Summary: Miss X complains the Council cut her care and support without reasoning and did not suitably review her needs. This caused her personal budget to be cut and her to miss out on the support she needed. The Ombudsman finds fault with the Council for failing to review Miss X’s needs in a timely manner, and for reducing Miss X’s support without clear reasoning. The Council has agreed to the recommended financial remedies.

The complaint

1. Miss X complains the Council did not suitably review her care needs in a timely manner.
2. Miss X complains the Council cut her services without reviewing her needs, and without explanation of why it was being cut. This left her family unsure of what was happening and left her without the right support.
3. Miss X complains the Council did not suitably communicate with her or her representatives about the change in her care.
4. Miss X complains that comments from a review conducted five years ago were used as the reason to change her care.
5. Miss X complains that she was without suitable care and communication from the Council during COVID-19.

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The Ombudsman’s role and powers

6. 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)
7. If we are satisfied with an organisation’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

8. I have considered the complaint and the documents provided by the complainant, her representatives and made enquiries of the Council. I considered comments from Miss X’s representatives and the Council on my draft decision.

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What I found

Duty to meet assessed care needs

9. The Care and Support (Eligibility Criteria) Regulations 2014 state that where a Council has determined a person has eligible needs it must meet these needs, subject to meeting the financial criteria.

What happened

10. Miss X has several physical and mental disabilities needing care and supervision. Miss X was attending two day care centres, Centre A and Centre B.
11. In 2017, the Council completed a review of Miss X’s needs. The review said that Miss X should have five days of support across Centre A and Centre B. It also said she should have 28 days of respite each year.
12. The assessment also documented that Miss X was having issues accessing the transport for Centre A, and that her parents were struggling because of her not accessing her support. It was noted that Miss X’s anticipated living arrangements in the future could be supported living.
13. In agreement with Miss X’s representatives, Centre A ended their support for Miss X, and a personal assistant (PA) was appointed to support Miss X. Miss X also continued to access Centre B three days a week. Centre B also arranged transport for Miss X to go to and from the day centre as part of its support package to her.
14. In March 2019, Centre B closed due to COVID-19. It continued to offer support remotely, however Miss X declined this support.
15. When Centre B reopened for support, it asked for a new assessment of Miss X’s needs before it could agree to support her. The Council arranged for temporary support while Miss X was reassessed.
16. Miss X’s parents complained to the Council in July 2021. They said that Miss X had had her care package cut without clear rationale and they felt this was a money saving exercise for the Council. They felt the previous travel support given to Miss X to attend Centre B had been removed.
17. Miss X’s representatives also complained that a comment about supported living in the 2017 assessment had resulted in budget changes in the 2021 assessment.
18. They also complained Miss X had not had suitable support during COVID-19 and there had been poor communication about the support Miss X should have been receiving.
19. The Council responded to the complaint. In the first complaint response the Council said the budget set in the 2017 assessment had been enough to cover the cost of Centre A. However, it was not enough to cover the cost of Centre B, which her representatives had asked to move her to. The Council said Centre B had changed the care it could provide and the Council would review Miss X’s needs to see if Centre B could meet her needs.
20. Miss X’s representatives felt the complaint response had not answered their complaint and the Council expected them to pay for transport for Miss X to access Centre B.
21. In its stage two complaint response, the Council said it had agreed funding for the travel expenses for Miss X to access two days a week at Centre B.
22. The Council said it would explore commissioning further services for Miss X, and it also explored whether Centre B would be able to support as it previously did.
23. The Council completed a review of Miss X’s needs in June 2021. It said it would need to reduce Miss X’s budget as the previous budget had predicted Miss X would move into supported accommodation. As she did not move into supported accommodation her budget would therefore need to be reduced.
24. Miss X’s representatives remained unhappy and bought a complaint to the Ombudsman on her behalf.

Analysis

Review of care needs

25. Legislation says that care needs should be reviewed in a timely manner. Council’s are expected to review care and support plans at least yearly, or more often if issues arise.
26. Miss X had a review of her care needs in 2017, when the Council produced a support plan that included her support from Centre A.
27. The Council did not review Miss X’s care needs again until 2021. This means there was a three-year delay in reviewing Miss X’s care needs.
28. I enquired to the Council to ask why there had been a delay in reviewing Miss X’s care needs. The Council said this was due to staffing issues and that it had offered reviews in order of date and priority. The Council accepted that it had not been able to meet its statutory duties to Miss X’s care review.
29. By failing to review Miss X’s care needs in a timely manner, the Council has not been able to review the changes that occurred with Miss X in the period between reviews. This would have explored whether Miss X was accessing the right support. Evidently Miss X’s care was changing, as shown by ending support and the need for temporary support.
30. The Council should have reviewed Miss X’s care needs yearly. This would identified what support was suitable and would have reduced some of the concerns raised by Miss X’s representatives about the change of care and poor communication.

Changes in care and support

31. The assessment completed in 2021 reduced Miss X’s personal budget by nearly half. The reason for this given in the assessment was the assessment in 2017 noted that Miss X may move into supported accommodation, but as she had not moved, the Council needed to reduce her budget.
32. In the Council’s complaint response, it said the comments in the 2017 had no bearing on the budget, and the support provided to Miss X was within her personal budget.
33. However, the Council used the notes from the 2017 as a clear and direct reason to reduce Miss X’s budget in the 2021 assessment. This contradicts the Council’s complaint response.
34. Miss X’s assessment in 2021 does not identify any significant changes in her care needs. Although the assessment in 2017 documented that it was anticipated that Miss X might move into supported accommodation, there was no record that this was the reason for her budget.
35. The Council has redecided Miss X’s budget three times since the 2021 assessment was conducted, and has recognised the budget agreed does not fully support Miss X’s needs. It has since agreed a higher budget. On balance, I am not satisfied the budget and decision in the 2021 was reflective of the assessment, and feel this is evidenced in the Council’s decision to later increase the budget.
36. Therefore, I agree the Council has used a possible outcome from 2017 to justify the decrease in Miss X’s 2021, without clear reasoning for her care and support needs.
37. This is fault by the Council and has caused Miss X and her representative’s distress. It is also possible that Miss X has missed support because of the cut to her personal budget.

Transport costs

38. Part of Miss X’s complaint is that her care and support has changed without communication or clear rationale.
39. Miss X’s representatives feel that it was unfair for them to have to pay the transport costs for Miss X to attend Centre B as this was previously included in the support.
40. Miss X’s transport had previously been included in Centre B’s support, however after it reopened from COVID-19 it could no longer provide this.
41. The Council said that most provider’s charge for travel costs and that a lot of users pay for transport. Miss X's care and support review identified that she needed to attend Centre B. If the Council had identified, then it should have also considered how she would be able to access this service if no transport was needed.
42. In its stage two response the Council said it had then awarded transport costs for Miss X to access Centre B. This decision shows that Miss X had needed support to access Centre B, and this should have been considered by the Council at an earlier date.
43. To delay this decision was fault by the Council. This meant that Miss X and her representatives had to pay for her to access services when the Council should have explored earlier whether this was a part of her care and support needs.

COVID-19

44. Part of Miss X’s complaint bought by her representatives was that Miss X did not have suitable support during the COVID-19 lockdowns.
45. The Council has been able to evidence that staff contacted Miss X’s representatives to explore whether support was needed.
46. It also said that Miss X was offered remote support via Centre A, but this was also declined. Miss X’s representatives felt it was not suitable for her needs.
47. COVID-19 was a difficult time for Council’s and care providers. Miss X was contacted by the Council and the day care centre and it was explored whether she would be able to engage with the limited support that was being offered.
48. I am satisfied the Council and Centre A explored whether Miss X could engage with the limited support that was on offer.
49. Miss X’s representatives contacted the Council when she was ready to re-engage with services. I do not consider Miss X to have been caused an injustice during COVID-19. Services were struggling with the pandemic and she was offered the support that was available at the time.

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Agreed action

50. Within 4 weeks of my decision the Council has agreed to

• Write to Miss X and her representatives and apologise for the above fault.
• Pay Miss X £300 in recognition of the distress caused by not reviewing her care needs in a timely manner.
• Pay Miss X £500 in recognition of the missed support because of her budget being reduced without clear reasoning.
• Pay Miss X’s parents £300 in recognition of the additional care they provided while Miss X’s budget was in dispute.
• Pay Miss X’s representatives any costs for travel that they may have incurred before the Council’s decision to fund travel.
• Review whether Miss X could access any additional support to make up for the support she missed out on before her budget being increased.

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Final decision

51. I have now completed my investigation. I find fault with the Council for failing to review Miss X’s care needs, and for reducing Miss X’s care and support without clear reasoning. I do not find fault with the Council for how it provided support during COVID-19.

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Investigator's decision on behalf of the Ombudsman