Summary: The Council made all attempts to assist Mr X with the provision of care. There is no fault by the Council.

The complaint

1. Mr X (as I shall call the complainant) complains the Council has not accurately assessed his needs or provided a sufficiently flexible care plan. He says the Council’s failure to listen to him has been detrimental to his 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.
3. 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

4. I considered all the information provided by Mr X’s representative and by the Council. Both Mr X’s representative and the Council had an opportunity to comment on this draft statement before I reached a final decision.

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What I found

Relevant law and guidance

5. 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.
6. The Care and Support (Eligibility Criteria) Regulations 2014 sets 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 affects their wellbeing.
7. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). 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. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.

Everyone whose needs the local authority meets must receive a personal budget as part of the care and support plan. There are three main ways in which a personal budget can be administered:

• As a managed account held by the local authority with support provided in line with the person’s wishes;
• As a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes;
• As a direct payment.

8. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They provide independence, choice and control by enabling people to commission their own care and support to meet their eligible needs.
9. Local authorities must tell the person during the care planning stage which of their needs direct payments could meet. However, local authorities must consider requests for direct payments made at any time, and have clear and swift procedures in place to respond to them.
10. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the local authority must decide whether to provide a direct payment. In all cases, the local authority should consider the request in as timely a manner as possible. The local authority must provide interim arrangements to meet care and support needs to cover the period in question. Where accepted, the council should record the decision in the care or support plan. Where refused, the council should provide the person making the request with written reasons to explain its decision. (Care and Support Statutory Guidance 2014)

What happened

11. Mr X is an elderly man with multiple conditions affecting his health, including Parkinson’s disease, who lives alone in a bungalow adapted to his needs.
12. He initially contacted the Council for help in 2017 but after a period of assessment and enablement, he was not deemed eligible at that time for Council support.
13. In 2018 Mr X contacted the Council again as his needs had changed. He was assessed as eligible for two care calls a day. However, he declined to accept Direct Payments as he was concerned about managing the paperwork. He declined a financial assessment for a managed service. The Council’s records show his case was put on hold until he decided what he wanted to do.
14. By 2019 Mr X’s needs had increased again. An assessment in May deemed he was eligible for four care calls every day to assist with personal care, dressing, meal preparation and so on. He asked for Direct Payments which the Council agreed. The Council put in place a managed service until he could employ a suitable assistant.

The first complaint

15. Mr X complained about the managed service as he was unhappy with the timing of calls and the lack of empathy from the care workers. The Council investigated his complaint and upheld in part his concerns about the care agency which had initially delivered the service to him. It did not however agree to his request for compensation for the poor service he said he had suffered. The Council changed the care agency.
16. In October 2019 Mr X employed a personal assistant to provide his care, funded through Direct Payments. There were disagreement however, and the assistant resigned in January 2020. The Council’s records show Mr X had not been able to manage the Direct Payment administration in the required way. The Council withdrew its approval of Direct Payments for him in February 2020 after a meeting with him.
17. The Council put in place a managed service for Mr X again. In May 2020 the Council completed the annual review of Mr X’s needs, which remained the same.

The second complaint

18. In July Mr X complained to the Council again, however. He had concerns about the timings of care calls and inconsistency of carers, but also about the length of the calls themselves.
19. The Council responded to Mr X’s complaint in August. The Assistant Director who responded did not uphold the complaint. She said the Council had responded to every request for a review or conducted a needs assessment whenever it had been advised of a change in Mr X's needs or circumstances. She said when Mr X had requested a Direct Payment it had agreed, although he had then changed his mind several times. When the Direct Payment was set up he had difficulty managing it and so it had been terminated.

Further reviews of need

20. In August a social worker met Mr X in person at his home to discuss his needs again. The notes of the meeting say Mr X felt neither the morning call (an hour in length) nor the evening call of 45 minutes were sufficient: he said he needed longer in the morning to be able to soak in the bath to relieve the symptoms of Parkinson’s disease, and needed longer in the evening to prepare for bed and for someone to be with him while he ate because of the risk of choking.
21. The social worker discussed with Mr X his request for a Direct Payment again. It was noted that Mr X’s son (who was present at the meeting) was willing to be a named person for the payments but not to be responsible as an employer. The social worker reminded Mr X he had run into difficulties with some aspects of the employment previously. He referred Mr X’s request to the finance team which refused it, as Mr X had not previously been able to manage the Direct Payments and no-one would act for him as an authorised person.
22. The social worker also referred Mr X’s request for more hours to the Council’s funding panel, which rejected it until further evidence about Mr X’s needs could be provided. Neither the specialist Parkinson’s nurse nor the Speech and Language Therapist recommended more hours. The social worker tried to arrange a further face to face meeting with Mr X and his son, with himself and his manager, but dates were cancelled and Mr X’s son did not rearrange them.
23. The care agency told the social worker that sometimes Mr X spent the whole time of their visits on the phone or wanted to spend up to 45 minutes in the bath: they were then unable to complete all the tasks in the time available. As a result the care agency gave notice in November 2020, citing Mr X’s “unreasonable expectations”.
24. The Council sought other agencies to take over the care package but the records show many agencies were unwilling to support Mr X as previous experience of supporting him deterred them. The Council put in place a short-term care package from an agency who advised they could support him until January 2021. The social worker explained to Mr X’s sons that although they and Mr X said his support was insufficient, he had repeatedly cancelled the support available.
25. The Council conducted a further review of Mr X’s needs and increased his care package to include some more socialisation hours as well as an additional call. A review was arranged for March 2021 at which it was intended to discuss another request for a Direct Payment, but the review was cancelled by Mr X’s son.
26. Mr X complained to the Ombudsman. He said he wanted the Council to provide a personal assistant to provide his care as the care agencies it found for him were too prescriptive in their care. He said the Council’s assessments did not reflect his needs accurately and had resulted in many changes of care agency.
27. The Council says although there is a settled care package now in place it appears that Mr X continues to request care and /or time above the agreed package.

Analysis

28. The evidence shows the Council has responded to Mr X’s changing needs and requests whenever he or his family have contacted it.
29. The Council put in place a Direct Payment to allow Mr X more flexibility in his care but that broke down and to date has not been reinstated, due to the difficulty of finding someone to manage the Direct Payment appropriately. It remains under discussion.
30. The Council considered Mr X’s requests for additional time and hours and put these in place where evidence of need was obtained.

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Final decision

31. I have completed this investigation on the basis that there is no evidence the Council has failed to provide appropriate care for Mr X or respond to his needs.

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Investigator's decision on behalf of the Ombudsman