Summary: Mr X complained about the Council’s decision to reduce his support package following a review of his care needs. We have not found the Council to be at fault.

The complaint

1. Mr X complains about the Council’s decision to reduce his package of care support even though his needs have not changed. He says this has left him struggling to manage and relying more on his parents.
2. Mr X is represented by his mother, Mrs D, in making this complaint.

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The Ombudsman’s role and powers

3. 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)
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. As part of my investigation I have:

• considered the complaint and documents provided by Mrs D;
• made enquiries of the Council and considered its response;
• considered the relevant legislation (Care Act 2014 and Care and Support Statutory Guidance - “the Guidance”);
• spoken to Mrs D; and
• sent a draft version of this decision to both parties and invited comments on it. Comments received from Mrs D have been taken into consideration.

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What I found

Law and guidance

6. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan. The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. The support plan must include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person. The personal budget can be administered as Direct Payments.
7. In setting this budget the Guidance states, “the local authority should not set arbitrary upper limits on the costs it is willing to pay to meet needs through certain routes – doing so would not deliver an approach that is person-centred or compatible with public law principles. The authority may take decisions on a case-by-case basis which weigh up the total costs of different potential options for meeting needs, and include the cost as a relevant factor in deciding between suitable alternative options for meeting needs. This does not mean choosing the cheapest option; but the one which delivers the outcomes desired for the best value.” (Paragraph 10.27)
8. The Care and Support (Eligibility Criteria) Regulations 2014 set out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.

What happened

9. I have set out below a summary of the key events. It is not meant to show everything that happened.
10. Mr X is a young adult with a learning disability and autism. He lives in his own flat with support from a package of care funded by a direct payment. This care is provided by his family and an employed carer. He has a full-time job. He received 40 hours’ worth of paid support for several years. This helped him with tasks such as meal preparation, getting ready for work, shopping, maintaining his home, attending social events and participating in sport.
11. In May 2019, the Council carried out an annual review of Mr X’s care needs. The Council decided his needs could be met with less support, with a view to promoting his independence. It initially reduced his weekly hours down to 17, with an additional 16 “contingency” hours to reflect the fact Mr D was vulnerable because of a recent relationship breakdown. The Council said this would be reviewed again in three months.
12. Mrs D objected to this significant reduction. She explained that Mr X was only able to cope because of the support he received, both by the paid carers and the help he received informally from his family. She told the Council Mr X presented as more able that he was and this had affected the outcome.
13. In response, the Council said an occupational therapist (OT) would carry out a further assessment of Mr X’s skills. This would focus on his ability to perform tasks such as making a sandwich and using the vacuum cleaner. This would inform the Council’s future decision making.
14. It was also proposed and agreed that Mr X should have an advocate. This was due to a potential conflict of interest between Mrs D’s role as her son’s representative and her also being his paid carer.
15. In November 2019, a review took place. Mr X, Mrs D, the advocate, the OT and two social workers attended. This review confirmed the previous reduction of support. However, some additional contingency hours were available, together with an annual budget or £2400 to fund short breaks for Mr X. The Council explained this would also provide Mrs D and her husband with a break from their caring responsibilities.
16. In January 2020, Mrs D requested a reassessment. The Council refused because it was felt the hours provided met his assessed needs. The annual review carried out in March 2020, confirmed the reduced hours should continue.

Mrs D’s complaint

17. Mrs D first complained in June 2019 and again in July 2019. As her complaint was not upheld she brought her complaint to the Ombudsman in March 2020. Between July 2019 and March 2020, discussions continued between the Council and Mrs D about the reduction in support hours.
18. For brevity, I have not included all Mrs D’s comments and objections, but they followed a common thread relating to the following matters:
1. Reduction in support hours from 40 to 17. This was informed by a poor assessment process that failed to take into consideration Mr X’s views, was carried out by someone without knowledge of Mr X, did not take into account relevant information from other professionals or the impact such a reduction would have on Mr X.
2. Being pressured into accepting an advocate, whose views were misinterpreted.
3. Poor communication and complaint handling.
19. In response, the Council made the following points:
1. From December 2017, care packages were reviewed against the Council’s “Adult Social Care Strategy”. The focus was in supporting and maximising independence with more involvement from OT’s. The Council acknowledged that historically care packages were often more generous.
2. The Council was satisfied the assessment process was robust and the revised support plan met his identified eligible needs, while promoting Mr X’s opportunities for greater independence in certain areas.
3. Some of the areas of support provided by Mrs D were not “eligible care needs” that would normally be funded by the Council. It would be Mrs D’s choice to continue to support her son with these activities if she chose to do so.
4. The advocate was necessary because of a possible conflict of interest between Mrs D acting as Mr X’s representative and her being a paid carer who was adversely affected by the Council’s reduced support package.

Analysis

20. It is clear that Mrs D wants the very best for Mr X. It entirely understandable that she would be anxious that a reduction in Mr X’s support package would be challenging for him. However, although Mr X and Mrs D are unhappy with the outcome of the assessment, that is not, in itself, evidence of fault on the part of the Council. The role of the Ombudsman is to investigate complaints that injustice has been caused by an administrative fault, not to question a decision which has been taken properly, however much someone may dislike or disagree with it.
21. The Council was correct to conduct a review of Mr X’s care needs and support package and should do so annually.
22. I understand the reduction in service has led to a change to arrangements that had worked well for several years, but the Council was permitted to do this as long as it properly considered all the relevant information. Having considered all the available evidence, including the care assessments, support plans, detailed correspondence between Mrs D and the Council, I am satisfied it did.
23. The review process was thorough. I have seen evidence of Mr X and Mrs D being involved and meaningfully participating. While I understand Mrs D was unhappy about Mr D being involved (where previously she had been able to deal with reviews on his behalf), I do not criticise the Council for insisting Mr X was present. I accept historically reviews may have been carried out differently, but the introduction of the Care Act has encouraged assessments to be more “person centred”. Direct involvement of Mr X would be a crucial way of achieving this. It is clear from the social worker’s notes from the assessment that she was mindful of Mr X’s sensitivity and was careful to make sure he was as comfortable as possible.
24. The Council had regard to his learning disability and carried out the May assessment at home. When Mrs D challenged the outcome, the Council responded appropriately by making the referral to the OT service. This was the correct approach, particularly as there was a difference of opinion about Mr X’s functional abilities. This also addressed Mrs D’s concerns about the May review being flawed because the assessor did not have sufficient knowledge of Mr X, having not previously met him. The OT had several one to one sessions with Mr X.
25. The OT’s report was considered by the Council as part of the November 2019 review. The OT acknowledged that Mr X required support with many everyday tasks, including meal preparation and deep cleaning
26. I do not agree with Mrs D’s assertion that the Council did not have regard to this report in its decision making. In response, the Council increased his evening call to one hour, three times a week, by rearranging his care package. It also considered it reasonable for Mr X to privately fund a deep cleaning service if so required.
27. Mrs D raised a number of other concerns about the Council’s proposals being inadequate and inappropriate (for example, Mr D not needing support on a Saturday because he usually ordered a takeaway and was able to do online shopping). It is not necessary for me to respond to each point made by Mrs D, but I am satisfied both the review and resulting support plan followed the Care Act guidance. It considered all the outcomes and how these could be met by the proposed arrangements. Mr X was offered more support with promoting his independence, but this was refused. The Council properly explained its rationale. The Council made a professional judgement about how his needs could be met. It decided they could be met with less support. They were decisions the Council was entitled to make.
28. Mrs D claims this was a cost cutting exercise. The Council has denied this but has been open about the fact that historically care packages were more generous. There is no evidence to support what Mrs D has said. The Council can have regard to the budget implications of individual care packages (see paragraph 7 above). There is no evidence of this being the overriding consideration.
29. I appreciate that Mr X and Mrs D disagree with the adequacy of the care package, but the documentary evidence I have seen indicates the Council properly considered his needs, and so it is not for the Ombudsman to question the Council’s decision as to what amount of care provision is appropriate.
30. Nor do I criticise the Council for arranging an advocate for Mr X. There could have been a conflict of interest with Mrs D acting as both representative and paid carer. In relation to this, I note Mrs D had concerns about the Council misquoting the advocate’s agreement to the reduced care package. A case record from March 2020 confirmed the advocate informed the Council she did not agree with the Council’s level of support. I am therefore satisfied the Council was aware of her disagreement at this point. But I have found no evidence the advocate specifically told the Council she did not agree prior to this, and the Council deliberately misrepresented her views. For this reason, I do not find fault here.
31. Nor do I find fault with either the Council’s communication with Mrs D or its complaint handling. The main and contentious issue was the decision to reduce the support hours and I am satisfied the frustration felt by Mrs D was in relation to this, rather than the resultant communication about it.

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Final decision

32. There was no fault in the way the Council reassessed Mr X’s care needs and reduced his support hours. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman