Derby City Council (21 007 424)
Category : Adult care services > Assessment and care plan
Decision : Upheld
Decision date : 08 May 2022
The Ombudsman's final decision:
Summary: Ms C complained about the way the Council responded after March 2019, to her request for a reassessment of her needs. She also complained about the lack of reasonable adjustments the Council has made for her.
The complaint
- The complainant, whom I shall call Ms C, complained that
- The Council has failed to carry out a reassessment of her needs since March 2019. She only received this in October 2021.
- The Council has failed to involve the NHS / an autism specialist in her needs assessment, even though she has asked for this. She said she needs help to better articulate herself, explain her needs and how her condition impacts on her daily activities. As such, Ms C said this has put her at a disadvantage.
- It has been difficult for her to engage with the Council since March 2019, and pursue the above matters, due to her disabilities and not having anyone to support her.
- Ms C said that, as a result, she did not receive the support she has needed, and which the Council has identified now. She says this caused her distress and she also had to drop out of university as she needed a support worker to support her with certain aspects (via the Council).
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- I considered the information I received from Ms C and the Council. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received, before I made my final decision.
What I found
Relevant background legislation and guidance
- The Care Statutory Guidance says a council has a legal duty to make reasonable adjustments to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in accessible formats or with communication support.
- A council should also, as early as possible, consider whether an individual will have substantial difficulty in being involved in the assessment process and, if so, consider the need for independent advocacy. A council should also consider whether the person may have difficulty communicating (for example those with Autistic Spectrum Disorder or Profound and Multiple Learning Disabilities) and whether a specialist or interpreter may be needed to support communication.
- As such, there will be individual cases where specific co-operation will be required between the Council and partner organisations. The Care Act provides an express duty for a council and partner to ask each other for co-operation in such cases. If this happens, the relevant partner must co-operate as requested, unless in exceptional circumstances. This mechanism is intended to support partners with a means of identifying specific cases in which more targeted co-operation is required. Where a council decides to use this mechanism, they should notify the other in writing, making clear the relevant Care Act provisions.
What happened
- Ms C was diagnosed with autism in 2016. The Council completed a needs assessment of Ms C in March 2019. The records related to this pointed out that Ms C could do a lot on her own. However, she struggled in social situations. The assessor concluded that Ms C did not have any eligible needs at the time. The assessor sent a list of organisations and information to Ms C that she could contact if needed, who could provide different type of support to people with autism.
- Ms C told the Council after the assessment, that she was unhappy with it. She said she did not the social worker was assessing her, and the assessment was full of inaccuracies. She therefore asked the Council on several occasions to have a reassessment, including:
- In April 2019 when she spoke to an adult social care Service Manager. However, the record states that Ms C ‘did nothing but rant and rave’ and ‘was being very abusive’ and she put the phone down on the manager.
- In July 2019: Ms C spoke to a Customer Service Advisor who recorded Ms C wanted to make a complaint about adult social care because her needs assessments were unfair. The call handler failed to properly record what the result was of this call.
- In September 2019, when she spoke to an officer on the Safeguarding Team. She said she had made a complaint about her needs assessment and was still waiting for a response. Ms C then spoke to a social worker and said she would like a reassessment. Ms C admitted during this conversation that she can shout at people when she struggles to communicate, which people can perceive as being aggressive. Ms C said she had been rude to social workers at the Council and felt embarrassed about this. The social worker agreed to progress her request for a reassessment. However, there is no evidence in the Council’s records this happened. The Council told me it is sorry it did not respond to Ms C’s request at the time, and for any distress this caused.
- It took more than another year from then until Ms C contacted the Council again about her needs assessment. She told the Council in November 2020 that her autism was preventing her to have a proper assessment of her needs. This was because she said she could not express herself well in circumstances where she felt under pressure. It took several months before the Council gave Ms C’s case to a social worker.
- Ms C told the Council in March 2021 that she would need someone to assess her who has a knowledge/understanding of autism. In response, her social worker said: “I asked if we could speak to her GP at some point about her needs. She told me we were welcome to approach her GP if this could help (…) I said I would also speak to her GP as she had agreed to this”.
- Ms C’s social worker agreed to visit her on 19 May 2021, with a housing officer, and carry out her needs assessment. However, Ms C made a complaint about the social worker and cancelled the meeting. It is unclear from the records why Ms C made her complaint. I did not find evidence in the records the social worker acted inappropriately. Ms C has since told me that she cancelled the meeting because she had no one to support her at the meeting.
- The plan was subsequently to liaise with Ms C’s GP and look at a joint assessment with Health who deal with Specialist Autism. The social worker contacted the GP in July 2021 who said the Council could only request a joint health and social care referral through the forum of a Community Support Team Meeting (CST). It was agreed at the next CST in September 2021 to organise a needs assessment with Ms C’s GP. However, Ms C did not agree to this because, according to the records, she felt her GP did not sufficiently understand her condition and needs. Ms C was unhappy with the social worker contacting her GP, despite having given permission in March 2021 to liaise with the GP. As such, the Council reallocated her case to another social worker.
- The newly allocated social worker completed a needs assessment with Ms C in October 2021. The assessment did not have input from the NHS and/or someone who was specialised in autism. Since then, Ms C has provided comments on the assessment document the social worker completed, and the social worker has told Ms C the assessment identified she needs six hours of support a week.
- However, Ms C remained unhappy with the assessment and said it did not properly capture her specific situation and needs. Although the Council has agreed that Ms C can receive a direct payment to hire a personal assistant, the Council has not yet met with Ms C to discuss what she would like to use the six hours a week for.
- The Council said the social worker’s manager has contacted the Autism Information and Advice Service in December 2021 to discuss a possible joint visit with one of its autism workers. It followed this up in January 2022.
- The Council suggested in January 2022 to refer Ms C to an advocacy agency who could support Ms C during her reassessment. Although the advocate would not have specialist knowledge of autism, the Council said the advocate would have experience and training on how to support a person with autism. However, Ms C declined the offer, saying she had a bad experience with the agency in the past. Ms C told the Council that socials services have access to a register of all qualified, trained people in autism and they need to look at that.
- Ms C said that, because of the lack of support, she has:
- Suffered distress
- Had to drop out of university as she needed a support worker to support her. However, I have not seen any reference in the records to this, or received any evidence in support of this statement
- The Council has told me:
- The assessment in 2019 may not have fully taken the impact into account, that Ms C’s autism had on her day-to-day life. However, as it no longer has a copy of that assessment, it cannot compare that assessment and the outcome with the one in October 2021.
- It accepts that it missed an opportunity to respond to Ms C’s request for a reassessment in September 2019.
- It also accepts it failed to respond to the difficulties Ms C mentioned with asking support, and how Ms C’s autism related needs impact how she communicates, since then. The Council said it only started to take this into account from mid-2021 and would like to sincerely apologise to Ms C for this.
- Its contact with Ms C has at times been difficult, and this may have affected its response to her when she asked for help. It is sincerely sorry for this and the impact this has had upon her. It has already identified a need for further training on autism. Several teams have already received specific autism training during 2021.
- It has identified the need to strengthen how it responds to complaints and plans are in place to address this corporately across the organisation. It will also circulate a briefing to remind colleagues within Adult Social Care of the need to ensure that verbal complaints are captured through the Council’s formal complaints process, and how to do this.
- It provided briefings and training, which have resulted in an increase in knowledge and understanding of autism amongst its staff, since 2019.
- There is currently not a separate section about reasonable adjustments in its needs assessment form.
Analysis
The alleged delay in the reassessment
- The assessor concluded in March 2019 that Ms C did not have any eligible needs at the time. Ms C was unhappy about this and asked for a reassessment. The Council failed to appropriately respond to her complaint about the assessment and failed to organise a reassessment until May 2021. This is fault.
- Ms C cancelled the needs assessment in May 2021. However, it subsequently took an unreasonable time to carry out the reassessment. The reassessment resulted in a decision that Ms C could have a personal assistant to support her six hours a week. However, this has not been put in place yet as the Council has not had a discussion yet with Ms C about her support plan and how she can use a personal assistant to support her. While recognising that it has been difficult at times to discuss such matters with Ms C, this should have been completed and set up in a reasonable timeframe since the assessment in October 2021. This delay is fault.
- As Ms C was unhappy with this reassessment and the non-involvement of a specialist, the Council has made attempts to organise another reassessment with specialist support. However, this has still not taken place yet.
- I found that, in the absence of evidence to indicate Ms C’s needs have recently increased or deteriorated, it is more likely than not that she would have already been offered a package of support, if she would have been assessed earlier and with the right specialist input and support. As such, there has been an injustice to Ms C.
The alleged failure to involve an autism specialist in her needs assessment
- The Council decided at the end of 2020, that it would carry out a reassessment of Ms C’s needs. It also determined, in mid-2021, that this assessment should involve a person with specialist autism knowledge. However, despite some attempts, it has not so far been able to arrange this.
- It is not my role to specify who the Council should have involved to ensure there was appropriate autism specialist input as part of the assessment. However, I would have expected this to have been arranged within a reasonable timeframe, which has not been the case. This is fault.
The alleged failure to make reasonable adjustments
- Despite Ms C reporting at different times what her communication difficulties were, what her triggers were for becoming annoyed, and how she wanted the Council to communicate with her, the Council failed to:
- Have a specific discussion with Ms C about this,
- Come to an agreement with her as to how it would communicate with her and what reasonable adjustments it would make, and
- Have a way of ensuring that officers within adult social care and other departments have access to this agreement, to ensure all officers consistently apply this.
- This is fault. Not having received the right support and reasonable adjustments for a significant amount of time would have been distressing to Ms C.
- Taking Ms C’s reported difficulties into account with regards to communication etc, it took a long time before the Council considered involving an advocacy agency to support Ms C through the needs assessment process. However, when it did, Ms C said she did not want to involve the agency suggested by the Council.
- In response to my draft decision, the Council has said that the social workers who have worked with Ms C since 2021 have made attempts to make reasonable adjustments by:
- Summarising key aspects of discussions before leaving, leaving a written summary of what was discussed and giving her time to process information.
- Advising her to speak to her current social worker when contacting the Council, to avoid long conversations with other workers.
- The Council has said it has a pinned summary now to advise Derby Direct and Social Care Duty Workers on their approach with Ms C when she calls, to try and minimise the difficulties around communication experienced in the past. This information is not currently available to other departments (for example Housing and Derby Advice) but it will ask Ms C for her consent to share this with them.
Agreed action
- I recommended that the Council should, within four weeks of my decision:
- Provide an apology to Ms C for the faults identified above and the distress this has caused her. It should also pay her £2,000.
- Discuss and record Ms C’s communication difficulties and agree what reasonable adjustments the Council will make when communicating with her.
- Ensure that, with Ms C’s consent, its officers in adult social care and housing department have access to the above document.
- Provide evidence that the briefing paper mentioned in paragraph 20.5 has been disseminated.
- Offer Ms C an opportunity to discuss her support plan and what support she can ask her personal assistant to provide.
- Put the direct payments in place to enable Ms C to find a personal assistant.
- Obtain specialist support and subsequently offer a reassessment to Ms C.
- I recommend that the Council should, within eight weeks of my decision:
- Develop an action plan to put in place a system through which adult social care will routinely collect information about reasonable adjustments, and periodically review this with its service users, to ensure it is up to date.
- Develop an action plan to put in place a system through which it will ensure that:
- Information about reasonable adjustments is disseminated and accessible to other departments within the Council.
- Staff will check this before making contact with service users.
Final decision
- For reasons explained above, I found there was fault with the way in which the Council has assessed Ms C’s needs. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.
Parts of the complaint not investigated
- Ms C complained that even though she asked the Council to delete her March 2019 needs assessment, and despite the Council saying it did this, the Council’s Housing Department recently told her it has a copy of the assessment on its records. I did not investigate this, because if Ms C is unhappy about the way the Council dealt with her information, she should make a complaint about this to the Information Commissioner’s Officer (ICO).
Investigator's decision on behalf of the Ombudsman