Summary: Mr X complained the Council failed to provide him with a vision rehabilitation service which had a harmful impact on his independence and well-being and caused his wife avoidable distress. We have found service failure by the Council but consider the agreed action of an apology and symbolic payment provides a suitable remedy.

The complaint

1. The complainant, Mr X, complains via his representative that the Council failed in its statutory duty to provide him with preventive services in the form of a vision rehabilitation service from October 2022. Mr X also complains there was delay and poor communication about providing respite care.
2. Mr X says this has had a harmful impact on his independence and well-being and caused his wife avoidable distress.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. (Local Government Act 1974, sections 26(1), as amended)
4. We may investigate matters coming to our attention during an investigation, if we consider that a member of the public who has not complained may have suffered an injustice as a result. (Local Government Act 1974, section 26D and 34E, 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)
7. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)

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How I considered this complaint

8. I read the papers provided by Mr X’s representative and discussed the complaint with her. I have also considered information from the Council. I have explained my draft decision to Mr X’s representative and the Council and considered the comments received before reaching my final decision.

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What I found

Background and legislation

9. S.2(1) of the Care Act places a duty at on all local authorities to provide preventative services to prevent, reduce, and/or delay the development of long-term needs of adults within its area.
10. Para.2.9 of The Care and Support Statutory Guidance confirms that vision rehabilitation is classed as a form of preventative support that local authorities have a duty to provide to adults within its area.
11. The Association of Directors of Adult Social Services (ADASS) have published a position statement on this specific area. It sets out guidance to councils on timescales for sensory assessments and provision of vision rehabilitation. It states: “Assessments and support must be promptly available, as delays in receiving vision rehabilitation can have significant human consequences and financial implications for health and social care. The RNIB recommends that assessments are carried out within 28 days, and that support begins within 12 weeks of a person’s initial contact with the local authority.”

Key events

12. The following is a summary of key events. It does not include everything that happened.
13. Mr X’s representative has provided details of Mr X’s specific medical condition which is a rare form of dementia that affects visual processing in the brain. Symptoms tend to start with a decline in vision but as the disease progresses may present with more general symptoms of dementia. Mr X received the diagnosis in 2019.
14. Mr X was certified as severely sight impaired towards the end of September 2022. The Council received Mr X’s ‘certificate of visual impairment’ (CVI) in early October. The CVI set out that the Council should contact Mr X within two weeks to offer registration as severely sight impaired and identify any help he might need with day to day tasks. This would include vision rehabilitation which was support or training to help maximise independence such as moving around at home and getting out and about safely. The Council wrote to Mr X the following day.
15. The Council completed a Care Act assessment for Mr X in mid-October at his home with his wife present. This found Mr X had eligible needs and identified the risks to Mr X as falls if not guided and monitored both indoors and outdoors and of carer stress that could lead to carer breakdown. The assessed need was for two hours a day for two days a week at a resource centre and two hours for community access with a care worker (a total of eight hours each week). The resource centre would provide support about applying for a taxi card so Mr X could travel to and from the centre and be met on arrival. This was to provide Mrs X some respite from her caring role. The Council provided information about charging. A referral was also made to the Council’s sensory team for further assessment.
16. However, the Council advised Mr X that it did not currently have any rehabilitation officers and so there would be a delay in providing this service. The Council contacted the RNIB to ask if they could offer advice and support to Mr X in the interim period and it was confirmed he already had an allocated caseworker.
17. The Council agreed the recommended package of care in early January 2023. The Council wrote to Mr X with a copy of the assessment and set out the proposed care package and indicative personal budget. The Council noted it was likely Mr X would need to contribute towards the cost of his care and support and would require information to complete a financial assessment. However, the start of the care package was postponed by Mr X and his wife due to a family bereavement. Mrs X contacted the Council in March to ask if the care package could be further postponed. It was agreed to await further contact from Mr X and his wife.
18. Mrs X contacted the Council in June to highlight they were still waiting for a sensory assessment. The Council contacted Mr X in June about the care package that had been suspended to ask if they now wished for this to now be put in place. The Council also sought a reply to the financial assessment form previously provided to establish if Mr X would need to contribute towards the care package. The Council also spoke with Mrs X. She confirmed they were still not ready to pursue the care package and ideally she was looking for some respite. Mrs X also sought a cane for her husband and it was explained this would need to be issued by a specialist. It was noted Mr X had become lost when out with family and Mrs X asked about the use of a GPS device.
19. The Council agreed in July to provide a door sensor, night lights and talking watch. It was confirmed Mr X would remain on the sensory list for mobility training in and out of the house and possible provision of a cane. The Council demonstrated some GPS alternatives and left these for Mr X and his wife to use. There was a discussion about funding and Mrs X confirmed they were likely to be self-funders due to their savings.
20. The Council confirmed at a visit in July that the night lights and door sensor had been installed and Mr X had received the talking watch. Mrs X confirmed the GPS device was working well in August but a beacon was provided to improve performance. Mrs X confirmed they would like to continue the trial but had purchased a similar device themselves which they would use when the trial ended.
21. The Council provided an update to Mr and Mrs X in October about the ongoing difficulty in recruiting a Vision Rehabilitation Officer. Mrs X confirmed she was still seeking a vision rehabilitation assessment so that a cane and mobility training could be provided for Mr X but her main request was for some respite. Mrs X advised that Mr X had been admitted to hospital in September and following his discharge there had been a set back with his independence.
22. The Council completed a carers assessment for Mrs X in October. The Council also discussed the provision of a respite placement for Mr X. The Council provided a copy of its financial assessment form to Mrs X and confirmed as Mr X was a self-funder he would need to fund any placement. The Council provided a list of possible placements. The Council decided in November that although Mr X was a self-funder it would fund the respite placement as support to Mrs X as his carer. The Council confirmed to Mrs X that it would fund a one week placement for Mr X in November and would identify a suitable placement. The Council provided an update in December to say it continued to search for a suitable placement but currently was unable to find a vacancy. The Council arranged two weeks respite in January 2024.
23. Mr X was allocated to a Visual Impairment Officer in early March 2024 with an appointment arranged for the start of April. Mr X was provided with a white cane and other equipment in early April and continued to receive Visual Impairment Rehabilitation mobility training from mid-April to the end of July. It was assessed that Mr X would not be able to travel outside by himself. Although Mr X could use the cane to warn of trip hazards his cognitive impairment meant he could become disoriented and he was unable to make safe decisions about road safety. This meant Mr X would always need someone to walk with him to ensure he was safe.
24. Mrs X sought a further period of respite for a specific period in May as she was due to go into hospital. The Council discussed the options of providing respite care at Mr and Mrs X’s property for two to three days which they would fund with some additional days in a care home with that cost to be funded by Mr X or an EMI residential placement for the whole period with the cost being covered by Mr X. Mrs X confirmed she would prefer the EMI residential placement as it would allow her to better recover at home without carers being there. The Council confirmed Mr X would be means tested for the cost of the placement. Mr X received a 12 day period of respite in May.

Council’s comments on lack of Visual Impairment Rehabilitation Officer

25. The Council has explained the workforce of Visual Impairment Rehabilitation Officers is small with many workers reaching retirement age. The Council’s experienced Visual Impairment Rehabilitation Officer had retired. The Council has provided details of its efforts to recruit to replace this officer before their retirement. The Council attempted both permanent and agency recruitment but did not receive any suitable applications for the position despite several rounds of advertising for the post.
26. The Council’s previous Visual Impairment Rehabilitation Officer came out of retirement for the period March to August 2024. The Council used this time to upskill its workforce in relation to visual impairment interventions and develop its business case to improve the Sensory Impairment Team.
27. Based on the difficulties recruiting, the Council took a workforce improvement approach to build its own resource in-house. The Service had a Transformation Business Case agreed to change a Grade 9 Visual Impairment Officer Post into a Grade 11 Advanced Practitioner Visual Impairment Post and to create two Visual Impairment Apprenticeship posts. The purpose of the Grade 11 post is to attract a suitably experienced worker, at a higher rate of pay, who will hold a complex caseload whilst also managing and mentoring the apprentices. The Council has noted there are only two training courses for Visual Impairment Rehabilitation available but secured a place on one of the courses and successfully appointed a Visual Impairment Apprentice who commenced the two-year apprenticeship in May 2024.
28. The Council has provided details of its advertisements for the Advanced Practitioner Post and has confirmed to the Ombudsman that it has recently been successful in recruiting to this post.
29. The Council has also provided details of the actions taken for those on its waiting list during this period. People who are waiting for home equipment and adaptations are being supported by its Visual Impairment Apprentice or a qualified Occupational Therapist (OT). It is also bringing in an additional OT resource to address these needs. As noted above, training was also completed by the previous Visual Impairment Officer during their temporary return to upskill the Council’s workforce around general visual impairment support. This allowed basic needs to be addressed and reduced the needs that were unmet by the resource gap.
30. The Council acknowledged it could not meet the need for visual impairment rehabilitation and outdoor white cane orientation training during the relevant period. It also accepts there was a delay in Mr X receiving the mobility and rehabilitation support he needed.

My consideration

31. Based on the information provided, I have found no evidence of fault by the Council about the provision of respite care. The Council had agreed a package of care for Mr X which was to address both his needs and provide some respite to Mrs X as his carer. However, this package of care was postponed indefinitely by Mr and Mrs X. The Council subsequently provided information about respite alternatives and charging to Mr and Mrs X.
32. However, it is accepted that the Council did not provide Mr X with visual rehabilitation and mobility training between October 2022 and April 2024. The relevant guidance would suggest this support should be provided within three months of contact. It would be reasonable for Mr X to have expected to receive visual rehabilitation and mobility training early in 2023. This service was not available to Mr X until March 2024.
33. The Council has provided detailed information about its efforts to recruit a suitable Visual Impairment Rehabilitation Officer during this period and the alternative services available to Mr X and others on its waiting list. In the circumstances, I consider the delay constitutes service failure.
34. Mr X’s wife has confirmed he was able to make some progress during the Visual Impairment Rehabilitation mobility training between April to July this year but has acknowledged the effects of his medical condition are now much worse. Mrs X considers her husband would have benefitted more if the training had been provided sooner.
35. I consider it is not possible to determine, even on balance of probabilities, what the impact would have been on Mr X’s independence if the Visual Impairment Rehabilitation and mobility training had been provided sooner. However, I am satisfied that both Mr X and his wife will have been caused a degree of uncertainty about the outcome and avoidable distress during an already difficult period which requires a remedy.
36. I am satisfied the Council has taken appropriate action to address the issue affecting others and so I have not made a service recommendation.

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Agreed action

37. The Council will take the following action within one month of my final decision to provide a suitable remedy
1. write to Mr X and Mrs X to apologise for the delay in providing visual impairment rehabilitation and mobility training; and
2. pay Mr and Mrs X £750 to recognise the uncertainty and avoidable distress caused by the above delay.
38. The Council should provide us with evidence it has complied with the above actions.
39. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.

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Final decision

40. I have completed my investigation as I have found service failure by the Council but consider the agreed action above provides a suitable remedy with the action the Council has already taken.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman