Summary: Mrs X complained the Council delayed in providing the support it had assessed her husband as needing, causing harm to their children and putting avoidable pressure on her. The Council failed to meet Mr X’s needs. It needs to apologise, pay financial redress and take action to improve its services.

The complaint

1. The complainant, whom I shall refer to as Mrs X, complained the Council delayed in providing the support it had assessed her husband as needing, causing harm to their children and putting avoidable pressure on her.

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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)

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How I considered this complaint

4. I have:
• considered the complaint and the documents provided by Mrs X’s advocate;
• discussed the complaint with the advocate;
• 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 the advocate and the Council, for me to consider before making my final decision.

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What I found

What happened

5. Mr X lives at home with his wife and their two young children, both of whom have special educational needs. He has early onset dementia. This has resulted in inappropriate behaviour towards his family and when out in the community.
6. The Council assessed Mr X’s needs on 5 May 2022. The assessment noted the difficulty Mrs X was having dealing with her husband, while also working part-time and meeting the needs of their children. Mr X’s GP said Mr X’s health needs would increase fortnightly and he would need residential care within six months. The assessment identified the need for support with:
• managing and maintaining nutrition;
• maintaining a habitable home environment;
• developing and maintaining family / personal relationships;
• making use of necessary facilities in the local community;
• carrying out caring responsibilities for a child.
7. The assessment identified the urgent need for three hours of support for Mr X to access the community twice a week and four weeks of residential respite care a year. It said this would enable Mr X to get out and do things he wanted to do without bringing the family and provide time away from the family and they from him. The Council’s brokerage team was to source the package of care and the proposed start date was 13 May. The assessment said Mrs X would meet her husband’s need for support managing finances.
8. However, no action was taken until 11 July, when the social work team asked the brokerage team to treat Mr X’s package of care as a priority. The brokerage team said no care plan had been requested for Mr X, so it was not close to sourcing his package of care. It suggested asking the rapid response team for support, but the social care team noted it was not the kind of support it could provide.
9. On 19 July the children’s social worker reported Mrs X saying the situation was getting worse. The brokerage team told the social work team it had contacted care provider 1, which works in Mr X’s area, but it could not provide a care worker for two three-hour sessions, but offered to spread the hours across different days.
10. On 21 July Mrs X told the Council Mr X had done some voluntary work in a charity shop. She confirmed the days when support would be helpful. The Council agreed to check with care provider 1 and did so by e-mail.
11. On 1 August Mrs X told the Council she felt uncomfortable about sending her husband for a short respite break in a care home which was not appropriate for his needs and age. She said she would check with a mental health support worker if they could provide social support.
12. On 5 September Mrs X told the Council the Police had cautioned her husband because of his behaviour in the community. She said she was at the end of her tether and would make a complaint if it didn’t sort something out soon, as they had been waiting since May. The Council called care provider 1 to chase a response to its e-mail of 21 July.
13. The Council contacted three-day services on 6 September, which said they may be able to support Mr X. Care provider 1 offered three one-hour slots, which Mrs X agreed to accept, pending a reassessment of her husband’s needs. The Council told her it could start supporting Mr X from 9 September (but care provider 1 put this back to 16 September). The Council noted a mental health support worker was visiting Mr X on Fridays for two hours, until a package of care started.
14. On 8 September Mrs X asked for a carer’s assessment. She complained to the Council when she was told there was a 12-week waiting list, and asked if she could be given priority for a carer’s assessment as it had not previously told her she was entitled to one. The Council agreed to send a social worker out the following week to reassess Mr X and do a carer’s assessment.
15. The Council received a safeguarding referral relating to the risk to Mr X when out in the community. On 12 September it decided not to make safeguarding enquiries, as the risk to him could be managed by assessing his needs under the Care Act.
16. On 14 September Mrs X asked the Council when someone would come to assess Mr X’s needs and do her carer’s assessment. She said she could no longer cope with Mr X when he had nothing to do.
17. Care provider 1 told the Council it visited Mr and Mrs X on 15 September to do its initial assessment, but they were not at home. It said it had called Mr X to tell him it would return the next day, but that meant it could not start supporting him that day. It asked for Mrs X’s telephone number so it could let her know.
18. Care provider 1 started supporting Mr X on 21 September.
19. When the Council visited on 26 September to assess Mr X’s needs, Mrs X said she was unhappy about having to wait so long for support to be put in place. She said she was not happy with Care provider 1 or the fact they were only getting support for three hours a week, when the Council had already assessed Mr X as needing six hours a week. Mr X agreed to consider going to a day centre. The assessment said care provider 2 would support Mr X for four hours every Monday to Saturday to access the community. It also provided for four weeks of residential respite care a year.
20. On 4 October the Council spoke to Mrs X about the possibility of arranging short-term respite breaks (one night or a weekend). According to its records, the next day the Council updated Mr X’s care and support plan to provide for:
• three hours of 1:1 support three days a week;
• attending a day centre three days a week.

The Council has failed to provide a copy of the updated care and support plan.

21. The Council contacted Care provider 2 about providing the 1:1 support. By this time Mrs X had arranged weekly therapy for the children.
22. On 18 October Care provider 2 told the Council it could take four to five weeks to find someone to provide Mr X’s 1:1 support. It also suggested providing 1:1 support five or six days a week, rather than attend a day centre which was unlikely to be appropriate for someone of his age. Mrs X asked the Council about arranging residential respite care but the place she had identified, care home A, was not taking respite placements.
23. Care provider 2 told the Council it had found someone to provide 1:1 support for Mr X two days a week, who should be able to start by 18 November.
24. The day centre arranged to visit Mr X to assess him on 1 November. The Council noted it may not be an appropriate service for him and, after visiting Mr X, the day centre told the Council it was not because of his age and his wish to be out in the community. The Council contacted care home A, but it was still not taking respite placements and had a waiting list for permanent placements.
25. The Council held a professionals meeting on 9 November. This noted the urgent need for additional support, including respite breaks, and identified the possibility of paying a support worker to stay with Mr X overnight in a hotel, provided he agreed to this.
26. On 14 November, Mrs X told everyone involved with her husband’s care about the impact his condition was having on the family and the risks his behaviour caused when out in the community. She said they had gone six months without any significant support. She also pointed out she had still not had a carer’s assessment. The Council told Mrs X it had been unable to find a care home to provide respite care over a weekend. Care provider 2 told the Council it was waiting for DBS (Disclosure and Barring Service) checks to come back, before it could start supporting Mr X.
27. Mrs X’s advocate complained to the Council on 27 November about the lack of support. The Council set out the action it would take to address Mr X’s needs and the impact the lack of support was having on the family.
28. The Council started looking for residential placements. Mrs X said she wanted her husband to have short stays initially, so the children could get used to him being away from home. The care homes contacted questioned the practicalities of providing weekend breaks. The Council assigned officers to reassess Mr X and to do a carer’s assessment with Mrs X. They did both on 7 December.
29. On 23 December the Council told Mrs X care home B had agreed to assess Mr X, but this did not happen.
30. Care provider 2 started providing a care worker to support Mr X on 4 January 2023. This was for four hours a day three days a week. This continued until 23 January, when a second care worker started supporting Mr X one or two days a week. Care provider 1 stopped visiting Mr X the week before. Mrs X passed information about day centre P to the Council, which care provider 2 had recommended. The Council helped Mrs X register Mr X with the Vulnerability Registration Service, which prevents people from registering for credit facilities. The Council set up direct payments, so Mrs X could pay for care herself. The Council contacted more care homes.
31. In February Mrs X asked the Council about arranging residential respite care. The Council funded some ad hoc support with cleaning, which Mrs X paid for via the direct payment account using her £60 a week carer’s allowance.
32. In March Mr X started attending day centre P one day a week for six hours. The Council also funded transport to and from the day centre.
33. When the Council assessed Mr X’s needs on 5 April 2023, it agreed to fund four hours of support Monday to Saturday to access the community and four weeks of residential respite care a year. It also started providing three hours a week of support with cleaning. It arranged for a live in carer to support Mr X for three days in May, providing respite for Mrs X and their children.
34. In June Mr X started attending day centre Q one day a week (also recommended by care provider 2). Care provider 3 started providing 1:1 support for four hours three days a week. Between June and August Mr X received four hours of ad hoc support on nine occasions. He also had support from a live-in carer for one day.
35. In July Mr X started attending day centre P for two days a week. Care provider 2 stopped supporting him. The Council arranged for him to stay in care home A for three nights. He had further stays in August (12 nights then three nights).
36. Mr X had a further ten-night stay at care home A in September.

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

37. Although the Council’s initial assessment identified the need for support carrying out caring responsibilities for Mr X’s children, it failed to address how that need would be met. That was fault by the Council. Before Mr X’s illness he had shared responsibility for their two children with his wife. But his illness left Mrs X meeting all their needs, which was difficult for her to manage because the children have different needs.
38. Despite identifying the urgent need for support in May 2022, the Council took no action to meet that need for two months. That was further fault by the Council. It took another two months for care provider 1 to start providing three one-hour visits a week, not the six hours the Council had assessed Mr X as needing. The family had to wait until January 2023 before care provider 2 started providing all the 1:1 support the Council had assessed Mr X as needing. Although the delay was partly due to the time taken to complete DBS checks, it remains a service failure.
39. There was a further wait until May 2023 for a respite break agreed in May 2022. This was also a service failure, which reflected the lack of suitable residential provision for someone of Mr X’s age. However, it was also fault by the Council as it should have been able to arrange a live-in carer in less than a year.
40. The failings caused significant distress for Mrs X and her family. She was left trying to work from home while also meeting the needs of the children. She did not have the time to meet all her husband’s needs, resulting in him being at risk and sometimes causing alarm to others who did not understand his condition.

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Agreed action

41. The Council has agreed to take these actions to remedy the injustice it has caused:
• within four weeks write to Mrs X apologising for the lack of support and the distress caused to her and her family and pay her £1,000; and
• within three months:
1. identify the action it is going to take to avoid delays in taking action to meet urgent needs for care and support;
2. review its care commissioning arrangements and create an action plan for improving the availability of care providers to support people such as Mr X.
42. The Council should provide us with evidence it has complied with the above actions.

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Final decision

43. I have completed my investigation on the basis there has been fault and service failure by the Council, which have caused injustice which requires a remedy.

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Investigator's decision on behalf of the Ombudsman