Summary: Mr X complained the Council decided to stop his care package after a flawed reassessment of his social care needs, and that a subsequent reassessment was delayed. The Council was at fault for delay in completing the first reassessment. This caused Mr X avoidable frustration and uncertainty for which the Council will apologise. It will also issue a staff reminder about needs assessment timescales. The Council was not at fault in the other matters Mr X complained about.

The complaint

1. Mr X complained the Council decided to stop his care package after a flawed reassessment of his social care needs, and that a subsequent reassessment was delayed. Mr X also complained the Council took too long to respond to his complaint.
2. Mr X said this meant his needs are not being meant, which is harming his wellbeing and putting unnecessary pressure on his partner.

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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. 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)
5. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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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How I considered this complaint

7. I have considered:
• all the information Mr X’s former advocate provided and offered to discuss the complaint with Mr X;
• the Council’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman's guidance on remedies.
8. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

Care and support

9. Sections 9 and 10 of the Care Act 2014 (the Act) require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be carried out over an “appropriate and reasonable” timescale. It must be of the adult’s needs and how they impact on their wellbeing. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer) for an adult with eligible needs. The care and support plan sets out what support the council will put in place to meet the person’s needs. The care and support statutory guidance explains that councils can meet needs in a range of ways, including by providing a service, advice, adaptive technology or by signposting a person to another service.
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.

What happened

12. Mr X has several conditions which impact his daily life. After an assessment of his needs in April 2021, the Council decided Mr X needed a package of care, delivered through direct payments. Mr X used the payments to commission a mentoring service.
13. In 2022, the Council decided to reassess Mr X’s needs. In November 2022, it spoke to Mr X who said he would be willing to have a meeting to inform the review of his needs without his advocate if they were not available.
14. The Council met with Mr X in December 2022. Mr X’s advocate was not available to support him during the meeting.
15. In June 2023, the Council completed the reassessment. The assessor considered:
• Mr X’s views, after speaking with him, and his partner’s views;
• the mentoring services’ case notes;
• the views of medical professionals involved with Mr X, including his GP and a local mental health service; and
• existing reports and assessments.
16. The assessment noted Mr X had direct payments for 21 hours a week but had not always been using them for their intended purpose. It noted Mr X’s mental health conditions could affect his ability to maintain his personal hygiene, wear appropriate clothing, take care of his home and access the community. The assessment noted that mental health services had recently assessed Mr X and he did not have a mental health need at that time.
17. The assessor found another of Mr X’s conditions could impact his ability to feed himself and use the toilet, but he could ask his GP for a referral to a specialist health service for help with his symptoms if they became a problem. Overall, the assessor concluded Mr X did not have any eligible needs and so was not entitled to social care support.
18. The Council told Mr X of the outcome of its reassessment in July 2023 and gave him two months’ notice that it would stop his direct payments. In August 2023, Mr X’s advocate complained to the Council. In response, the Council agreed to carry out a further reassessment of Mr X’s needs. While his complaint was ongoing, the Council reduced Mr X’s direct payments to 6 hours per week instead of stopping them altogether.
19. The Council held three meetings with Mr X, his partner, mentor, advocate and his partner’s social worker in September 2023, to carry out the reassessment of his needs. The assessor considered their views and details of Mr X’s recent involvement with services including the local NHS mental health service and the mentoring service.
20. In November 2023, the assessor concluded Mr X had eligible needs for support around accessing the community, making use of his home, maintaining his home, going to the toilet and eating.
21. Mr X’s advocate complained to the Ombudsman in late December 2023. They said:
• neither they, nor Mr X knew about the December 2022 reassessment;
• the November 2023 assessment was delayed;
• the reduction in hours was affecting Mr X’s wellbeing; and
• the Council had taken too long responding to Mr X’s complaint.
22. The Council issued Mr X’s care and support plan following the November 2023 reassessment in late February 2024, after discussing the content of the plan with Mr X’s advocate. The plan set out most of Mr X’s needs could be best met by health, housing or other services, which it directed Mr X to. It said Mr X could either have direct payments for two hours a week, or a commissioned service for that amount of time, to help him plan his week and provide social emotional support.
23. In mid-March 2024 the Council responded to Mr X’s complaint. Its complaint response thanked Mr X for agreeing it could wait to respond to the complaint until after it had completed the November 2023 reassessment. The Council has no record of Mr X’s agreement.

Findings

June 2023 reassessment

24. Mr X complained the Council did not tell him or his advocate about the reassessment of his needs, which it started in December 2022. However, the Council spoke to Mr X in November 2022 to tell him about the reassessment and ask whether he wanted his advocate involved. Mr X was therefore aware of the reassessment, and at that time he told the Council he was willing for it to go ahead if his advocate was unavailable. The Council was not at fault.
25. The Council started the reassessment in December 2022 and did not complete it until June 2023. There is no good reason the reassessment took six months to complete. This was not in accordance with the care and support statutory guidance, which says that needs assessments should be completed within a reasonable and appropriate timescale. This delay was fault and caused Mr X avoidable frustration and uncertainty while the assessment was ongoing. The delay did not, in any case, cause Mr X to lose out on support.
26. The Ombudsman cannot question a council’s decision if it is made without fault. As part of the June 2023 reassessment, the Council considered the views of Mr X and his partner and gathered information from professionals involved with him. The Council considered Mr X’s stated needs and whether there was any impact on his wellbeing. The Council considered relevant information in coming to its decision, which it made in line with the Act. There was no fault in how the Council made its decision that Mr X did not have any eligible needs at that time, so I cannot question it.

November 2023 reassessment

27. Following a complaint from Mr X, the Council agreed to further reassess his needs. It began the reassessment in September 2023 and completed it in November that year. I do not consider that amount of time to be fault.
28. Mr X is unhappy the Council has not reinstated his support package to the 21 hours he previously had. However, the Council considered relevant information in completing the November 2023 reassessment and, in line with the Act, the assessment set out Mr X’s needs and their impact on his wellbeing. There was no fault in the Council’s assessment.
29. Following the assessment, the Council created a care and support plan, which it issued in February 2024. The plan was based on the November 2023 reassessment and set out that most of Mr X’s eligible needs could be met by health and other services, which it signposted him to. The Council was entitled to come to this decision; the care and support statutory guidance sets out that councils can meet a person’s needs by directing them to a suitable service. The plan set out Mr X could either have a commissioned service for two hours per week or receive direct payments to commission those hours himself. This gives Mr X the option to decide how he wants to receive the social care support to plan his week and manage his emotions. The Council was not at fault in how it decided on the content of Mr X’s care and support plan so I cannot question its decision.

Complaint

30. The Council’s complaint response thanked Mr X for agreeing it could wait until after it had completed the November 2023 reassessment to respond to his complaint. The Council has no record of this agreement but, on balance, I am satisfied Mr X did make that agreement. I conclude this given the Council believed it to be true enough to state so in the complaint response and given Mr X’s advocate did not complain until after the assessment had been completed. The Council should have kept a record of Mr X’s agreement, but this does not amount to fault.

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Agreed action

31. Within one month of the date of my final decision, the Council will take the following actions.
1. Apologise to Mr X for the frustration and upset he experienced due to its delays completing the June 2023 reassessment. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology.
2. Remind relevant staff that they must complete adult social care needs assessments in a reasonable and proportionate timescale.
32. The Council will provide us with evidence it has complied with the above actions.

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Final decision

33. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman