Summary: Miss X complains the Council failed to support her in her carer role and confirm respite; changed her son’s support package and failed to confirm what it will be; and retracted some provision it had previously offered. We find the Council was at fault. This caused significant distress to Miss X. We make several recommendations to address this injustice caused by fault.

The complaint

1. The complainant, Miss X, complains the Council:
1. has failed to organise a new social worker after the relationship between the current social worker and her broke down;
2. has failed to support her in her carer role and confirm respite for her;
3. has changed her son’s support package and not confirmed what it will and will not include; and
4. retracted some provision it had previously offered.
2. Miss X said this has had a significant impact on her mental 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 spoke with Miss X about her complaint. I considered all the information provided by Miss X and the Council.
6. Miss X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Care Plan

7. 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.

Reviews

8. 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.

Carer’s Assessment

9. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
10. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Direct payments

11. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

Summary of the key events

12. Miss X provides care for her son Mr Y. He also receives six hours of care per day five days per week from two personal assistants (PA’s). Mr X also receives respite care and three hydrotherapy sessions per week.
13. The Council contacted the current respite service Mr Y was using (placement B) in August and September 2022. This was to query a holding fee invoice Miss X had received.
14. Placement B said the current placement was temporary. They said the only way this could be made permanent was for a weekly retainer fee to be paid. But it was noted the Council could not fund this due to the amount. It was also noted there was a lack of respite services for Mr Y’s level of need.
15. The Council completed a review of Mr Y’s care needs in September 2022. It was noted that:
• Miss X expressed concerns around the current issues with the respite;
• the PA’s encouraged Mr Y to engage in a variety of activities such as art, drama, swimming and music;
• everything else was working well; and
• Miss X said she would like to pay the PA’s more with the cost of living rising.
16. The Council told Miss X it could not pay the £1879 per week for respite as it said it was not achievable. This was because Mr Y attends respite for a couple of days every fortnight. It said it was working to find a solution.
17. At the end of September 2022, the Council’s notes stated:
• Mr Y has learning disabilities and epilepsy. He has 24hour care needs;
• the social worker had made a request for a list of alternative learning disability respite placements. But said they needed to get more information on Mr Y’s needs and presentation in respite before proceeding; and
• it needed to explore mobility needs and establish whether Mr Y’s 2:1 support has been assessed as necessary by an occupational therapist (OT).
18. In October 2022, placement B confirmed Mr Y received 1:1 respite care 24 hours a day.
19. The Council completed a carer’s assessment with Miss X. It noted that:
• the social worker asked Miss X whether an increase of hours or support could help. Miss X agreed to consider some additional hours during the week and weekends;
• Miss X was physically exhausted. She needed additional support to be able to maintain her caring role, and her own mental, emotional and physical wellbeing; and
• the work being completed with Mr Y would ease some of Miss X’s responsibilities and therefore no further action would be taken with the carer’s assessment.
20. Miss X told the Council B had been using 2:1 care since he was young. She said when he has seizures, he often needed 3:1 care.
21. In November 2022, Placement B said Mr Y’s placement would continue until the end of November.
22. The social worker told Miss X they were looking to increase the PA hours and said the PA rate would increase to £12.91 per hour. The social worker also recommended that Miss X take up placement B’s offer for a potential respite in the area. They said they could continue funding respite through the direct payment and in the meantime, they would continue to try and source a managed respite service.
23. Miss X told the social worker she had read through the carer’s assessment and said the personal relationship section was wrong which she found very upsetting. She asked for this to be changed.
24. The social worker updated Miss X in December 2022. They said:
• the Council was worried about commissioning a service without exploring all the options. It would therefore like a bit more depth around an accurate idea of Mr Y’s night needs, behavioural needs and the caring role needed;
• there were concerns the Council was not looking at progression with Mr Y and needed to do some work around his goals, objective and striving towards independence;
• they would make a referral to the behavioural advisory team who would complete a report. As they had no involvement from OT’s regarding the 2:1 support, it was important to get that evidenced need for 2:1 support;
• they were looking to get respite in place without the increase in PA hours for now; and
• they were hoping to complete a reassessment of Mr Y’s care and support needs.
25. An OT/functional skills report was completed in January 2023. It stated Mr Y required 2:1 support and possibly 3:1 support in certain cases where he was supported to walk in the community. It also stated he required constant supervision at night.
26. The social worker contacted Miss X in March 2023. They said:
• the funds in the direct payment account could be used to begin respite at a new placement. This was a respite placement Miss X had found; and
• a new direct payment agreement will begin next week. Changes to the agreement include the removal of swimming and an uplift to the PA’s rate of pay. This would be backdated to when the initial raise was requested.
27. In the same month the direct payment agreement was made up of payments for:
• 2 x 30 hours for PA cover for five days per week;
• every other weekend respite;
• PA holiday cover/contingency of 105 hours; and
• one-week annual respite.
28. Miss X said she was not happy with the new agreement as she had previously been given an extra 83 hours a year. She said this was used for appointments or anything that was out of Mr Y’s usual day.
29. The social worker said those additional hours were put in place when Mr Y was attending a day service. They said PA support was more flexible than a day service and provides the support to attend appointments. They said Mr Y had 60 PA hours and any medical appointments could be accommodated within those hours.
30. Miss X questioned this as she said no one had made her aware. She said she was still waiting for respite as she was told the social worker had got the respite costings wrong.
31. The social worker said the respite placement gave them the wrong costings. The correct costings were above what the Council could pay to a non-complex provider. They said management suggested putting this through as managed with a registered rolling respite provider. But Miss X said she wanted it to continue with a direct payment.
32. In April 2023 the direct payment agreement was made up of payments for:
• 2 x 30 hours PA cover for five days per week;
• 105 contingency hours;
• hours for the PA to attend family holiday; and
• every other weekend rolling respite.
33. In June 2023 Miss X said the respite placement could only have Mr Y one weekend. The Council said it had found one other respite placement that could cater for Mr Y’s needs. Miss X contacted the placement and arranged a visit, and the respite was in place by July 2023.
34. The Council said it could not fund this due to the amount. But said due to the backlog of respite not being used and creating a surplus of direct payments, this could be used to fund this respite in September/October whilst it explored other options.
35. Towards the end of August 2023 Miss X asked the social worker if they could confirm whether Mr Y could continue attending the respite placement. The social worker agreed. But said after October, they could no longer facilitate this due to the costings being above the current respite allowances. They said the current respite allowance would only provide two nights respite per month, and not four.
36. Miss X asked the social worker for a list of the registered respite provisions that the social worker had agreed to send. But in response the social worker said they were waiting for the list to be provided.
37. A support worker working with Miss X contacted the social worker in September 2023. They said:
• the current respite was in place until October and they had discussed the risks of a further placement not being available in time. They said the social worker had agreed to look into this and asked for an update; and
• the previous carers assessment from 2022 noted that Miss X needed extra support but said nothing was put in place. They asked what the outcome of that assessment was.
38. The support worker told the Council Miss X would prefer a new social worker due to the breakdown in their relationship. They said something needed to be done so Miss X felt supported.
39. It was noted in October 2023 that a review had been completed and a managed service was considered to be more of a suitable option to source the respite due to ongoing issues around the sourcing of respite. It said the respite aspect of the direct payment would now be changed to a managed service.

Complaint to the Council

40. Miss X complained to the Council about the service she had received. She said:
• the social worker had been contradictory and had no compassion;
• she was not happy the social worker confirmed a pay rise for the PA’s when the new direct payment package was not actively put in place;
• at meetings where other family members/carers were present, Miss X said she was never asked if it was ok to speak about Mr Y in front of them; and
• she wanted a new social worker.
41. As part of Miss X’s complaint, she attached a timeline of phone calls, meetings and emails. Within the timeline Miss X noted:
• at a meeting in September 2022 the social worker explained the package could be expanded as they said Mr Y was entitled to more;
• the respite would be put in place before Christmas as matter of urgency;
• the PA’s were entitled to a pay rise and Miss X was entitled to a carer’s assessment;
• in October 2022 the social worker said Mr Y could receive more hours of care on weekends and during the week;
• in November 2022 the social worker said Mr Y was no longer entitled to his swimming funding. They also said they wanted to add extra hours but cut back on his carers;
• there were names on the carer’s assessment that should not have been there due to police matters;
• the social worker said the PA’s pay rise would be in place once the new package had been approved. But when questioned about why the swimming funding had stopped, they said nothing should have changed;
• although she had been told respite would be in place before Christmas, the social worker now needed to complete re-assessments which was never mentioned before. But Miss X said Mr Y had completed previous assessments throughout the years;
• in January 2023 the social worker met with Miss X to prepare her for an assessment to establish whether it was suitable for Mr Y to remain living at home. But said the social worker left her with the emergency plan paperwork and did not attempt to help her complete this;
• the social worker said Mr Y’s funding was being questioned and when Miss X queried this, the social worker could not respond; and
• the social worker was concerned there was no paperwork to state why Mr Y needed 2:1. But Miss X said she had paperwork to evidence this.
42. In response the Council said:
• the social worker was newly qualified. Part of their practice is to reflect on cases to ensure they are provided with the correct guidance. It said this may have resulted in them initially providing the differing information that was first discussed;
• the social worker would have been asked to provide sufficient evidence when formulating their assessment, particularly when a person needs 1:1 or 2:1 support;
• it apologised if Miss X felt the social worker had no compassion. But said its important that plans and contingencies are in place around the future to avoid crisis or emergency situations;
• the social worker said in November 2022 that Miss X was being paid a lower direct payment rate than the Council standard of £12.91. It said this is not the rate for wages and that is an arrangement between Miss X and the PA;
• it apologised for the family history that was sent on the document. It would ensure the relationships are deleted; and
• it could not facilitate a new social worker as it did not think this would be the best outcome. This is because the social worker has already gathered a lot of information and was devising a suitable support plan.

Analysis- was there fault by the Council causing injustice?

Part a of the complaint

43. Miss X asked the Council to allocate a new social worker. This was due to several issues which are detailed in paragraph 41. The Council considered this request. But it said it did not think it would have been the best outcome for Mr Y. This was because the social worker had gathered a lot of information and was devising a suitable support plan. The Council also said it would ensure there was oversight from other council officers when working the case.
44. As the Council had evidenced it considered Miss X’s request and provided a detailed response, we cannot question its decision. We understand the Council has now allocated a new social worker. But this does not mean it was fault for the Council to have not done this sooner. It is for the Council to decide whether or not to allocate a new social worker.

Part b and d of the complaint

45. A carers assessment was completed in October 2022. It noted that Miss X was physically exhausted and needed additional support. It was also noted that the social worker asked Miss X whether an increase of hours or support could help. Miss X agreed to consider some additional hours during the week and weekend.
46. The carers assessment noted that work being completed with Mr Y would ease some of Miss X’s responsibilities and therefore no further action was taken with the carers assessment.
47. From the evidence seen the PA hours remained the same and the three sessions of hydrotherapy were removed. Therefore, given that no additional hours were granted, there is no evidence to suggest any of Miss X’s responsibilities were eased. This is fault and not in line with the carers assessment. This caused significant distress to Miss X who had agreed to consider some additional hours.
48. Placement B amended their fees in 2022. The Council was in contact with them about this in August/September 2022. But it was established the Council could not fund this. Placement B made the Council aware in November 2022 that the placement would end.
49. In December 2022 the Council said it wanted to do further assessments to get an accurate idea of Mr Y’s needs and evidence of the need for 2:1 support. There was an OT assessment in January 2023.
50. We cannot criticise the Council for what initially happened in 2022 when placement B amended their fees. But the Council was aware of these issues in August 2022, and it took until the 21 December 2022 to make the decision it needed to carry out further assessments. The delay is fault.
51. Miss X questioned the Council’s reasons for requesting evidence of the 2:1 support needs as she said she already had this information. The Council told us it needed an up-to-date assessment as the last assessment was from 2013. We could not criticise the Council for requesting this information as it needed a more recent assessment. But as stated in paragraph 50 the Council was aware of the issues in August 2022 and could have acted quicker.
52. Miss X found a new respite placement towards the end of February 2023. Due to the social worker being given the wrong costings by the placement, this was not in place until April 2023. We cannot criticise the Council for the placement sending the wrong details. But due to fault by the Council Miss X and Mr Y went without the respite between November 2022 and February 2023. This caused Miss X significant distress.
53. Miss X told us Mr Y attended respite once in April. From the evidence seen, Miss X told the Council in June the placement could only have Mr Y for one weekend a month. In response to this the Council found a new placement which started in July 2023. Therefore, the Council acted promptly, and I cannot find fault.
54. After the Council sought the placement, it later told Miss X it could not fund this due to the costings being above the current respite allowances. It said due to the backlog of respite not being used and creating a surplus of direct payments, this could be used to fund this respite in September/October whilst it explored other options.
55. We would have expected the Council to ensure it was fully aware of the costings before agreeing to put respite in place. This is fault. We acknowledge that this did result in respite being in place. But this caused significant stress to Miss X who was worried about what would happen if a further placement was not in place by October.
56. In August 2023 the Council said the current respite allowance would only provide two nights respite per month, and not four. But the direct payment agreement noted in paragraph 27 and 32 stated Mr Y would have respite every other weekend. Therefore, this is evidence of further fault.
57. In October 2023 the Council said due to issues with respite, the respite aspect of the direct payment would now need to be changed to a managed service. Miss X has confirmed respite is in place, but it has not become a managed service. She said the respite was instead funded by health. But she said she was awaiting written confirmation.
58. In November 2023 the social worker told Miss X they were looking to increase the PA rate to £12.91 per hour. They confirmed the uplift to the rate in March 2023 and the payments were backdated to the initial request. Miss X said she was not happy the social worker confirmed a pay raise for the PA’s when the new direct payment package was not actively put in place.
59. There is a four-month delay in the uplift being put in place. This is fault. But the injustice is limited as the Council has backdated the payments.

Part c of the complaint

60. Miss X said Mr Y’s support package had been changed. But she said the Council has not confirmed what it will and will not include. From the evidence seen the social worker did send a copy of the direct payment agreements to Miss X in March and April 2023. This detailed what was included.
61. But there were some hours of care removed. This is detailed in paragraph 28. Miss X questioned this, and the social worker explained why it had been removed. But I have not seen any evidence to suggest this was explained to Miss X prior to the removal. This is fault.

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Agreed action

62. To remedy the injustice caused by fault, within one month of my final decision, the Council has agreed to:
• apologise to Miss X for the fault identified in this statement;
• pay Miss X £1000 to acknowledge the significant distress caused to her by the faults identified in this statement; and
• provide Miss X with a written update regarding the funding of the respite going forward.
63. Within two months the Council has agreed to carry out refresher training for its officers regarding carers assessments and how identified needs are met.
64. The Council should provide us with evidence it has complied with the above actions.

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Final decision

65. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The above agreed actions provide a suitable remedy for the injustice caused by fault.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman