Summary: Miss X complains the Council has failed to provide enough support to meet her needs since July 2022, causing avoidable distress. The Council failed to ensure its care agency was providing the support it had assessed Miss X as needing. But this did not cause enough injustice to her to warrant a remedy.

The complaint

1. The complainant, whom I shall refer to as Miss X, complains the Council has failed to provide enough support to meet her needs since July 2022, causing avoidable distress.

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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 a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)

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What I have and have not investigated

5. I have investigated events since July 2022. I have not investigated events going back to 2019 because of the restriction in paragraph 4 above. The information provided by the Council shows Miss X had opportunities to complain about these events before now, but did not pursue them. There are therefore no grounds to exercise the Ombudsman’s discretion to investigate a late complaint now.

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How I considered this complaint

6. I have:
• considered the complaint and the documents provided by Miss X;
• discussed the complaint with Miss X;
• considered the comments and documents the Council has provided in response to my enquiries;
• considered the Ombudsman’s guidance on remedies; and
• invited comments on a draft of this statement from Miss X and the Council, for me to consider before making my final decision.

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What I found

What happened

7. Miss X lives with her two children. She has several medical conditions which causes pain and dizziness, and affect her mobility. She uses walking aids outside her home, but not in her home.
8. When the Council reviewed Miss X’s needs in February 2022 she was receiving two 15-minute calls a day to help with:
• changing a catheter;
• wiping down the bathroom, if needed;
• tidying the kitchen;
• stripping the bed;
• putting washing in the washing machine, if needed;
• hanging wet washing from the machine; and
• reminding her to take medication.
9. The review said Miss X’s needs had not changed but she could now do some household chores more independently. However, it also said Miss X was independent with medication.
10. An Occupational Therapist visited Miss X in July 2022 to assess her. Miss X said she had had her catheter removed as it was causing severe pain and she had stopped taking all her medication as it made her feel worse. She said she experienced urinary urgency, so remained upstairs most of the time to be near the toilet. She said the Council had promised a downstairs toilet when she moved, but that was not correct. She said she did not use the stairlift as it took too long, made her feel dizzy and the sitting position was too painful. She said she wanted a toilet in an outbuilding converted so it was part of the house. The assessment identified the need for support accessing the community and making use of the home safely. It did not identify the need to convert the outside toilet, as Miss X could access the upstairs toilet with “minimal issues”, and it would take longer to access the downstairs toilet. The assessment accepted Miss X may experience problems with fatigue through repeated trips to the toilet.
11. The Occupational Therapist told Miss X her reasons for not using the stairlift were medical issues and recommended asking for a review to enable her to use the stairlift. The Occupational Therapist offered to look at alternative seating for the stairlift, but Miss X declined saying she would not use the stairlift as it caused her anxiety. The Occupational Therapist agreed to ask for a grab rail outside her back door and to have her front step extended by 15 cm to fit her rollator.
12. When the Council responded to Miss X’s complaint in June 2023 it said:
• It was not possible for everyone to have a long-term dedicated social worker. A duty social worker was available during office hours, alongside other support from the adult social care contact centre. Outside office hours, an emergency duty team was available. Miss X had contacted all three services in recent months (at least nine days in April and May).
• Miss X’s care agency had removed the care worker from her calls who had failed to remind her to take medication. Its July 2022 review of Miss X’s needs had found her independent with medication. Assistive technology could reduce the need for care workers to remind her to take medication and provide more independence. It would consider this at her next review.
• The care agency had visited twice a day over the past year to support with catheter care (which was no longer in place), provide medication reminders and help with laundry. It did not accept it had left her without care.
• Miss X’s Individual Voluntary Agreement with her creditors was not a matter for the Council, as she had the capacity to manage her own finances. It told her where she could get support with debt management.
13. When the Council reassessed Miss X’s needs in August 2023, it involved Miss X, her advocate and the care agency. The Council noted the care agency’s care plan did not reflect what the Council had commissioned it to do, as it included tasks from previous years. The Council The assessment said Miss X’s needs had changed. It said she reported these issues:
• She no longer had a catheter in place and was using the toilet independently.
• She had recently been diagnosed with a functional neurological disorder and was waiting the results of a brain scan.
• She reported anxiety, stress, fatigue, memory loss, dizziness and low motivation.
• She had been advised to stop taking medication for anxiety as it was affecting her liver, but did not feel able to until she had the desired level of care in place.
• A doctor had recently prescribed an anti-depressant.
• The care workers helped with laundry, wellbeing checks, preparing drinks and sometimes prompting medication.
• She could some tasks independently, such as laundry and meal preparation, but this could lead to further fatigue.
• She felt socially isolated, found it difficult to leave the house and did not have friends in the local area.
• She would prefer one 30-minute call a day.
14. The assessment identified the need for support in five areas and the care and support plan sets out how they are to be met:
• Maintaining personal hygiene - care workers to visit once a day for 30 minutes to prompt and encourage Miss X to shower and wash her hair, to prevent self-neglect, but otherwise she is independent with these tasks.
• Maintaining a habitable home – Miss X pays privately for two hours of cleaning a week. Otherwise, she is to aim for independence, but the care workers are to help when needed.
• Medication prompts – assistive technology to be explored.
• Developing and maintaining family / personal relationships – referred to befriending service and provided with information community groups.
• Making use of necessary facilities in the local community – advised to request support from health services with appointments. Referred to a befriending service. Information provided on community groups and on a dial-a-bus service.
15. The Council has identified the need to review Miss X’s care and support plan in six months, to see how the longer calls are working. Miss X has

Is there evidence of fault by the Council which caused injustice?

16. It appears there was a lack of joined up working between the Council and the care agency, which resulted in the care agency having plans in place which did not reflect the result of the Council’s assessments. This raised Miss X’s expectations over what the care workers should be doing for her.
17. Having recently reassessed Miss X, the Council has updated her care and support plan with her and the care agency. This should resolve the previous problem. The care and support plan provides the same amount of care as before, but in a single 30-minute call day. Given that modest change, there is not enough evidence to say Miss X was caused enough injustice by the previous lack of clarity to warrant a remedy.

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Final decision

18. I have completed my investigation on the basis the Council’s fault have not caused enough injustice to warrant a remedy.

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Investigator's decision on behalf of the Ombudsman