Summary: Miss X complains about the Council’s decision to reduce her daughter, Miss Y’s, care package from 15 hours per day to 14 hours per day. Miss X also complains about a significant delay in completing a review of Miss Y’s needs. We have found fault with the Council’s decision making, communication and handling of the complaint. The Council has agreed to apologise, make a financial payment and service improvements to remedy the injustice caused to Miss Y and Miss X.

The complaint

1. Miss X complains about the Council’s decision to reduce her daughter, Miss Y’s, care package from 15 hours per day to 14 hours per day, despite there being no change in her health or circumstances. Miss X also complains about a significant delay in completing a review of Miss Y’s needs.
2. Miss X said this has caused Miss Y considerable worry and stress and is affecting her health.

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The Ombudsman’s role and powers

3. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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 considered the information provided by Miss X and discussed the complaint with her. I made enquiries of the Council and considered its response.
6. Miss X and the Council had the opportunity to comment on my draft decision. I considered all comments before reaching a final decision.

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What I found

Relevant law and policy

Care and support needs

7. The Care Act 2014 gives councils legal responsibility to provide a care and support plan. The care and support plan should consider what needs 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. When preparing a care and support plan the council must involve any carer the adult has.

Reviews

8. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Guidance says councils should review plans at least every 12 months. They should carry out reviews as quickly as is reasonably practicable and in a timely manner proportionate to the needs to be met. Council must also conduct a review if the person acting on behalf of the adult makes a reasonable request for one.

What happened

9. What follows is a chronology of key events. It is not meant to show everything that happened and does not contain all the information I have reviewed during my investigation.
10. Miss Y is an adult diagnosed as quadriplegic and has significant long term health issues. Miss X received direct payments to provide 1:1 care for Miss Y at home.
11. In April 2022, the Council contacted Miss X to arrange a review and assessment of Miss Y’s care and support plan.
12. On 11 May, the Council visited Miss X and Miss Y at home to complete the assessment.
13. On 24 May, a social care assessor (SCA) informed Miss X that the direct payments would need to be approved by a panel. The social worker asked Miss X for further information about how much support Miss Y required on a weekly basis and what support was provided by the family. The social worker also asked Miss X to clarify whether Miss Y required respite care. The social worker offered Miss X support with gathering this information.
14. Miss X responded the next day and confirmed that she was happy to complete the assessment. The social worker and Miss X discussed how best to engage Miss Y in the assessment process to ensure it was as least distressing as possible and captured her views.
15. On 6 June, the social worker visited Miss X and Miss Y and agreed to complete the assessment and send it to Miss X to review. The social worker said the direct payment funding request would need to go to panel but was not sure when this would be.
16. The next day, Miss X sent the social worker an email stating that Miss Y:

• had fixed and rigid thought processes and behaviours which indicated she had autism;
• was confined to a wheelchair and unable to complete any personal care needs without assistance;
• required support with communication; medication; preparing meals and drink; eating meals; finances; domestic activities; attending medical appointments; shopping and socialising;
• needed 24-hour care and attention to meet all her needs and maintain good health;
• waking support between 07:00 hours to 22:00 hours (15 hours per day);
• night support between 22:00 hours and 07:00 hours (9 hours per day); and
• required four weeks respite per year.

17. On 9 June, the social worker acknowledged receipt of Miss X’s email and confirmed she would re-write the assessment before sending it to Miss X for checking.
18. The social worker did not contact Miss X again until 6 September. The social worker said the Council was changing the way it carried out reviews of care and support plans. The social worker asked Miss X whether Miss Y could be left alone for an hour. Miss X responded the next day. She said Miss Y had been very ill throughout the summer. Miss X explained that Miss Y had been diagnosed with dysphagia and she had been advised by a nurse that Miss Y was never to be left alone as she was at high risk of choking. Miss X explained that she was able to monitor Miss Y at night via a camera in Miss Y’s bedroom.
19. On 28 September, the social worker contacted the National Health Service (NHS) to verify Miss Y’s diagnosis of dysphagia and whether she was at high risk of choking. The NHS responded and said that notes prior to 2017 were not available on its system. However, a speech and language therapy assessment was completed in 2017 which briefly mentioned swallowing, but no new concerns were raised at the time.
20. On 6 October, the social worker told Miss X that the funding request for Miss Y’s care and support would be considered by the panel on 11 October. Miss X responded and said the review had taken far too long. Miss X said she had not received a copy of the revised assessment as previously agreed. Miss X said Miss Y also wanted to see the revised plan before it went to panel.
21. The social worker shared the assessment with Miss X and confirmed the request to panel was for care at home for 15 hours per day and respite at home for four weeks. Miss X confirmed she was happy with the assessment, and it had captured Miss Y’s needs very well. The social worker agreed to make amendments about Miss Y’s behavioural patterns.
22. On 11 October, the social worker contacted Miss X by email and said Miss Y’s funding had been approved for four months. The social worker explained the panel had requested a recent speech and language assessment and ways to increase Miss Y’s independence. The social worker offered to support Miss X and Y with this including carrying out a home visit. Miss X responded and said it would be good to meet up and talk about things in more detail. Miss X confirmed her availability for 26 October.
23. On 13 October, Miss X told the social worker that Miss Y was feeling anxious about the home visit. On 25 October, the social worker postponed the visit and followed up the speech and language assessment. In November, the social worker chased the NHS about the assessment and for a response to her questions about Miss Y being at high risk of choking.
24. On 20 December, the social worker received a response from the NHS. It said, it had looked at notes from 2013, 2014 and 2015 and there was no suggestion that Miss Y was at high risk of choking or should not be left alone because of choking risk. It said in the absence of any new clinical concerns a reassessment was not indicated.
25. The social worker told Miss X that the panel had supported the social care team’s recommendation that from 16 January, on a trial basis, Miss Y’s care would be reduced by one hour per day to allow her some time on her own and see how well this worked. The social worker told Miss X that Miss Y would be allocated a new social worker from the end of January and a further panel hearing would take place as the funding had only been agreed for four months.
26. On 2 January, Miss X contacted the SCA and said she disagreed with the decision to reduce Miss Y’s care by one hour per day as it was not in her best interests. Miss Y had not requested a reduction in her hours and was feeling very anxious, having increased spasms and she was complaining of chest pain.
27. On 11 January, Miss X complained to the Council about its decision to reduce Miss Y’s care provision. The Council responded to the complaint on 20 February and said the decision was made following information received from the NHS. The Council said it found no evidence that Miss Y required constant 1:1 support. The Council said Miss Y’s new social worker would continue to support Miss Y and Miss X going forward.
28. On 26 February, Miss Y told the Council in writing that she could not be left alone, could not do anything by herself and needed help with everything. Miss Y said she could not turn the internet on and off if something was to go wrong. She could not go to the toilet alone, make a drink, prepare food, feed herself or answer the phone or the door. Miss Y explained that if she got spasms in her right arm then her mobility was restricted. Miss Y said she felt scared about the Council’s decision that she should be left alone for an hour each day.
29. On 9 March, the Council confirmed the new social worker (D) would meet with Miss X and carry out a further review of Miss Y’s needs.
30. On 17 March, Miss X asked the Council to explain how it intended to promote Miss Y’s independence by being left alone for an hour every day. Miss X said she was requesting a full explanation of the decision with evidence.
31. On 28 March, D visited Miss Y and Miss X at home. Following the visit, D confirmed that a new assessment would be completed.
32. On 27 July, D received information from Miss Y’s General Practitioner (GP)as requested. The GP said Miss Y needed support from Miss X to access the toilet and required hoisting from her wheelchair. The GP explained that Miss Y needed to access the toilet between eight to sixteen times a day. The GP said Miss Y suffered from significant constipation.
33. On 3 August, Dr told Miss X that Miss Y’s care hours had been reinstated to 15 hours per day due to her toileting needs. D said the increase had been agreed by the panel for 5 months pending a further review in January 2024. D said the panel had requested an update on Miss Y’s respite and ongoing bowel issues ahead of the next review.
34. On the same day, Miss Y sent a further letter to the Council stating she hated being in a wheelchair.
35. On 4 September, the Council responded to Miss X’s letter dated 26 February. The Council said the trial of the one-hour reduction in care provision was not intended to cause harm or upset and the hour had been reinstated in August. The Council apologised for the delay in responding to Miss Y directly.
36. On 11 September, the Council responded to Miss X’s correspondence from March and July. The Council said following its decision to reduce Miss Y’s care, further concerns were raised about Miss Y’s toileting needs which were not clear at the time of the original decision in January. The Council apologised for the distress caused and the delay in responding to Miss X’s complaint.

Analysis

37. It is not the role of the Ombudsman to carry out an assessment of Miss Y’s needs or to say what her care provision should be. I can only investigate whether the Council has properly assessed Miss Y’s needs and fully explained how it reached its decisions.
38. The Council contacted Miss X about completing a review and assessment of Miss Y’s care and support needs in April 2022. The first home visit was completed in May, however the assessment was not finalised until October. I acknowledge there was a period of delay in arranging the initial home visit and waiting for information from the NHS but there were significant periods of time where no action was taken, and the assessment was not progressed. This is fault. Six months is an excessive amount of time for people to wait for a review and assessment to be completed to establish their needs. The delay caused both Miss Y and Miss X uncertainty and frustration.
39. The Care Act and the Guidance stress the importance of putting a person’s needs and wishes at the centre of the care planning process. If a Council is planning a change, particularly a reduction of support, it is even more vital that the person is consulted, given a chance to explain what their needs are, what outcomes they want to achieve and how this will affect their wellbeing.
40. Miss Y and Miss X were consulted when the Council reviewed Miss Y’s assessment. The recommendation to reduce the support hours on a trial basis was informed by the information the Council received from the NHS as set out in paragraph 24 above.
41. The panel supported the social care team’s recommendation to reduce Miss Y’s care provision without input from Miss Y or Miss X about this. Before making the decision, the Council should have consulted further with Miss X and Miss Y to explore further what support Miss Y was receiving and find out what their views were and what the impact would be of the reduction. I find the Council’s decision making focussed solely on whether Miss Y at high risk from choking instead of taking a holistic approach that considered Miss Y’s needs and safety. It was unreasonable for the Council to ask Miss X whether Miss Y could be left alone without explaining the basis for its questions and that it was considering a reduction in care provision. If the Council had been open and transparent with Miss X, she may have provided a more detailed response. The panel agreed the reduction in the care provision without any further consultation or assessment of risk. That was fault.
42. The Council said it reduced the care hours on a trial basis to allow Miss Y some time on her own and to see how well this worked. However, there is no evidence that Miss Y or Miss X expressed this as an aspiration when it decided to cut provision. The Council’s complaint response contradicts the reasons for the reduction and stated that it had consulted with the NHS and found no evidence that Miss Y required constant 1:1 support.
43. In August 2023, the Council agreed to re-instate the care provision back to 15 hours for five months after which another review would take place. The Council explained that it did so on the basis that Miss Y required support with her toileting needs that it was previously unaware of. I disagree with the Council’s explanation here. The assessment finalised in October 2022 stated that Miss X was reliant on others for all aspects of her daily care and living needs and she was not able to do anything physically without 1:1 support, including toileting. Whilst the assessment did not contain the level of detail provided by Miss Y’s GP in July 2023, if the Council had properly considered the assessment and further assessed the impact of the reduction in care provision before making its decision, it is more than likely that it would not have made the decision to reduce the care package in January 2023.
44. Miss X did not leave Miss Y alone between January 2023 and August 2023, therefore Miss Y did receive care to meet her needs during this period. However, Miss X has been caused an injustice as the Council only provided funding for 14 hours support and not the 15 hours support that Miss Y needed. In addition, both Miss Y and Miss X have been caused significant distress, frustration and uncertainty that could have been avoided. Miss Y told the Council that she felt scared and anxious about being left alone. This would have also added to Miss X’s distress.
45. I have also found fault with the Council’s communication with Miss Y. Miss Y expressed her fears and anxiety to the Council in February 2023, but the Council failed to respond to Miss Y until September. This was fault. Miss Y experienced significant distress by the Council’s decision to reduce her care provision and the lack of response would have added to her distress and uncertainty. Miss X told me that Miss Y became depressed, and I have no reason to doubt that.
46. Miss X contacted the Council in March 2023 and July 2023 regarding her complaint and the Council’s response. The Council did not respond to these emails and Miss X’s complaint until September 2023. This was fault. This would have added to Miss X’s distress and caused her avoidable time and trouble in pursuing her complaint with the Council.

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Agreed action

47. Within one month of my final decision the Council will:
1. apologise in writing to Miss Y and Miss X for the faults identified in this statement;
2. pay Miss X for the additional unpaid care and support she provided Miss Y for one hour each day between January 2023 and August 2023, at the hourly rate already agreed;
3. Pay Miss Y and Miss X £250 each for the distress and uncertainty caused by the faults identified in this statement;
4. remind staff of the importance of completing reviews and assessments in a timely manner; and
5. remind the social care team to carry out consultations with the person affected and their families before agreeing a reduction in care provision.
48. The Council should provide us with evidence it has complied with the above actions.

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Final decision

49. I have found fault by the Council causing and injustice to Miss Y and Miss X. I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman