Summary: The Council failed to properly consider Mr X’s care and accommodation needs from July 2021 onwards.

The complaint

1. Mr X complains about the way the Council has dealt with his care and accommodation needs since his discharge from hospital in March 2021.
2. He also complains the Council disposed of his bed without his consent.

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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 consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I have:

• considered the complaint and discussed it with Mr X;
• considered the correspondence between Mr X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mr X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

6. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult who appears to need 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.
7. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
8. There is no set definition of an assessment. The Care and Support Statutory Guidance (the CSSG) notes that: ‘The nature of the assessment will not always be the same for all people, and depending on the circumstances, it could range from an initial contact or triage process which helps a person with lower needs to access support in their local community, to a more intensive, ongoing process which requires the input of a number of professionals over a longer period of time’. (Section 6.4 of the CSSG)
9. The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. This should then inform the council’s response to any identified needs. The response ‘might range from offering guidance and information to arranging for services to meet those needs’. (Section 6.5 of the CSSG)

Background

10. Mr X is in his late sixties. He has complex health problems which impact on his day-to-day life. Records show he is hard of hearing and lip reads when engaging in discussion.
11. Mr X was discharged home from hospital in March 2021 with four daily care visits funded under the NHS ‘discharge to assess’ pathway. The scheme allows people in hospital, who are deemed to be ‘clinically optimised’ to be discharged home or to another community setting to allow assessment of their longer-term care and support needs.
12. The Council assessed Mr X’s needs on 19 May 2021. The assessment is detailed and comprehensive. It records Mr X’s ongoing health issues, that he was unable to stand and mobilise independently and needed support with all daily living activities. He was unable to access the community independently. His brother was providing support with shopping, but he would be returning to work which would limit the support he could provide. The assessor recorded that Mr X declined direct payments so a commissioned service would be provided.
13. Mr X says he was not given information about the financial assessment in a suitable format, and because of his hearing loss he misunderstands information. He believes he should not have to pay the charges because he was unable to make an informed choice.
14. The records show the Council completed a financial assessment to establish if Mr X should contribute towards his care. It wrote to Mr X on 23 June 2021 informing him of the outcome and provided a breakdown of the assessment. I have had sight of the letter. It shows Mr X’s disability related expenditure had been considered and that £18.00 would be offset from the weekly charge. The letter clearly states Mr X needed to contribute £87.21 per week towards his care.
15. The Council says a care and support plan was completed on 19 July 2021. It has not explained why it took eight weeks to complete the plan. The plan records the impact the pandemic had on Mr X’s mental health and the subsequent support he needed from the mental health team. It set out “…the complexity of [Mr X’s] physical decline, and impact on his mental health. [Mr X] is developing anxiety, and he becomes fixated to ideas of how his care and support should be considered. The case presented to extra care panel for consideration of supported living for [Mr X], which was declined due to [Mr X] can still be managed in the community with other options like direct payments to have flexible care and support”.
16. Mr X says the Council has made slanderous allegations against him, accusing him of being violent and displaying threatening behaviour. He says he has been verbally aggressive to a social worker because he is frustrated with his current accommodation and the social worker will not answer his questions. He says his application to move has been blocked due to these accusations.
17. The Council says Mr X’s aggressive behaviour was linked to his perception that he was not receiving adequate care and support. It says this was ‘acknowledged’ at a Multi-Disciplinary Team meeting in October 2021. The meeting was held because Mr X had threatened to set fire to his flat if he was not moved. Mr X says the comment was made in desperation. I have had sight of the minutes of this meeting. Mr X’s GP reported a deterioration in Mr X’s mobility, and it was his view that Mr X needed a residential care placement. Mr X’s accommodation was said to be unsuitable and that a referral to the ‘extra care panel’ put forward by Mr X’s social worker had been declined. The notes record Mr X’s declining mental health. At this point there had been no formal assessment of Mr X’s mental health. The GP agreed to make a referral for such an assessment, and to submit a health report to the Council to support a ‘resident led assessment’. A strategy to prevent an intentional fire was discussed.
18. It appears the Council reassessed Mr X’s needs in November 2021. I have not had sight of the assessment but correspondence the Council sent to Mr X refers to the assessment being carried out with a view to sourcing alternative accommodation. I have no information to show what, if any, subsequent action flowed from this.
19. Officers from social services visited Mr X again in January 2022. Mr X again expressed his need for alternative accommodation. Following the meeting Mr X submitted a formal complaint to the Council
20. Prior to Mr X’s discharge from hospital, a new bed was delivered to his home. Mr X says his existing bed was removed and disposed of without his consent. These decisions were taken by the NHS, not the Council. However, the Council has obtained information about this from the NHS. The NHS records show a discussion between the hospital discharge hub and Mr X’s brother, that he (Mr X’s brother) “…provided verbal consent and provided mobile phone number to also use to contact…”.
21. In response to my enquiries, the Council says it is “…clear that [Mr X’s] housing situation was having a negative impact on his mental well-being as he repeatedly requested for a move to a more supportive living environment which he felt was being ignored by the Local Authority”.
22. The Council says Mr X has now been assessed as requiring a change of accommodation due to an increase in his needs. He is now on the waiting list for extra care accommodation.
23. I recently discussed the situation with Mr X. He explained he had a recent visit from the police following an allegation made by the housing scheme manager. Mr X says he is suffering extreme pain and he acts out of frustration and desperation. He says his social worker has told him he is considered a threat to other residents. Mr X says he is virtually immobile and not a threat to anyone. Mr X acknowledges that making threats, empty or otherwise is unacceptable.

Analysis

24. It is not the Ombudsman’s role to decide what services a person is entitled to receive. The Ombudsman’s role is to establish if the Council has assessed a person’s needs properly. If it has, then we cannot criticise the decisions made.
25. Following discharge from hospital Mr X’s care was arranged and funded by the NHS. I have not considered events during this period.
26. The Council completed its assessment in May 2021. There is no evidence of fault by the Council in the completion of the assessment. However, there is evidence of fault by the Council beyond this point.
27. There was an eight-week delay in the completion of Mr X’s care and support plan. There was no good reason for the delay. This is fault by the Council.
28. From July 2021 onwards the Council was aware of Mr X’s wish to move to more suitable accommodation. People’s wants and needs are not the same, the Council’s duty is to provide for needs. In this case I am not persuaded the Council properly considered Mr X’s overall care and accommodation needs. An application for extra-care housing was declined on the basis that Mr X’s care could be managed in the community with direct payments. It is not clear if the panel had been made aware that direct payments was not an option as Mr X had already been offered and declined direct payments. In any event such payments would not affect any change in Mr X’s living environment.
29. By October 2021, the records show the decline in Mr X’s physical and mental health, and that his accommodation was a significant contributor. No action was taken until January 2022, when Mr X was placed on a waiting list for alternative accommodation. I have little doubt that the delay contributed to Mr X’s frustration and his subsequent behaviour. The Council says Mr X felt that he was being ignored by the local authority, so it was aware of the reasons for Mr X’s frustration, but it failed to address the issue of accommodation. In essence Mr X was correct, his needs were being ignored.
30. Whilst threats of any kind are inappropriate, Mr X is in difficult circumstances and believes he is powerless. The Council was correct to record the threat, but it is my view it failed to record the context of the threat. This may have impacted on Mr X’s housing/ accommodation applications.
31. The Council’s failure to properly consider Mr X’s accommodation needs sooner than it did cause him a significant injustice. He suffered avoidable frustration, distress, and uncertainty about whether he would be supported to access more suitable accommodation.
32. I had no information to show what, if any, suitable accommodation became available between July 2021 and January 2022 it is difficult to establish if Mr X missed out on the opportunity to move to such accommodation. The Council later confirmed this, and this showed Mr X had missed opportunities to move to more suitable accommodation.
33. In respect of Mr X’s complaint about the way in which the Council completed a financial assessment and/or provided him with information about charging. The information in the financial assessment could only have been obtained from Mr X, specifically information relating to disability related expenditure, which is unique to every service user. I am satisfied that Mr X was aware of and engaged with the financial assessment process, and that he was aware that care services may be chargeable. The outcome of the assessment was sent by post, so Mr X was not disadvantaged because of his hearing impairment. There is no fault by the Council here.
34. In respect of Mr X’s complaint about the removal of his bed. The evidence I have seen shows the Council was not involved in the decision to remove the bed, as such I have no further comment on the matter.

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Agreed action

35. The Council will, within four weeks:

• provide Mr X with a written apology for the failings set out above;
• pay Mr X £250 to acknowledge the delays identified above, and a further £250 to acknowledge the time and trouble he has been put to pursuing his complaint with the Council and this office;
• backdate Mr X’s application/priority to reflect the delay.

36. The Council has confirmed that Mr X is now at the top of the waiting list for extra-care accommodation.

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Final decision

37. There is evidence of fault by the Council, in that it failed to properly consider Mr X’s care and accommodation needs from July 2021.
38. There is no fault in the way Council dealt with a financial assessment of Mr X, and no fault in the way it communicated the outcome of the assessment to him.
39. The above recommendations are a suitable way to remedy the injustice caused.
40. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman