviour which impacted negatively on other residents.
• Not receiving future emergency visit if calls to paramedics continued with no need for treatment.
25. The assessment did not consider whether Mr X was struggling with personal care in the evenings or whether X needed evening care.
26. The assessment increased Mr X’s support care to seven mornings a week.
27. The Council said it was not clear from its records whether it had shared the June 2018 assessment with Mr X.
28. The Council sent Mr X’s weekday care provider a support plan which contained the same information as in his June 2018 assessment. Mr X said this information was false and defamatory.
29. Mr X asked the Council if it could include costs of correspondence and phone call support in the financial assessment. Mr X also asked the Council to start evening care as a matter of urgency.
30. Mr X asked the Council to consider the costs of his over-the-counter medication as DRE. In October 2018, Mr X’s doctor provided the Council with information on the medication he used.
31. The letter noted Mr X told her he needed the medication, but that none of the treatments were available on the National Health Service (NHS). The doctor confirmed these were medications Mr X had to pay for.
32. The Council said it considered the letter showed the medication was self-prescribed by Mr X. The Council declined Mr X’s request for the costs to be considered as DRE as it did not consider the expenses to be medically required.
33. In November 2018, Mr X asked the Council to provide him with a copy of the letter his doctor sent. Mr X said the Council refused to provide him with a copy of the letter.
34. The Council provided a copy of a letter, undated, which referred to a copy of the doctor’s letter being attached for Mr X’s information. The letter noted it was in response to a letter Mr X sent to the Council in March 2019.

Analysis

DRE – medication and doctor’s letter

35. The Council’s policy highlights it will allow DRE when the service user shows evidence of a reasonable expense caused by their disability. It is a cost they must meet because of their disability. The Council appropriately asked Mr X to provide evidence the medication he took was to treat an illness or to help his disability.
36. I note the doctor’s letter did not state Mr X needed the medication to treat an illness or to help his disability. Instead, the letter highlighted it was Mr X who felt he needed the medication.
37. The Council was entitled to consider the information provided by Mr X’s doctor. The Council has highlighted it considered the evidence available showed the medication Mr X paid for was self-prescribed. Therefore, the Council did not consider it to be a medically required expense.
38. The evidence shows the Council has properly considered the evidence and made its decision in line with its policy. As the Council has made its decision properly, I cannot find fault with the decision itself.
39. Mr X asked the Council to provide him with a copy of his doctor’s letter in November 2018. The evidence suggests the Council did not provide him with a copy until after March 2019. Therefore, while the Council did eventually provide Mr X with a copy, it took around four months for the Council to send it. This is fault.
40. I consider the fault identified caused Mr X an injustice. While having a copy of the letter would not have, on balance, let to a different outcome, Mr X was caused some frustration at the delay in the Council sending him the letter.

Support with telephone calls and letter writing

41. Mr X’s assessments in March and June 2018 noted his difficulty with using the telephone and writing letters. However, the assessments do not set out whether the Council considered Mr X needed letting writing and telephone support. It is also not clear from the assessments how often Mr X received support for these tasks, and from who.
42. There is some evidence Mr X’s allocated worker had sourced potential support in April 2018 for letter writing. However, there is no further mention of this support after April 2018.
43. There is also evidence Mr X asked the Council if it could include correspondence and phone call support as costs in the financial assessment. I note there is no evidence Mr X provided the Council with evidence of what he was paying for letter writing and telephone support.
44. I do consider there has been fault in the way the Council has dealt with Mr X’s request for support with the cost of telephone and letter writing support. This is because it is not clear whether the Council considers this to be an eligible need which arises due to Mr X’s disability/ill health. Given there is a record of the allocated worker trying to source this support, this would suggest this was support the Council considered Mr X needed. Therefore, it would be reasonable to expect the Council to have considered this in its assessments.
45. However, I do not consider the fault identified caused Mr X any significant injustice. This is because there is no evidence Mr X has incurred any costs for the letter writing and telephone support he receives. There is also no evidence Mr X has not been able to secure the support.

Evening support

46. Mr X’s complaint is the Council did not arrange evening support calls even though his allocated worker told him it would be arranged. There is evidence Mr X’s allocated worker had looked to source evening support in May 2018. This adds weight to Mr X’s view that he was told he would get the support.
47. Further, the fact the allocated worker was looking to source the evening support suggests the Council had considered Mr X needed the support. However, it is not clear from the available evidence how or why the Council had made this decision.
48. The Council did not put in place evening support as the assessment in June 2018 did not find he needed evening support, only weekend morning support. However, given the Council had considered it necessary to source Mr X evening support in May 2018, it would be reasonable to expect the June 2018 assessment to set out the Council’s rationale about why it no longer considered Mr X needed evening support.
49. Therefore, there is fault as the Council did not complete its June 2018 assessment properly.
50. I consider the fault identified has caused some uncertainty. This is because I cannot say, even on balance, whether the Council would have assessed Mr X as needing evening support had it completed the assessment properly in June 2018.

False and defamatory information

51. Mr X is unhappy with the information the Council shared with a care provider. The document shared contains information copied from the June 2018 assessment.
52. There is no evidence the Council shared the assessment with Mr X before it was finalised. Had the Council given Mr X the opportunity to comment on the assessment, on balance, it is likely Mr X would have commented on the information he was not happy with or disagreed with. This is then likely to have affected the information shared with the care provider.
53. While I cannot say the information shared was false and defamatory, I consider there is fault by the Council in not sharing the assessment with Mr X. This is because it should have given Mr X the opportunity to comment on the assessment.
54. I consider the fault identified caused Mr X some distress as he is unhappy with the information that was shared with the care provider.

Agreed action

55. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following:
• Apologise to Mr X for the injustice caused by the faults identified.
• Make a payment of £300 to recognise the uncertainty, frustration, and distress caused by the faults identified.
56. The Council should complete the above within four weeks of the final decision.

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Final decision

57. I find fault with the Council for the delay in sending the doctor letter, for not completing its June 2018 assessment properly, and for not sharing the June 2018 assessment with Mr X. These faults caused Mr X an injustice. I also find fault with the Council for not properly considering Mr X’s request for support with letter writing and telephone calls. However, this fault did not cause Mr X any significant injustice.

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Investigator's decision on behalf of the Ombudsman