Summary: Mr X complained about the overall lack of care and support he has received from the Council. We find the Council was at fault for telling Mr X it would suspend his direct payments if he did not register with a GP. This caused significant stress to Mr X. To address this injustice, the Council has agreed to apologise.

The complaint

1. The complainant, Mr X, complains about the overall lack of care and support he has received from the Council. In particular he said:
• the Council have not paid his carer since December 2022;
• the Council has refused to look into his request for direct payments;
• the Councils lack of communication and refusal to put statements made over the phone in writing;
• the Councils refusal to provide him with advocacy support;
2. Mr X said this has had a significant impact on his health. He said this has caused him significant distress.

Back to top

The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this report, we 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. We 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)
4. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
5. 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)

Back to top

How I considered this complaint

6. I spoke with Mr X about his complaint. I considered all the information provided by Mr X and the Council.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

Back to top

What I found

Law and guidance

8. A council must carry out an assessment of any adult who seems to need care and support. 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 appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). Having identified eligible needs through a needs assessment, the council has a duty to meet those needs. (Care Act 2014, section 18)
9. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
10. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
11. The guidance says plans can be reviewed in three ways: a planned review; an unplanned review (usually due to a change in circumstances); and a requested review (when the person or another party asks for a review). If there is any information or evidence that suggests that circumstances have changed in a way that may affect the efficacy, appropriateness or content of the plan, then the local authority should immediately conduct a review to ascertain whether the plan requires revision.

Direct payments

12. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.
13. The care and support statutory guidance states councils must be satisfied that the direct payment is being used to meet the care and support needs set out in the plan and should therefore have systems in place to proportionally monitor direct payment usage to ensure effective use of public money.
14. The care and support direct payments regulations 2014 sets out that the Council must review the making of direct payments initially within six months and thereafter every 12 months. The Council must not require information to be provided more often and in more detail than is reasonably required for the purpose of enabling the Council to know that making direct payments is still an appropriate way of meeting the needs, and that conditions upon which it is made are met.
15. The guidance also states when complying with its duty to conduct a review the Council must involve the adult, any carer the adult has and any authorised person to whom the direct payment is being made.
16. The Council’s direct payments guidance states direct payments can be managed by using a managed account which is also known as a third-party account. This is when it has been agreed to be necessary to ensure that direct payments are managed properly. The Council holds the money and the person receiving the direct payments will submit invoices or timesheets which the Council then pays.

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’s new social worker called him in August 2022 to introduce themselves. Mr X said he did not consent to the social worker contacting any organisations about him. Mr X also said he wanted a typist company to work with him due to not being able to get an advocate. The social worker confirmed a referral had been sent. It was also noted that 12 hours had initially been agreed for decluttering to take place at Mr X’s property.
19. A council officer contacted Mr X in the same month. They agreed four hours would be provided for typist support and an additional 20 hours for decluttering. It was also agreed that Mr X’s social worker was his single point of contact who had agreed to call Mr X weekly between 9:30 and 10am.
20. The decluttering service began in August 2022 by Mr X’s support worker, Ms Z. Ms Z contacted the Council and said her team provided a wide range of services which included sending any messages that Mr X required. This was because she said he could not find an advocate. She said Mr X had requested that two officers from the housing department were not to get involved in his housing case. She said Mr X wanted this confirmed in writing. This was due to the fact that Mr X had several repair issues at his property.
21. Ms Z told the Council she would be invoicing it for four hours per week at £18 per hour from July 2022 as an advocate. But the Council’s notes stated as Mr X had requested a typist, any changes to this request would need to be reviewed.
22. The social worker sent Mr X a letter on 18 August 2022 which stated social services and housing are two separate agencies. It said if Mr X had further complaints regarding staff from housing, this should be directed to the housing department. The social worker explained they do not have authority to comment on staffing matters regarding housing related issues. The social worker also sent Mr X a further letter providing him with a list of advocacy services in the area. This was also followed by a phone call to Mr X, where the social worker explained housing is a different department.
23. The social worker attempted to call Mr X over the next four weeks. But Mr X’s phone was either off or he did not answer. The social worker contacted Ms Z to try and arrange a call with him.
24. Ms Z contacted the Council’s safeguarding team in October 2022. She said Mr X had not been eating or drinking.
25. In the following month, the Council’s notes stated Mr X did not want to use any of the advocacy services provided as he said he did not trust them. It was also noted that Mr X had been refusing to communicate via the agreed weekly calls and had been making attempts to contact a council officer from the direct payments (DP) department.
26. Ms Z contacted a council officer in November 2022. She said Mr X did not think his concerns were being addressed regarding the housing officers. She also said Mr X was severely depressed and had not been eating or drinking. She said she had sent an email to the safeguarding team but had no response. In response the Council said:
• it was not aware Ms Z’s organisation was set up to provide advocacy support;
• it confirmed the names of the housing officers who were engaged to provide support and reiterated the agreed communication plan;
• as Ms Z was working with Mr X in a professional capacity, it advised her to report any concerns to the appropriate health and care professionals;
• it had reviewed the case notes and stated the care and support plan in place had been made in partnership with Mr X;
• any changes to the care and support being provided must follow the correct processes.
27. The social worker rang Mr X in December 2022. They asked to arrange an urgent home visit which Mr X declined. This was because he wanted confirmation two housing officers would not be involved in his case.
28. In January 2023, the social worker called Mr X. They said the housing repairs team were still waiting for Mr X to agree to move to the decant property which had been offered to him. But Mr X said he was not willing to work with housing until he had confirmation two housing officers would not be involved. Ms Z was provided with details of who Mr X would need to engage with regarding his housing.
29. The social worker completed a review of Mr X’s care and support plan in the same month, which Ms Z was invited to but did not attend. The review stated:
• Mr X currently had DPs to manage his care needs such as food, shopping, managing his admin, appointments and decluttering his property;
• Mr X stated he had depression, anxiety and stress. He was advised to register with a GP so a diagnosis could be confirmed. The social worker agreed to send him a list of GPs.
30. The social worker advised Ms Z that Mr X would need to register with a GP for social services to continue working with him. Ms Z and Mr X disputed this as Mr X had not been registered with a GP for many years. But in February 2023, the social worker said they had told the DP department to suspend any payments until Mr X had registered with a GP.
31. In the same month, the social worker asked Ms Z whether she was a carer or an advocate. This was because the invoices she had submitted to the Council stated she was a carer. Mr X later told the social worker Ms Z had not been to his property in two weeks as she had not been paid. The social worker said Ms Z’s hourly rate had changed from £18 per hour to £20 which Mr X said he was not aware of. The social worker asked Ms Z for a breakdown of her care plan for Mr X. They asked her to send in revised invoices as the Council had not agreed to pay £20 per hour. But Ms Z said she made the DP team aware of this over the phone and stated the increased fees were based on less hours.
32. The notes stated the DP team had also advised Ms Z to revise her invoices. It was also noted they had no recollection of ever agreeing to the £20 as it was not their place to set the hourly rate.
33. In March 2023, the Council’s notes stated Ms Z had not provided any evidence of the care she provided and therefore it could not agree to pay the higher rate. The social worker continued to ask for evidence from Ms Z.
34. Mr X complained to the Council in the same month. He said the social worker had stopped his support due to him not registering with a GP.
35. After Mr X and Ms Z had contacted a councillor who contacted the Council, the Council responded and said:
• the DP rate was £13.80 rising to £14.88 on 1 April 2023;
• Ms Z was initially requesting £18 and the gap between the latter two was being met by underspend the Council holds on behalf of Mr X, but is not formally agreed;
• Ms Z was now requesting £20. This was against a backdrop of being unable to confirm the care and support being delivered;
• whilst the social worker did request suspension of the DPs, this had not occurred;
• the Council is not assured the care being delivered was meeting eligible needs or being used as such.
36. A council officer called Mr X and explained the DPs had not been stopped. But said it needed to be reviewed and they needed to speak with Ms Z.
37. The Council responded to Mr X’s complaint in April 2023. It said under DP regulations the Council had a duty to review the DPs to ensure this is the appropriate method to meet his needs. It also said Ms Z had requested more money which was above the hourly rate. It said this had now been rectified and backdated. The Council explained this would be at the rate of £18 per hour.
38. The social worker explained to Mr X that although they had stated the DPs would be suspended as he had not registered with a GP, the reason for the suspension was due to the new hourly rate. The social worker advised him to look into another agency for support if Ms Z would not send in revised invoices.
39. Mr X was sent a letter from the DP team explaining the new rate increases. Ms Z said Mr X had been trying to get hold of this team via the number on the letter but could not get through. The council officer stated they could only work with the budget available, or the service user would need to either top up themselves or reduce the hours. The officer stated they would not call Mr X as the social worker was dealing with his complaints.
40. The social worker continued to call Mr X weekly. But Mr X said until his support was reinstated, and Ms Z was paid, he would not discuss his care. But in June 2023 Mr X did agree to complete a review of his care and support over the phone. The review concluded that:
• Ms Z visits him four times a week and encourages him to attend to his personal care;
• she calls him every morning to motivate him to get up;
• she helps him to send messages.
41. In the same month, Ms Z confirmed she had received payments for January and February 2023.

Analysis

42. The Ombudsman’s role is to review councils’ adherence to procedure in making decisions. Where a council has followed the correct process, considered all relevant information, and given clear and cogent reasons for its decision, we generally cannot criticise it. We do not make decisions on councils’ behalf, or provide a route of appeal against their decisions, and we cannot uphold a complaint simply because a person disagrees with a council’s decision.
43. The Council has provided us with evidence of the invoices submitted to it which state the agreed hourly rate was £18 per hour. In February 2023 Mr X told the social worker Ms Z had not been paid. The social worker explained this was because Ms Z had requested £20 per hour which had not been agreed. Ms Z was repeatedly asked to provide evidence of the support she provided to Mr X. But she failed to do so. The guidance states councils must be satisfied that the DP is being used to meet the care and support needs set out in the plan. Therefore, the Council is entitled to request this information before it can decide, and I cannot criticise it for doing so. Once the review had been completed, the Council paid Ms Z. Whilst I understand Ms Z said she spoke with another council officer over the phone who said she could proceed with the charges; the Council’s notes stated this information had been misinterpreted. Whilst there are two differing accounts of what happened, no evidence has been provided to suggest the Council were aware of the changes to Ms Z’s hourly rate. The Council followed the correct process, and I cannot question its decision.
44. Mr X said the Council suspended his DP’s as he would not register with a GP. The Council did state in February 2023 that they would contact the DP team to suspend his payments as he would not register with a GP. This is fault which caused significant stress to Mr X. But whilst the social worker did state this would happen in February 2023, they explained to Mr X the following month the DP’s had not stopped but needed to be reviewed. In April 2023, the social worker told Mr X although they had stated the DPs would be suspended as he had not registered with a GP, the reason for the suspension was due to the new hourly rate, which it said needed to be reviewed. The Council did apologise to Mr X in April 2023 for suspending the DPs.
45. In August 2022 Ms Z made the Council aware she would be invoicing it at £18 per hour for four hours per week as an advocate. The Councils notes stated as Mr X had initially requested a typist which was agreed, any changes would need to first be reviewed. But a review did not take place until January 2023. This is fault and it would have been up to the Council to establish what Ms Z’s role involved. But I do not consider this fault to have caused any injustice to Mr X as he still received care and support during that time. As Ms Z increased her hourly rate in January 2023 this was a further change which required a review. Therefore, I cannot say that had the review been completed earlier, the payments would have continued.
46. Mr X complained about the Council’s lack of communication and refusal to provide him with advocacy support. From the evidence seen, the Council provided Mr X with a list of advocacy services in August 2022. But Mr X chose not to go ahead with any of these as he said he could not trust them. That was his choice and there is no evidence the Council refused to provide him with advocacy support. Regarding the Council’s communication, it was agreed in August 2022 that Mr X’s social worker was his single point of contact. The social worker agreed to call him weekly between 9:30 and 10am. From the evidence seen, the phone calls did not always fall in between this time frame. But I do not consider this to have caused Mr X any injustice as the social worker did maintain weekly contact with Mr X throughout.
47. Mr X also said the social worker refused to put requests made over the phone in writing. Mr X told the social worker he did not want two housing officers involved in his case. He said he wanted this put in writing. In August 2022, the social worker wrote to Mr X and explained that social services and housing were two different departments. This letter clearly stated what steps Mr X would need to take when raising any housing concerns. In November 2022, a council officer also confirmed to Ms Z the names of the housing officers who were engaged to provide support to Mr X. In January 2023, Ms Z was provided with details of who Mr X would need to engage with regarding his housing. Therefore, it was up to Mr X to contact the relevant department and there was no fault by the Council.
48. Mr X told us the Council failed to respond to a safeguarding concern it received about him. Ms Z sent the Council’s safeguarding team an email on 21 October 2022 stating Mr X had not been eating or drinking. But she said she did not receive a response. The Council told us no formal safeguarding concerns were raised between August 2022 and May 2023. We have two differing accounts of what happened. In December 2022, the Council received further information stating Mr X was not eating or drinking. This was followed up by the social worker who maintained contact with Mr X. But Mr X declined any home visits. This evidences the Council made efforts to contact Mr X to check on his well-being. On the balance of probabilities, if the Council had received the email sent by Ms Z in October 2022, it would have acted on it.

Back to top

Agreed action

49. To remedy the injustice caused by fault, within one month of my final decision, the Council should:
• Apologise to Mr X for stating it would suspend his direct payments if he did not register with a GP.

Back to top

Final decision

50. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The above agreed actions provide a suitable remedy for the injustice caused by fault.

Back to top

Investigator's decision on behalf of the Ombudsman