Summary: Mr X complained about the Council’s decision to withdraw his care and support package. We do not find the Council to be at fault. It carried out a review prior to the change and made a professional judgement that Mr X did not meet the eligibility criteria.

The complaint

1. Mr X complains that the Council’s care needs assessment failed to recognise his eligible social care needs. This has left him without a support plan.
2. He says this has contributed to a deterioration in his mental health and general well-being.
3. He also complains about the Council’s refusal to consider his complaint about this under its complaints procedure.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. 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

7. I spoke with the complainant and reviewed the information provided.
8. I made enquiries with the Council and reviewed the relevant law.
9. Mr X and the Council had an opportunity to comment on my draft decision. I have considered their comments before making a final decision.

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What I found

Relevant law and guidance

10. The Care Act 2014 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 they impact on their wellbeing and the results they want to achieve.
11. Where an assessment determines that a person has any eligible needs, councils must meet these needs. The Care Act Regulations set out the eligibility threshold for adults with care and support needs.
12. To be eligible for support, a person’s needs must arise from a physical or mental impairment or illness and mean the person is unable to achieve two or more of the following:

• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the adult's home safely;
• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;
• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.

What happened

13. Mr X has depression and a hoarding disorder. The conditions in his flat make daily living very difficult for Mr X. His flat is in a state of disrepair and many essential services are unusable.
14. In August 2019, the Council carried out an assessment of his social care needs. He was eligible in two areas:
1. Maintaining a habitable home environment.
2. Maintaining personal hygiene.
15. This meant he was eligible to receive a care service. The assessment recognised that despite Mr X being physically able to wash himself, his living conditions made this task particularly challenging. This was reflected in the resulting support plan. Rather than offer the help of a carer, the Council agreed to fund the services of a professional declutterer who specialised in working with clients with a hoarding disorder.
16. While this was partially successful in helping Mr X clear some areas of his flat, he said he needed more time with the declutterer and other areas of his life.
17. The Council encouraged Mr X to move out temporarily so his flat could be cleared properly, and repairs carried out. The Council arranged alternative accommodation for him. Mr X refused and this matter has been the subject of court proceedings that are not part of this complaint.
18. The Council carried out another assessment in June 2020. This time he was assessed as only having one eligible care need (maintaining a habitable environment) and so did not qualify for a service. Instead, he was advised to seek support for his mental health and to register with a GP.
19. The social worker’s assessment was that the areas possible social care need were mainly to do with the condition of the flat. Mr X had explained that personal care was “not important” and was not motivated to wash himself because of low mood as a result of his living conditions.
20. The social worker also explained that the extent of his needs could not be fully realised until after the involvement of mental health and other services. The Council did not have access to medical information to have a clear understanding of how his diagnosis impacts on his ability to meet his needs.
21. Mr X was unhappy with this outcome. In August 2020, he complained to the Council on the basis his needs had not changed since the 2019 assessment. To support his case, he provided the Council with a psychology report confirming his diagnosis and an independent social work assessment.
22. The independent social worker (ISW) assessed Mr X as having needs in the following areas:

• Maintaining personal hygiene.
• Managing toilet needs.
• Being able to make use of the adult's home safely.
• Maintaining a habitable home environment.
• Developing and maintaining family or other personal relationships.
• Accessing and engaging in work, training, education or volunteering.

23. In his opinion, he said if Mr X were not to receive care in these specific areas, this would have a significant impact on Mr X’s wellbeing.
24. The Council said it would not respond to the complaint through its Adult Care Services complaints procedure because Mr X’s solicitor was already in correspondence with the Council’s legal department about the same issues.
25. In response the Council said it agreed with the areas of care need identified by the ISW (paragraph 22 above). However, the Council took the view that “these difficulties are caused primarily by his undiagnosed mental health issues which as stated have led to his hoarding behaviours and the lack of basic amenities in his current accommodation.”
26. The Council set out the support that had been made available to Mr X:

• An allocated social worker.
• An advocate.
• Making suitable temporary accommodation available.
• A professional decluttering service.
• Signposting and encouragement to access local health services.

27. The Council explained that a further care needs assessment would take place once Mr X had moved to alternative temporary accommodation and he engaged with specialist health services.
28. This response led Mr X’s solicitor to threaten the Council with legal action. The Council agreed to carry out another assessment.
29. In response to my enquires, the Council confirmed it was in the process of carrying out this further reassessment. The purpose of this is to determine what support would be available should Mr X choose to engage with the process to move to temporary accommodation so that essential repairs could be carried out at Mr X’s flat.

Analysis

30. It is not the Ombudsman’s role to say what a person’s needs are, or what services they should receive. The Ombudsman’s role is to consider if a Council has followed the correct process to assess a person’s needs. In doing so we look at what information the Council considered. If a Council considers all this information properly the Ombudsman cannot find a Council at fault just because a service user disagrees with its decision, or outcome of an assessment.
31. Councils can only reduce or withdraw a care package following a review of that person’s care needs. Based on that review, it is the social worker’s role to determine if someone has eligible care needs.
32. In 2020, Mr X’s social worker identified only one area of need, compared to two in his previous assessment. This reflected the fact Mr X has said he was able to wash himself but that “personal care is not a priority” and that his main priority was his home environment.
33. I have read the previous assessment. Mr X is clear that his circumstances had not improved to his satisfaction, despite the many hours of decluttering funded by the Council. Nor had his ability or willingness to attend to his personal hygiene. It is therefore understandable why Mr X would question the different outcome. But this is not necessarily evidence of fault.
34. Mr X’s situation is a complex one. By his own admission, his hoarding behaviour has had a devastating impact of his health and well-being over many years. The psychologist confirmed he was suffering from a mental impairment, and this impacted on his ability to take care of himself.
35. The June 2020 assessment recognised the decluttering had not resolved the problem. The social worker assessed his inability to maintain personal hygiene in a different way. He decided that as Mr X was physically able to wash himself this was no longer an eligible social care need Instead the focus should be to support Mr X to address his mental health and hoarding disorder.
36. Both the 2020 assessment and the subsequent correspondence between the Council and Mr X’s solicitor make it clear the Council is committed to helping Mr X. I accept this may not be in the way Mr X would prefer, but these were decisions the Council was entitled to make and not ones I would criticise for the reasons set out at paragraph 30 above.
37. I am also satisfied the Council had due regard to the experts’ reports provided by Mr X’s solicitor. This was evidenced within the Council’s correspondence with Mr X’s solicitor. While the ISW came to a different conclusion about Mr X’s eligibility for a care package, the Council did not have to agree with it. This is a matter of professional judgement that the Ombudsman will not interfere with.
38. Similarly, I do not find fault with the Council’s decision to deal with Mr X’s complaint outside of its adult care complaints procedure. Mr X’s solicitor had already raised the assessment issue within an ongoing dialogue about Mr X’s housing situation and the Council’s legal department had been instructed to deal with the matter. This was a sensible approach to avoid unnecessary confusion and duplication of effort.
39. The Council has demonstrated its commitment to helping Mr X by making other support available to him and by agreeing to carry out a further reassessment.

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Final decision

40. I have completed my investigation. I have not found the Council to be at fault in the way it carried out a reassessment of Mr X’s care needs and related matters.

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Investigator's decision on behalf of the Ombudsman