Summary: Mrs X complained the Council failed to ensure a care package was in place for her husband, Mr X’s hospital discharge. She also complained about the Council’s delay in responding to her requests for direct payments and respite care and failing to correctly reassess Mr X’s finances. We find fault by the Council. This caused significant stress and uncertainty to Mr and Mrs X. To address the injustice caused by fault, the Council has agreed to apologise, make a symbolic payment and remind staff of the relevant guidance.

The complaint

1. The complainant, Mrs X, complains on behalf of her husband Mr X about the following:
• the Council failed to ensure a care package was put in place when Mr X was discharged from hospital in October 2021.
• the quality and reliability of the care package.
• the Council delayed responding to Mrs X’s requests for direct payments and respite care.
• the Council failed to correctly reassess Mr X’s finances in 2022.

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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. 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)
3. 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

4. I spoke with Mrs X about her complaint. I considered all the information provided by Mrs X and the Council.
5. Mrs X and the Council had an opportunity to comment on my draft decision. I considered their comments before making my final decision.

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What I found

What should have happened?

Assessment

6. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person 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. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
8. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
9. Where the Council is carrying out a carer’s assessment, it must include in its assessment a consideration of the carer’s potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Hospital discharge

10. Schedule 3 to the Care Act 2014 and the Care and Support (Discharge of Hospital Patients) Regulations 2014 set out arrangements for the discharge of hospital patients with care and support needs. The NHS can claim money back from councils that have caused delays transferring patients. The NHS must issue a notice to the council where it considers an NHS hospital patient receiving acute care may need care and support as part of a transfer from an acute setting regardless of whether it intends to claim repayment.
11. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
12. On receiving an assessment notice, the council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.
13. Where local authorities provide intermediate care or reablement to those who require it, this must be provided free of charge for a period of up to 6 weeks. This is for all adults, irrespective of whether they have eligible needs for ongoing care and support. Although such types of support will usually be provided as a preventative measure under section 2 of the Act, they may also be provided as part of a package of care and support to meet eligible needs. In these cases, regulations also provide that intermediate care or reablement cannot be charged for in the first 6 weeks, to ensure consistency.

Direct payments

14. Direct payments are monetary payments made to individuals to meet some or all of their eligible care and support needs. They provide independence, choice and control by enabling people to arrange their own care and support to meet their eligible needs.
15. Direct payments cannot be used to pay for care from a close family member living in the same household, except where the local authority has determined this to be necessary.
16. The council should consider the requests for direct payments as quickly as possible. The council 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 explain its decision in writing to the person who made the request. It should also tell the person how to appeal against the decision through the local complaints procedure. (Care and Support Statutory Guidance 2014)

What did happen?

17. This section sets out the key events in this case and is not intended to be a detailed chronology
18. Mr X spent nine months in hospital due to a brain haemorrhage. On 14 October 2021 the hospital sent the Council a discharge to assess form and asked for Mr X’s package of care to be set up on 21 October 2021.
19. Mrs X called the Council on 21 October 2021. She said Mr X had been discharged home with no package of care. Mrs X said she is registered blind and has a son with autism and therefore is not able to care for him. An emergency reablement package of care commenced the following day. It included care calls in the morning, lunch, tea and evening.
20. In the same month Mrs Y reported several concerns to the Council about the quality of care Mr X was receiving between October 2021 and January 2022. She said she would prefer to use the care agency she used for her own care and requested direct payments to fund this. She requested a reduction in Mr X’s care package. As Mr X was receiving a reablement package of care, the Council said if he required ongoing care, this could be funded through direct payments.
21. The Council reviewed Mr X’s care in November 2021. It said he required an ongoing package of care to assist with personal care, meal preparation and prompting medication.
22. In December 2021 the Council told Mrs X the Council’s panel had agreed to the care reduction requested by Mrs X and transfer to a different care agency. But it said it may take time for this to commence but once completed it said it could consider Mrs X’s request for direct payments. It also said following its referral, the carers information service had agreed to assess her for respite.
23. The Council called Mrs X the following month. She said the issue with the care agency regarding the quality of care provided to Mr X had been resolved. The Council said it would be transferring Mr X’s case to its disability team who could support with direct payments.
24. A carers assessment completed in February 2022 for Mrs X identified a main need for sit-in service and carers one-off payment. The Council requested support for Mrs X with walking her guide dog.
25. Mrs X told the Council in the same month she wanted to end the tea and evening care calls. This was because the type of care provided at this time could be provided by Mrs X. The request for reduction was actioned by the Council.
26. The Council’s notes stated Mr X’s case was transferred to the Council’s disability team on 14 March 2022.
27. On 20 March 2022, the Council’s notes stated it would send a financial assessment form and information on disability related expenditure to Mr and Mrs X. Mrs X completed the financial assessment with the Council over the phone in June 2022. The Council said to start direct payments it would first need to know the cost of care contribution. Mrs X said she was happy to continue with the care agency until the direct payments were completed.
28. The Council completed a review of Mr X’s package of care.
29. The Council called Mrs X in April 2022 following concerns raised by the carers information service. She said she had recently had two heart attacks. She said she did not require further care calls for Mr X but would benefit from respite/sit-in services. She said she had access to a sit-in service as an emergency arrangement put in place by the carers centre but said this was not adequate. She also asked about her request for direct payments.
30. The Council’s notes stated in May 2022 its disability team said it would facilitate Mrs X’s request for direct payments, decrease package of care and refer Mrs X for a carers assessment.
31. Mrs X expressed concerns to the Council between June and July 2022 about the care Mr X was receiving. She said care workers had not turned up and asked about the direct payments. The Council said it would contact the care agency and said it had asked Mrs X several times if she wanted to change care providers whilst waiting for direct payments to start.
32. Mrs X contacted the Council in June 2022. She said the financial care costs sent to her were too high. She said the financial assessment process had not previously been explained to her properly. She asked to appeal the decision. The Council sent Mrs X the details for its financial assessment team and referred her for a taxi card application.
33. The Council contacted the carers information centre. It asked how many hours Mrs X had left of her sit-in service. The Council’s panel agreed to provide three hours of sit-in services every Saturday to commence 1 August 2022.
34. The Council contacted Mrs X in the same month. It said her direct payments card would arrive in a couple of weeks. It said she should facilitate Mr X’s care and payments would be backdated to 11 July 2022 when direct payment care started. It said the current care would end the day before.
35. The carers information service asked the Council on 19 August 2022 when Mr and Mrs X would receive the direct payment card. She said Mrs X had been unable to arrange a package of care. The Council apologised for the delay and said it would look into it.
36. In the following month, the Council contacted Mrs X. It said due to technical difficulties the card had taken longer than usual to be processed. It said it should be with Mrs X the following week.
37. The Council completed a financial reassessment for Mr X in September 2022 and the sit in service was added to the direct payments in November 2022.

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Analysis

38. The hospital sent the Council Mr X’s discharge to assess form on 14 October 2021 and asked for his package of care to commence 21 October 2021. The Council told us it sent the form to the relevant teams to action, but Mrs X told the Council Mr X had been discharged home with no package of care. This is fault. While the Council did put an emergency care package in place the following day, Mr X went without proper care for one day. This caused distress to him and Mrs X who was unable to care for him.
39. In October 2021 Mrs X requested to be referred for direct payments to fund care for Mr X through a different care agency as she was not happy with the quality and reliability of the care package. The Council told Mrs X it could consider this request if Mr X required ongoing care. It said in December 2021 its panel had agreed to transfer the case to the Council’s disabilities team and said it would then be able to consider Mrs X’s request for direct payments. But said it may take time before it could do so. This was because the care agency Mrs X wanted to use was not one of the Council’s providers. The Council transferred Mr X to its disability team in March 2022. It referred Mr X for direct payments in June 2022. The Council said it could change Mr X’s care provider whilst waiting for direct payments to start but Mrs X declined. We cannot criticise the Council for this. But Mr and Mrs X did not receive the direct payment card until September 2022. The Council said there was a delay starting the process. This is fault. While Mr X did still receive care during this period, this caused uncertainty to Mr and Mrs X as to how Mr X’s care needs were going to be met.
40. Mrs X told us the Council sent her a bill of £1200 for Mr X’s care but said in November 2022, the Council removed the bill. The Council told us it has no record on its system of an assessed charge towards Mr X’s care services. I have seen no evidence to suggest the Council sent Mr and Mrs X any charging costs from the Council or Mrs X.
41. Mrs X told us the Council failed to correctly reassess Mr X’s finances in 2022. I asked the Council to provide any financial assessments completed for Mr X. But it said no financial reassessments had taken place in addition to the financial uplifts processed every March/April. It said it had received no requests for a financial reassessment. But the Council’s notes state Mrs X requested the Council reassess Mr X’s finances in June 2022. The Council did not reassess Mr X’s finances until September 2022. This is fault. The care and support statutory guidance states Council’s must reassess a person’s ability to meet the cost of any charges at the request of the person. But this did not cause an injustice to Mr and Mrs X as there is no evidence of any charging costs.
42. In the carer’s assessment completed for Mrs X in February 2022, it identified a need for a sit-in service. The Council’s panel agreed to provide three hours of sit-in services every Saturday to commence 1 August 2022. Mrs X told the Council she changed her mind about having a domiciliary sit-in service and requested it be changed to direct payments. Mrs X told us despite this request, the Council closed the case which meant her, and Mr X had no sit-in service. The Council told us it did not record this request on its notes. It said the sit-in service was added to the direct payments 22 November 2022. This is fault. While Mr and Mrs X did receive some sit-in services as an emergency arrangement, Mrs X told the Council in April 2022 this was not adequate. There is no evidence to suggest how the Council satisfied itself this was sufficient and there was delay in actioning Mrs X’s request. This caused distress to Mrs X who has been caused significant stress by not having time for herself, to enable her to continue in her caring role.

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Agreed action

43. To address the injustice caused by fault, within one month of my final decision the Council has agreed to:

• Apologise to Mr and Mrs X for the faults identified in this statement
• Pay Mr and Mrs X £150 each to acknowledge the uncertainty caused by the delay in issuing the direct payments.
• Pay Mrs X £150 to acknowledge the distress caused by the delay in agreeing to the sit-in service.

44. Within two months of my final decision, the Council should issue written reminders to relevant staff to ensure they are aware of:

• Point 12.22 of the care and support statutory guidance which says in all cases, the consideration of the request for direct payments should be concluded in as timely a manner as possible.

45. The Council should provide us with evidence it has complied with the above actions.

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Final decision

46. There was fault by the Council. The actions the Council has agreed to take remedy the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman