Summary: Mr X says the Council have failed to increase his budget for care meaning that he is having to cover additional costs for his carers. Mr X also says the Council has removed his nighttime care award and not explained why. Mr X says this has affected him financially. We find fault with the Council for the confusing correspondence sent to Mr X and the delay in completing the 2022 review. The Council has agreed to apologise and pay a financial remedy for the distress caused.

The complaint

1. Mr X says the Council has failed to increase his budget for care meaning that he is having to cover additional costs for his carers. He says the Council has also removed his nighttime care award and not explained why.
2. Mr X also complains the Council has failed to cover additional costs whilst he is being transferred to being funded by NHS Continuing Healthcare (CHC).
3. Mr X says this has affected him financially.

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The Ombudsman’s role and powers

4. 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)
5. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. 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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What I have and have not investigated

7. I have investigated Mr X’s complaint that the Council has failed to increase his budget for care meaning he is having to cover additional costs for his carers and has also removed his nighttime care award and not explained why.
8. I have not investigated Mr X’s complaint that the Council has failed to cover additional costs whilst he is being transferred to the care of the NHS. This is because the matter is still ongoing and occurred after Mr X brought the original complaint to us. If Mr X is unhappy with a transfer to CHC funding after it is complete, he can raise a separate complaint about this with the Council or the NHS.
9. I have not considered Mr X’s complaint about an outstanding tax bill as this is in relation to a third party who were dealing with Mr X’s direct payments. If Mr X is unhappy with the way the third party has acted, he may wish to raise the issue with them directly.

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How I considered this complaint

10. I considered all submissions and correspondence from Mr X. I also considered information received from the Council.
11. Mr X and the Council were invited to comment on my draft decision. I have considered all responses received before making a final decision.

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What I found

Legislation and guidance

12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). 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. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
13. 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.
14. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
15. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.

(Care and Support Statutory Guidance 2014)

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What happened

16. Mr X has eligible care needs and has been receiving a care and support package from the Council for a number of years.
17. The Council have reviewed Mr X’s care needs and personal budget each year and increased his personal budget during this time.
18. In May 2022 the Council made a one-off payment of £2,270.52 to cover a shortfall in Mr X’s care costs due to an increase in minimum wage and to cover payments to HMRC.
19. Mr X received different information about the total personal budget he would receive. For example, in May 2022 Mr X’s Wellbeing Support Plan noted a personal weekly budget of £1,159.31 but a letter sent in August 2022 stated a personal weekly budget of £1,202.85. Mr X’s personal budget was paid at £1,159.31.
20. The Council started a review in August 2022 which was not completed until March 2023. Following this a further review was requested in April 2023 but was not completed until October 2023 when CHC funding was granted.
21. Mr X complained to the Council. In his complaint he said the Council had failed to increase his personal budget meaning his account which is managed by a third party has not had enough funds to pay for his care needs. Mr X says the Council did not increase his personal budget at all to cover additional tax and pension contributions and has cut his nighttime care allowance.
22. The Council responded to Mr X’s complaint and said it had regularly reviewed Mr X’s funded support and that his support had not been reduced.
23. Mr X remained unhappy and brought his complaint to the Ombudsman.

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Analysis

24. The Council has broadly reviewed Mr X’s care and support package yearly and has increased the payments made in his personal budget. However, it failed to provide clear information to Mr X about the amount of his personal budget. This is not in line with the Care and Support Statutory Guidance and is fault by the Council, causing Mr X confusion.
25. The review which starting in August 2022 was not completed until October 2023 and involved several review requests. This is not in line with Section 27 of the Care Act 2014 which states reviews should take place within a timely manner and again is fault, causing Mr X further confusion and distress. The outcome of the review was a referral to the CHC. As set out in paragraph 9, if Mr X feels he missed out on care because of the delayed transfer to CHC, this would need to form part of a new complaint to the Council once the transfer has taken place.
26. The Council has made a one-off payment in around May 2022 to cover any shortfall regarding the increased minimum wage and to cover payments to HMRC.
27. I cannot see that the Council has reduced the number of hours, or the total personal budget allocated to Mr X as he described. What I can see is that Mr X’s personal assistant said he was providing care which was more than the agreed care in care plan. It is likely that when this was addressed directly with the personal assistant, they reduced the care given to just the approved care, and therefore Mr X feels he has lost care entitlement, when in reality his care was bought in line with what it should have been according to the care plan.
28. Mr X has been caused uncertainty by both the conflicting information he received about his personal budget and the delay in completing the review which was requested in August 2022 but not completed until October 2023.

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Agreed action

29. Within one month the Council has agreed to:

• Write to Mr X to apologise for the fault identified.
• Pay Mr X £250 in recognition of the confusion and frustration caused to him.

30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. I find fault with the Council for the confusing correspondence issued and the delay in completing the 2022 review.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman