Summary: Ms X complains the Council failed to support her properly after she asked for help in December 2023, and was only just setting up her direct payments when she contacted us in March 2024. The Council took far too long to set up Ms X’s direct payments. It needs to apologise and pay financial redress. It also needs to improve its working practices.

The complaint

1. The complainant, Ms X, complains the Council failed to support her properly after she asked for help in December 2023, and was only just setting up her direct payments when she contacted us in March 2024.

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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 complaint and the documents provided by Ms X;
• discussed the complaint with Ms X;
• considered the comments and documents the Council has provided in response to my enquiries;
• considered the Ombudsman’s guidance on remedies; and
• invited comments on a draft of this statement from Ms X and the Council, for me to consider before making my final decision.

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What I found

What happened

5. Ms X has eligible needs for care and support arising from fluctuating physical health conditions and mental health problems.
6. Since November 2023 Ms X has been living in a women’s refuge, having fled domestic abuse. The Council has accepted the duty to provide Ms X permanent suitable housing under the Housing Act.
7. Following a referral from a health and wellbeing practitioner, the Council tried calling Ms X on 1, 4 and 5 December, but was unable to get through or leave a message.
8. The Council managed to contact Ms X on 6 December. Ms X said she was managing her activities of daily living. She said she was struggling most with washing, cleaning and carrying shopping, due to flare ups in her medical conditions. The Council referred Ms X’s case to a community care officer “for signposting etc”.
9. On 8 December Ms X asked for urgent help bringing her belongings into the refuge, as only one member of staff was on duty and the delivery staff would not be allowed in for safety reasons. According to the Council’s records, the member of staff at the refuge would contact their manager and get back to the Council to see how the issue could be resolved. The Council received no further contact.
10. On 13 December Ms X complained to the Council about the delay in assessing her needs. She said she:
• had been waiting two weeks for a social worker;
• had asked for help carrying her belongings when moving to the refuge;
• needed help with daily activities;
• had been asking for help since being in hospital in November.
11. On 14 December Ms X asked for support going to hospital. The Council advised her to call an ambulance and how to manage the visit while at the hospital. The Council contacted the refuge which said Ms X had left, but it didn’t know where she had gone. It said it did not have the resources to accompany someone to hospital, so would call an ambulance.
12. On 15 December Ms X told the Council she wanted to make an urgent referral for help with daily living activities. She provided a summary of her circumstances. She said she could not cook, shop or do cleaning.
13. On 19 December the Council noted it had referred Ms X to the wrong team, as it had failed to pick up on the fact she had asked for urgent support. The Council contacted Ms X to get more information about her circumstances.
14. On 20 December a social worker visited Ms X with a physiotherapist to start assessing her needs under the Care Act. The social worker noted Ms X:
• had eligible needs under the Care act for support with meals, personal hygiene and dressing; and
• wanted to be in control of her care package, so they would explore direct payments, having first found out how this was done in Tameside as they were not familiar with the process (being new to the Council).
15. When the Council replied to Ms X’s complaint on 21 December, it said:
• it sent her request to the wrong team on 15 December and should have sent it to the correct team sooner;
• a social worker contacted Ms X on 19 December to gather information;
• a social worker from the Urgent Integrated Care Team visited Ms X on 20 December with someone from the Physiotherapy Team. The social worker would discuss the support which may be offered to her and would signpost her to other services where appropriate.
• It apologised for the delay in contacting her.
16. On 21 December the Council received a complaint from Ms X about the failure to support her when she went to hospital on 14 December. She explained about the distress this had caused, including seizures while at the hospital. She said she had experienced distress and increased pain since leaving hospital (in November 2023) due to a lack of support from the Council.
17. On 22 December Ms X took her complaint to the second stage of the Council’s complaints procedure. She said:
• She had spoken to the Council on 5, 6 and 8 December;
• She was vulnerable and had hurt herself from over exertion because she needed help;
• The social worker who assessed her on 18 December assumed she was coping and didn’t recognise that she needed urgent care, and later apologised that she would have to explain her circumstances again to the complaints team;
• Since 21 December she needed full time support and was waiting for the form to apply for help.
18. On 27 December the Council sent Ms X a financial assessment form to complete. It said a direct payment may be the best way forward for arranging her care. It offered to get someone from its direct payment team to contact her. Ms X said she was looking for support six days a week as soon as possible. The Council said it would complete her assessment by 29 December. Ms X told the Council she wanted two two-hours calls each day, apart from Friday, when she wanted a four-hour call, and did not need any support on Saturdays. The Council noted it may be difficult to commission this from a care provider and it would be best for Ms X to have a direct payment.
19. The Council met Ms X on 10 January to continue the assessment of her needs. Ms X said she was paying a care agency to support her for two to four hours a week. The assessment identified eligible care needs relating to:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being able to make use of the home safely – but said she could keep herself safe
• Developing and maintaining family and other personal relationships – but said she did not want contact with her family and was maintaining a relationship with a friend
• Making use of necessary facilities in the local community
20. It is not clear when the Council completed the assessment, as it is not dated. The Council continued to update the assessment until at least May, as it refers to events in February and May. Ms X says the Council told her it would provide her with 17 hours of support a week, but the Council has no record of this. The assessment said:
• Ms X asked for a package of care via a direct payment
• The Council would fund 14 hours a week
• Ms X wanted to employ personal assistants for 10 hours a week and continue using the care agency for four hours a week
• Having completed a financial assessment, Ms X would have to contribute £122.50 a week towards the cost of her care
21. On 12 January Ms X went to hospital and was detained under Section 2 of the Mental Health Act. The next day she was transferred to a hospital in another part of the country. Ms X left hospital in February and stayed in a hotel for at least two nights before returning to the refuge.
22. On 14 February the social worker was asked to complete Ms X’s assessment, before completing a care and support plan. They were advised to arrange a visit with a direct payment officer.
23. When the Council replied to Ms X’s second complaint on 16 February, it said:
• The call on 5 December had been in response to a request for an assessment from a Health and Wellbeing Practitioner;
• After getting more information from Ms X on 6 December, it decided Ms X’s needs “were not of an urgent nature” and referred her to a Community Care Officer for support;
• On 8 December Ms X had asked for urgent help brining her belongings into the refuge, as only one member of staff was on duty at the refuge. The records said the refuge would look at how the issue could be resolved.
• On 14 December Ms X asked for support attending a hospital appointment. The Council advised her how to manage the appointment herself, as staff at the refuge could not support her.
• On 19 December the Council accepted it had referred Ms X to a neighbourhood team by mistake, as she had been asking for urgent support. It apologised for this error and said it would ask staff to follow the correct pathways for urgent and non-urgent support.
• A social worker from the Integrated Urgent Care Team visited Ms X on 21 December and again on 10 January to assess her needs under the Care Act.
24. On 27 February Ms X’s social worker contacted the Council’s direct payment team about arranging a joint visit to set up direct payments.
25. On 28 February Ms X’s Councillor asked about progress in arranging her support. The Council said Ms X had declined a commissioned care package and wanted to wait for the direct payment, which took time to complete.
26. The Council produced a care and support plan for Ms X on 7 March. This provided for 14 hours a week of support with:
• Personal care
• Dressing – but did not identify this as an eligible need
• Meals
• Laundry
• Medical appointments
27. Ms X said she would use her personal budget to pay for:
• 45-minute calls in the morning and evening each day
• 2 hours a week to support with appointments
• 1 ½ hours a week as a contingency
28. The care and support plan identified eligible needs for support with:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being able to make use of the home safely – but said she could keep herself safe
• Developing and maintaining family and other personal relationships – but said she did not want contact with her family and was maintaining a relationship with a friend
• Making use of necessary facilities in the local community
29. The social worker sent the paperwork off for authorisation. They also contacted the direct payment team again about arranging a joint visit.
30. The Council received a letter from Ms X on 26 March. Her social worker contacted the direct payment team again and arranged to visit Ms X on 3 April to sort out her direct payments. The social worker also contacted the finance team to check Ms X’s weekly contribution towards the cost of her care.
31. When the social worker visited her on 3 April with an officer from the direct payments team, Ms X said she wanted to pay her personal assistants £15 an hour and agreed to fund the additional cost above the Council’s hourly rate of £13.60. The direct payment team was to arrange a further visit to complete all the paperwork with Ms X. The social worker was to update the care and support plan based on 14 hours a week.
32. The next day the social worker updated the care and support plan and sent it for authorisation. They also contacted Ms X and the direct payment team, so they could make the final arrangements, and the finance team to chase up Ms X’s financial contribution.
33. On 17 April the social worker asked the direct payment team about progress in setting up Ms X’s direct payment.
34. On 22 April the social worker asked the finance team for confirmation of Ms X’s weekly contribution. This was provided the next day.
35. On 8 May the social worker asked the direct payment team about progress in setting up Ms X’s direct payments.
36. Ms X went into hospital again on or shortly before 13 May. She was again detained under section 2 of the Mental Health Act in another part of the country, before being moved to a hospital in Tameside. Ms X left hospital on 28 May.
37. After learning Ms X had left hospital, the Council arranged to meet her on 17 June to discuss her direct payments and to update her assessment.
38. On 17 June they completed the direct payment paperwork with Ms X and her personal assistants. Ms X said she wanted to use four of her hours to employ the care provider she had been using for several months. The Council updated her care and support plan to reflect this. She agreed to pay the difference between the Council’s rate of £21.10 an hour for a care agency and the care provider’s rate of £28 an hour. This meant Ms X would have to pay £41.60 a week on top of her assessed charge of £122.55.
39. Ms X was able to start employing her personal assistants.

Is there evidence of fault by the Council which caused injustice?

40. The Council accepts there was a delay in progressing Ms X’s request for an assessment. This was because it did not initially identify her request for support as urgent. However, despite correcting that error in December 2023, it still took the Council another six months to start paying Ms X her direct payments so she could employ her personal assistants. While some of the delay can be explained by the time Ms X spent in hospital (nearly one and half months), that does not alter the fact that it took the Council too long to get everything in place. That was fault by the Council
41. The evidence shows the social worker repeatedly chased colleagues about progress. It appears the need for urgency was not taken into account by all those involved in arranging Ms X’s care. The Council needs to consider what action it needs to take to ensure urgent cases are treated as such throughout the whole process, and not just at the initial stage.
42. Having fled domestic abuse, and having physical as well as mental health problems, Ms X’s needs were particularly urgent. The Council should have offered to commission interim support for her while arrangements were made to set up her direct payments. There is no evidence this happened, which is also fault by the Council.
43. Some of Ms X’s initial expectations – that the Council could provide someone to support her with carrying her belongings and a hospital appointment at short notice – were unrealistic. There was therefore no fault by the Council over those issues.

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Agreed action

44. I recommended the Council:
• Within four weeks:
1. writes to Ms X apologising for the failure to treat her case as urgent throughout the process and the avoidable distress this caused; and
2. refunds her in full for the care she paid for between December 2023 and June 2024, and pays her £200 for the distress caused.
• Within eight weeks identifies the action it is going to take to ensure urgent cases are treated as urgent throughout the process, and not just at the start.
45. The Council has agreed to do this. It should provide us with evidence it has complied with the above actions.

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Final decision

46. I have completed my investigation on the basis there has been faut by the Council causing injustice which requires a remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman