Summary: The Council acted in line with Care and Support Statutory Guidance before reducing Mr X’s care hours and direct payment. So there was no fault.

The complaint

1. Mr X complained Staffordshire County Council (the Council) reduced his care despite his needs and circumstances not changing.
2. Mr X said this caused him avoidable distress and a financial loss because he is paying for some care and activities from his own money.

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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. I considered Mr X’s complaint to us, the Council’s response to his complaint and documents described in this statement. I discussed the complaint with Mr X
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

7. A council must 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 outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
8. The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)
9. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2)

10. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
11. Councils can arrange care and support for people through a care agency or they can give the person a direct payment. A direct payment is money for care and support a council provides to meet eligible unmet needs. Direct payments give people choice and flexibility.
12. A council should revise a care and support plan where circumstances have changed in a way that affects the plan. Where there is a proposal to change how to meet eligible needs, a council should take all reasonable steps to reach agreement with the adult about how to meet those needs. (Care Act 2014, sections 27(4) and (5))
13. Councils must have regard to Care and Support Statutory Guidance (CSSG) when assessing an adult’s needs, devising care and support plans and allocating funding to meet identified eligible needs. I have summarised relevant paragraphs of CSSG below:
• Councils should commission services with regard to cost effectiveness and value for money (4.27)
• Reviews should not be used to arbitrarily reduce a care and support package. A reduction should be the result of a change in need or circumstance (13.33)
• a council is allowed to take into account its budget and finances, including that it must ensure the funding available to it is enough to meet the needs of the whole local population. It may balance the requirement to meet an individual’s eligible needs with its overall budgetary responsibilities. It can take case by case decisions 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 options for meeting needs. (10.27)

What happened

Background and previous complaint to the Ombudsman

14. Mr X has a medical condition causing tiredness and low energy. He lives in his own home and is eligible for adult social care. The Council gives Mr X a direct payment which he uses to fund a care worker from an agency to support him.
15. Mr X complained to us in 2019 about a reduction in his hours and about other issues. Although we upheld other aspects of his complaint, in relation to the reduction, we found the Council was not at fault because the reduction took place following an assessment which concluded that there was no medical requirement for freshly cooked meals. We decided that until Mr X’s doctor provided supporting evidence, the Council was entitled to decline to provide social care funding for a care worker to cook fresh meals for Mr X. The GP provided a letter and the Council increased the hours.
16. The current complaint is about a more recent assessment and reduction in hours.

Chronology

17. A social worker carried out a fresh assessment of Mr X’s needs starting in October 2020. The assessment was signed off by a manager in January 2021. It included comments from Mr X’s GP supporting Mr X getting freshly cooked meals and a summary of what Mr X told the social worker about his difficulties carrying items of shopping in supermarkets and about how he had previously lost weight.
18. The assessment said Mr X was using a care agency to supply his care workers. This agency charged £18.40 an hour.
19. The assessment concluded Mr X had eligible needs in the domains of:
• Maintaining a habitable home
• Managing and maintaining nutrition
• Being appropriately clothed
• Managing personal hygiene
• Being able to make use of the home safely
20. The assessment went on to say that:
• He could use on-line shopping or a voluntary agency. Mr X advised that online shopping was not ideal and he preferred to go out shopping as this enabled him to interact with other people
• The Council would not fund the travel or meal costs of the care worker
• He required support to prepare two meals a day. This could be done in 45 minutes, including time to clean up the kitchen
• While he was eligible for support with dressing. He told the social worker he was able to manage this himself and did not want support
• The Council would fund support with laundry and cleaning
• He was also eligible for support with personal care, but wanted to do this independently
• He had declined the lifeline system as he always had his mobile phone close
• There were no unmet needs
• He was doing a college course and had been using the direct payment to fund the course fees and transport to and from college. He could access college independently using his wheelchair
• He did not require care and support to access education. It was not an eligible need for Mr X.
21. Mr X’s care and support plan set out the agreed funding and hours of care and support:
• One hour a week for support with cleaning and one hour a week for support with laundry at £11.26 an hour (£22.52 a week)
• 45 minutes a day with meal preparation and light housework connected to cooking (5 hours 15 minutes a week at £17.26 an hour, £90.62 a week)
22. The Council told me it paid a lower hourly rate for laundry and cleaning because these were non-regulated tasks that did not require a care worker with qualifications)
23. The Council wrote to Mr X in March 2021 to say that it would give him £113.04 a week for his direct payment.
24. The Council provided me with a copy of a further assessment dated May 2021. The rest of the information on the form is the same as the assessment I have described above and the Council told me it generated the form to check the correct hourly rates were being applied.
25. Midlands Partnership NHS Foundation Trust (the Trust) manages complaints on behalf of the Council. The Trust’s response to Mr X’s complaint said:
• Cost can be considered when creating a care and support plan. Guidance says councils can have regard to value for money that services offer public funds
• The previous care and support plan said he had eligible needs in the domains of maintaining a habitable home and managing and meeting nutrition. The plan also said he could have 12 hours of care and support to support with attending the supermarket, preparing meals, laundry and cleaning
• His most recent social care assessment concluded he had some eligible needs and some ineligible needs. The assessment identified the same eligible needs as previously and allowed for 45 minutes a day for meal preparation and two hours a week of cleaning and laundry. The difference in the time allowed was because he could shop on-line and/or go to the supermarket independently. The social worker identified the time needed to complete each task and this gave a figure of seven hours and 15 minutes
• He previously received £80.40 a week for four hours of day opportunities and money for transport. He said during the assessment that he used this for taxis and towards payment for course fees. This was not in line with the care and support plan. These needs related to different eligibility outcomes: accessing and engaging in work, leisure or training.
• The Council’s rate for agency home care is £17.26 and for personal assistants (PA) is £11.21. He needed to contact his social worker for help identifying a PA at the appropriate rate. If he chose to keep the current PA, he would need to pay the additional cost.
26. Mr X told us the Council paid an (average) hourly rate of £14.42 and so he had a shortfall of £3.98 in terms of what he paid out for his care.
27. The Council has confirmed to me that from April 2021, Mr X’s direct payment is £17.86 an hour for home care and £11.81 for domestic help.)

Findings

28. The assessment of need identified eligible needs in the five domains described in paragraph nine. The assessment noted Mr X preferred to remain independent in three of those domains (personal care, dressing and making use of the home safely). Mr X was noted to have been using his direct payment to pay college fees and taxi fares. A council’s duty under section 18 of the Care Act 2014 is to meet a person’s eligible needs. The Council was not at fault in saying it would no longer fund college fees or taxis because the assessment did not conclude that Mr X required care and support to:
• participate in work, education or training or
• make use of community facilities.
29. This means the Council was not required to provide Mr X with a direct payment to cover his college fees or transport to and from college. It only had to provide funding to meet eligible needs and this did not apply in Mr X’s case for the reasons given in the last paragraph.
30. The Council concluded Mr X could use the internet to do his shopping rather than go to the supermarket. And that he did not require the support of a care worker at college. I have no grounds to criticise these decisions. Mr X said the time allocated for meal preparation was not sufficient. But I have no grounds to criticise the time allowed in the absence of fault.
31. I note also that councils can consider cost when devising a care and support plan and there should not be an arbitrary reduction in care and support. I am satisfied the reduction was actioned following appropriate consideration of Mr X’s eligible needs and consideration of the time required to meet the eligible needs identified. So the Council acted within the scope of paragraphs 4.27, 13.33 and 10.27 of Care and Support Statutory Guidance and so there was no fault.
32. In terms of the hourly rates the Council pays, the Council sets two rates, with a lower rate for tasks that do not involve personal care. I find no grounds to criticise that approach because councils are entitled to consider value for money and their overall budget when commissioning services. Mr X uses an agency which charges a higher rate. But the Council is not required to pay the difference.

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Final decision

33. The Council acted in line with Care and Support Statutory Guidance before reducing Mr X’s care hours and direct payment. So there was no fault.
34. I have completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman