Summary: Mrs Y complains on behalf of her adult son, Mr D, that the Council wrongly reduced his personal budget without explanation. She says Mr D’s eligible care and support needs have not changed. In our view, there is procedural fault because Mr D’s support plan does not contain a breakdown of his personal budget which has caused confusion for Mrs Y. The Council has agreed to remedy the injustice caused by fault with the actions listed at the end of this statement.

The complaint

1. Mrs Y complains on behalf of her disabled son, Mr D. Following a social care assessment in February 2023, she says the Council wrongly reduced Mr D’s personal budget. Mrs Y says the Council has failed to use its discretion when deciding how to provide funding to meet Mr D’s eligible needs.

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The Ombudsman’s role and powers

2. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
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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What I have and have not investigated

5. I have investigated the concerns which Mrs Y raised in her complaint letter to the Council dated 30 May 2023. Those concerns are summarised in paragraph one of this statement.
6. I have not investigated the issues which Mrs Y raised with the Council after making her complaint. Those issues include a failure to provide funding for Mr D to receive specialist Physiotherapy and Chiropody. This is because the law says we should allow the Council an opportunity to respond to a complaint before we investigate. Whilst Mrs Y has contacted a social worker about these concerns, she has not raised a formal complaint and it is therefore premature for the Ombudsman to consider.

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How I considered this complaint

7. During my investigation I discussed the complaint with Mrs Y by email and considered the information she provided.
8. I made enquiries of the Council and considered its response.
9. I consulted the relevant law and guidance about assessments, support plans and personal budgets.
10. Mrs Y 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

Law and guidance relevant to the complaint

Assessments and support plans

11. Sections 9 and 10 of the Care Act 2014 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 of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
12. The Care Act 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 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.

Personal budgets

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.

16. Section 28 of the Care Act says “Having reviewed an independent personal budget, a local authority must:
• if it revises the independent personal budget, notify the adult to whom the independent personal budget relates of the revisions and provide an explanation of the effect of each revision, or
• if it does not revise the independent personal budget, notify the adult accordingly”.

Background summary of key events relevant to the complaint

17. Mr D is disabled and has eligible care and support needs. Mrs Y advocates on his behalf.
18. In January 2022 Mr D had a care and support plan which, according to Mrs Y, sufficiently met his eligible needs. The personal budget was £653.24 per week (£33,968.48 per year) to fund the following.
• Personal Assistants (PA) to provide 32 hours of support a week, including all associated costs, holiday pay, sick pay, NI etc.
• Activities to maintain physical and emotional wellbeing such as attending the gym, physio sessions. To visit places of interest to stay connected to the community.
• Property maintenance including a window cleaner and gardener.
19. The Council reviewed Mr D’s support needs on 13 February 2023. The assessment document says Mr D’s current personal budget is working well and the funding for PAs is to continue with Mrs Y maintaining records for audit purposes. The assessment document does not say that Mr D’s needs had changed or decreased since the previous assessment in 2022.
20. The Council issued a new care and support plan in July 2023. The new personal budget was £535.03 per week (£27,821.64 per year) to fund the following:
• Personal Assistants to provide 20 hours of support a week made up of four hours per day, Monday to Friday.
• Life coach support for three hours per week every Saturday.
• Gym sessions two times per week.
• Property maintenance including a window cleaner once a month and gardener up to six times a year.
• Mileage allowance for Mr D’s PA to travel 19 miles each way, five times a week.
• Respite support ‘floating’ seven hours a week to be used for respite breaks.
• PA to support Mr D to attend activities of his choice. Should Mr D want to attend events or concerts he may request funding for PA support.
21. Mrs Y complained to the Council on 30 May about the apparent reduction in Mr D’s personal budget. She expressed her view that the Council had neglected Mr D’s needs and she asked for a re-assessment.
22. The Council responded to Mrs Y’s complaint on 17 July. In summary it said:
• It is satisfied the assessment completed by the social worker in 2023 was in line with the Care Act. The assessment considered Mr D’s needs and the support plan outlines how the Council will support Mr D to meet the outcomes for any unmet needs.
• The social worker concluded that a life coach would support Mr D to develop his skills. Although it appears that Mr D’s support hours have reduced, it is the case that an alternative service was offered in its place.
• The overall personal budget allocated to Mr D has not changed but is to be used differently.
• In response to Mrs Y’s request for the personal budget to fund mileage for days out, the Council confirmed the budget is to be used only to achieve the agreed outcomes based on Mr D’s identified care needs.
23. The Council completed a home visit on 15 September. The social worker explained to Mrs Y that it was not possible to pay mileage to take Mr D to appointments. The Council again reiterated this in emails dated 4 January and 8 February 2024.
24. Mrs Y complained to the Ombudsman.

Was there fault in the Council’s actions causing injustice?

25. Our role is not to ask whether the Council could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did so, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome.
26. When comparing the 2022 and 2023 support plans there is a difference between the personal budgets, in particular for the PA hours and how these are to be used. As paragraphs 18 and 20 show, the 2022 plan provides funding for 32 hours of PA support each week whereas the 2023 plan includes 20 hours of PA support plus three hours of life coach support and ad-hoc support for Mr D to attend events.
27. The Care Act makes clear that councils must notify the service user and explain any reasons for the reduction in their personal budget. The ‘Care and Support Statutory guidance’ also says: “The plan must detail the needs to be met and how the needs will be met and will link back to the outcomes that the adult wishes to achieve in day-to-day life as identified in the assessment process and to the wellbeing principle in the Act”.
28. Having reviewed the assessment document, case notes and email exchanges with Mrs Y, there is no evidence of any such explanation. To the contrary, the February 2023 assessment makes clear that Mr D’s support plan is working well and proposes for the PA support to continue. The corresponding support plan does not reflect the findings of the assessment, and this is fault.
29. When Mrs Y questioned the apparent reduction, the Council told her in its complaint response that Mr D’s overall personal budget remains unchanged. It said the way he can use the funding has changed because the Council thinks a life coach is a more suitable way to meet some of Mr D’s needs. This is not referred to in the February 2023 assessment.
30. When we made enquiries, we also asked the Council to clarify the reasons for the change. In response to our enquiries, the Council said: “The current support plan weekly cost come to £535.03, which leaves approximately, £118.21 left in the personal budget. This equates to approximately 9 hours for PA support hours to assist [Mr D] to attend events/concerts. This has yet to be implemented as Mrs [Y] has declined to sign off current support plan, due to outstanding issues regarding health input around physiotherapy and chiropody input”.
31. Although the Council has made assurances that Mr D’s personal budget has not changed, the breakdown now provided is not reflected in the July 2023 support plan and is fault. Thie is because plan we have seen contains no reference to the £118.21 to be used for nine hours of PA support. Instead, the personal budget suggests Mr D can request PA support for events as needed. This does not necessarily equate to nine hours every week. This could represent a significant change in Mr D’s personal budget because he used to receive the whole 32 hours each week to meet his identified needs. The fault has caused injustice to Mrs Y because she has experienced confusion from the conflicting explanations given by the Council and time and trouble in pursuing the matter on Mr D’s behalf.

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Agreed action

32. Within four weeks of our final decision, the Council will:
• Apologise and pay £150 to Mrs Y for the time and trouble caused by the fault we have found. 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.
• Arrange a meeting with Mrs Y and Mr D to discuss his care and support needs. If the Council maintains its decision to allocate only 20 hours for weekly PA support, with the remaining hours set aside for life coaching and events, it should discuss the reason for this change and provide its rationale. This is to ensure that Mr D’s support plan is person-centred. Before finalising the support plan, the Council should provide Mrs Y and Mr D with the opportunity to comment on any changes it makes. In the meantime, the Council should continue to provide what is set out in the 2022 support plan.
33. The Council will provide us with evidence it has complied with the above actions.

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Final decision

34. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The actions listed in the section above will provide an appropriate remedy for the injustice caused by fault.

Investigator’s draft decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman