Summary: Ms X complained that following a needs assessment the Council has refused to meet her eligible needs for care and support. The Council has failed to show how it is satisfied Ms X’s eligible needs for care and support are being met. It has agreed to apologise to Ms X for the frustration and uncertainty caused and review her needs assessment and support plan.

The complaint

1. Ms X complained that following a needs assessmnet the Council has refused to meet her eligible needs for care and support. Miss X says she is struggling day to day and is not receiving the support she requires.

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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 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)
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 have considered the information provided by Ms X and have discussed the complaint with her on the telephone. I have considered the Council’s response to our initial enquiries and the relevant law and guidance.
5. I gave Ms X and the Council the opportunity to comment on a draft of this decision. I considered any comments I receive in reaching a final decision.

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What I found

Relevant law and guidance

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. Where the council identifies “eligible” care needs it will prepare a care and support plan that sets out how those needs will be met. The council can meet the person’s eligible needs by arranging for a care provider to provide care.
7. The Care and Support Statutory Guidance sets out that councils should also have regard to how needs may be met beyond the provision, or arrangement, of services by the authority. A person may already receive care and support which meets their needs. For example, needs may be met by a carer, in an educational establishment or by another institution other than the local authority. If the council is satisfied the alternative means is meeting the person’s eligible needs then it may not have to actually arrange or provide services.
8. However, the duty to meet eligible needs is not discharged just because a person has another entitlement to a different service which could meet those needs, but of which they are not availing themselves. The needs remain ‘unmet’ (and so the council remains under a duty to meet them) until those needs are actually met by the relevant service being provided or arranged.

What happened

9. Ms X has mental and physical health conditions. She meets once a fortnight with officer A, from the NHS mental health services, who supports her with her mental health conditions and the impact of these.
10. In February 2023 a social worker met with Ms X and her advocate to carry out an assessment of her care needs. Following this the social worker emailed officer A. The email stated ‘I feel [Ms X] would benefit from the support of a personal assistant (PA) but am apprehensive at the moment if she could not commit to a session and cancelled due to anxiety because PAs are self-employed and only get paid for work they do so it would be difficult to keep a PA. Officer A responded that they agreed and said Ms X regularly cancelled appointments with them. They advised they would see if Ms X could be allocated a peer support worker and that the mental health service would continue to work with Ms X.
11. The social worker completed the needs assessment in early March 2023. This noted:
• Ms X’s mother and grandmother supported her with her finances. However, Ms X did not consider this a long-term solution as they were not always available for support.
• Ms X experienced anxiety about going outside. She expressed her desire to overcome this and to be able to spend time in the community.
• Officer A contacted Ms X fortnightly and they were currently managing anxiety about going out of the home.
• Getting to appointments was physically and mentally difficult for Ms X. Ms X’s mother provided support. However, she wanted support from someone else or to be able to do it independently.
12. The social worker noted Ms X would benefit from one-to-one support to access the community which would meet her physical and mental health needs as she is at risk of social isolation. However, they noted Ms X struggled to engage in appointments with officer A. The social worker concluded that until Ms X had built up the confidence and skills to do this, a paid support worker would not be practical. They concluded that Ms X should continue to work with officer A regarding her mental health and anxiety about going out of the house.
13. The Council wrote to Ms X in May 2023, closing her case. The letter said there was currently no role for adult social care to support Ms X and she needed to continue to work with officer A.
14. Ms X complained to the Council in May 2023. She considered the Council had failed to place her in the centre of the assessment and had failed to meet several eligible needs identified by the assessment.
15. The Council responded to Ms X’s complaint in June 2023. It said Ms X was able to fully participate in the assessment and her views were clearly recorded. It said it was reported that Ms X felt the assessment was a fair and balanced view and that the best support was already in place to meet her needs via officer A. Additionally it said the assessment highlighted that Ms X was not able to consistently engage with officer A, so there would be a concern about putting a PA in place which could have a financial impact on her and the PA. It said the assessment suggested Ms X commit to working with officer A and a peer support worker provided through the mental health services officer A worked for, prior to a personal assistant being explored at a later date. It said it was therefore agreed with Ms X that she would continue to work with officer A to manage her mental health and anxiety about leaving the house.
16. It noted any eligible social care needs identified by an assessment did not necessarily need to be met by the Council if the needs could be met in a different way. In Ms X’s case it said the mental health services Ms X received appeared to be the most appropriate service to meet her current low-level needs identified by the recent assessment. It did not uphold Ms X’s complaint.
17. Ms X remained unhappy and complained to us. She said the Council identified eligible care and support needs but was not meeting them. She said the Council repeatedly suggested the mental health services could meet her needs and she had agreed to this but that was not the case. The mental health services did not provide one-to-one support with things such as help with finances, accessing the community and appointments which is why she had wanted an assessment.

Findings

18. It is not the Ombudsman’s role to decide what, if any, care and support a person needs. That is the Council’s role. The Ombudsman’s role is to consider if the Council has followed the correct process and taken all relevant information into account in assessing a person’s needs.
19. The Council assessed Ms X and she and her advocate were able to participate in the process. It identified she had eligible needs for care and support. It then decided the mental health services Ms X was receiving were meeting her eligible needs. Ms X disagrees with this decision.
20. The Council’s assessment sets out the Council’s concerns that using a PA may be unsuccessful and has referred to Ms X receiving support from a peer support worker from the mental health services but I have seen no evidence this has progressed. The needs assessment does not clearly set out how the Council considers Ms X’s eligible needs are being met, whether through the Council or elsewhere. This is fault. This has caused Ms X frustration and uncertainty over whether she should be receiving support from the Council.

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Agreed action

21. Within two months of the final decision, the Council has agreed to apologise to Ms X for the frustration and uncertainty caused by its lack of clarity. It has also agreed to review Ms X’s needs assessment and support plan. If it identifies eligible needs for care and support it should clearly set out how these are to be met, through the Council or otherwise.
22. The Council should provide us with evidence it has complied with the above actions.

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Final decision

23. I have completed my investigation. There was fault leading to injustice which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman