Summary: Mr X complained the Council has discriminated against him and failed to properly consider his care needs. He said the matter has caused him significant distress and he has had to turn down work opportunities due to embarrassment about his personal hygiene. We find the Council was at fault for a delay in completing the review. This caused significant distress to Mr X. To address this injustice caused by fault the Council has agreed to make a symbolic payment.

The complaint

1. The complainant, Mr X, complains the Council has discriminated against him and failed to properly consider his care needs. He said the matter has caused him significant distress and he has had to turn down work opportunities due to embarrassment about his personal hygiene.

Back to top

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)

Back to top

How I considered this complaint

4. I spoke with Mr X about his complaint. I considered all the information provided by Mr X and the Council.
5. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

Back to top

What I found

Law and guidance

6. 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.
7. 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.

Summary of the key events

8. The Council raised a request for a review of Mr X’s care on the 4 July 2022 and he was placed on a waiting list.
9. Mr X’s GP contacted the Council in February 2023. It said Mr X was waiting for a review of his care and had been told he was on a waiting list. The GP asked the Council if this could be expedited and said Mr X had recently needed to engage with the mental health team.
10. The Council contacted Mr X in March 2023 to arrange a review of his care needs. Over the next few months, the Council had various chats with Mr X about his care. This included:
• exploring support services to support Mr X with management of relationships, debt and work opportunities;
• discussions around personal aids as an alternative to personal care; and
• Mr X to think about applying for job. Mr X told us having a job is very important to him. But he said due to his disability, he has difficulty keeping a job.
11. In June 2023 it was noted that Mr X had started to disengage. He had declined referrals and information on different services. The Council asked if he would like to continue with the review.
12. Mr X said he had found a job and wanted to see how it went and whether he could manage his personal care before ending care. He asked the Council to stop the review and the Council agreed to keep the referral for two weeks to enable Mr X to update it on his progress.
13. The Council spoke with the care provider who said they currently supported Mr X to have a shower and apply creams. But they said when he goes away for a week, on return they do not notice any sore areas which indicate he is achieving. They also said Mr X was able to do housework independently. It was noted the plan would be to gradually decrease support to weekend and assess how he was managing. This was discussed with Mr X and detailed in the care assessment. It was noted one carer was to provide reablement approach support to develop strategies to promote abilities and skills to meet all assessed eligible needs.
14. In June 2023, the care provider said they would need two weeks’ notice to decrease the care package. The Council discussed with them the outcome of the care assessment and it was agreed the reduced package would start on the 24 June 2023.
15. The following day the Council received a request to cease the package of care from the care provider. The Council questioned this and updated Mr X.
16. In early July 2023, the care provider said they would provide Mr X with support at weekends and said this would end on the 18 July 2023. They said they had no concerns for Mr X regarding personal care and said the only need was domestic duties.
17. The Council spoke with Mr X who said he wanted the full care package back as he said he had sores to his body. The Council advised him to speak with his GP. It also discussed the option of a reablement service to enable him to access support to promote independence. Mr X agreed to do his own personal care in the interim of reablement being sought.
18. The Council went back to the care provider to reiterate Mr X’s concerns and said it was concerned that carers had not been accurately reporting back on how Mr X was coping.
19. In July 2023, the care assessment noted:
• Mr X had recently lost his job. Prior to starting he received care seven days a week to assist with personal care and one hour of domestic support weekly;
• in the interim period of the care provider giving notice to cease the package of care, carers would assist Mr X to develop strategies with the use of aids to develop new ways that he can achieve personal care independently;
• Mr X said the carers had not supported him to develop strategies as specified in the current plan; and
• due to Mr X’s employment ending and him not managing his personal care, he had been assessed as eligible for an increase in care to 4.5 hours weekly from the 6 July 2023. This would be provided from Monday to Friday.
20. On the 14 July 2023, it was agreed the care provider would provide the reablement package of care. It was noted this would start on the 17 July 2023 and was made up of five visits of 30 minutes and a one-hour domestic visit.
21. An occupational therapist (OT) visited Mr X in the same month. It was agreed Mr X would be provided with a perching stool and shower seat to support him.
22. The OT visited Mr X in August 2023 and it was noted Mr X needed support with dressing/drying and applying creams.
23. In September 2023 the Council completed a reablement review. It was noted that:
• Mr X had come to the end of reablement;
• Mr X was due to begin his new job and the Council explained he would need to complete a financial assessment; and
• Mr X had requested some adjustments to his care plan to accommodate his new work schedule. This included moving the morning care to the evening and an additional call on Sunday. Mr X was advised if the care provider could not agree to the changes, he may need to switch providers or wait for their capacity to change.
24. The care assessment was completed shortly after. It was noted that:
• the care agreed consisted of Monday to Friday with an additional half an hour on a Sunday;
• carers were to assist Mr X to continue to achieve personal care needs, wash and dry lower part of his legs as he is independent with other personal care needs; and
• carers were to encourage Mr X to complete domestic cleaning and laundry with minimal assistance.
25. On the 11 September 2023, the Council received a request for a decrease in care as they were unable to cover the Sunday visit. It was agreed that this would be increased again when capacity allows it. Mr X was updated.
26. The Council spoke with Mr X in October 2023. He said things were going well and there was no need for weekend support as he said he was managing. The social worker explained they would end their involvement.
27. A review was held in April 2024. It was noted that:
• Mr X said he needed more support with personal care as there are areas he could not see to reach;
• Mr X said he would like help to manage his diet, finances and the community;
• the care provider said Mr X was more able than he thinks and carers provided little support with personal care;
• the care provider said Mr X had made inappropriate comments to some carers who will no longer visit. Mr X disputed this and requested his care be cancelled;
• the Council suggested two half an hour visits to monitor Mr X’s skin integrity and a referral to alliance to support Mr X; and
• Mr X asked for the meeting to end.
28. The Council called Mr X a few days later to see if he wanted care visits twice a week and a referral to alliance. But he confirmed that he did not want care or a support referral. The Council confirmed it would cancel the care contract. This was updated in the care assessment.

Complaint to the Council

29. In Mr X’s complaint to the Council, he said:
• he had been asking for a review of his care as he was struggling with his mental and physical health;
• when he eventually got the review, the social worker was very opinionated and decided they would do all they could to take away the care; and
• he had a rare disability. But because he did not meet the Council’s criteria of being in a wheelchair or being incapacitated, then he doesn’t need care. He said the Council has discriminated against him.
30. In response the Council said:
• the social worker was allocated to complete a review on the 9 March 2023. It noted Mr X did wait a considerable time for a review and the Council apologised;
• the social worker completed a review on the 14 March 2023 and no changes were made. But the social worker was considering voluntary agencies as additional support for Mr X;
• there was evidence of ongoing contact from the social worker from March to June evidencing they looked into support him with employment and accessing voluntary services;
• there were further discussions with the care provider. The carers had assessed that Mr X could achieve a level of independence with his personal care and so they would look to reduce the care;
• following the decrease in care, the provider gave notice to cease the care package;
• it can see it has now secured 3.5 hours of care to look at ways to increase his independence using the reablement team and he had input from the OT; and
• there was no evidence of discrimination.

Analysis- was there fault by the Council causing injustice?

31. The Council raised a request for a review of Mr X’s care on the 4 July 2022 and he was placed on a waiting list. Mr X’s GP contacted the Council in February 2023 and stated Mr X’s mental health had deteriorated. The Council allocated an officer to complete the review on the 8 March 2023. Therefore, there is a significant delay in carrying out the review. This is fault. I note the Council has acknowledged this delay and apologised. But this caused significant distress to Mr X.
32. The Council has taken action to improve its waiting times. It has formulated a review team that focuses solely on reviews to ensure that the need for a review is not competing against the priority for new assessments. It said it has seen a significant decrease in waiting times.
33. As stated in paragraph 31, the Council contacted Mr X in March 2023 to arrange a review. There were several discussions between him and the Council about exploring support services to support him. But it was noted Mr X started to disengage and had declined referrals. In June 2023, Mr X explained he was happy for the Council to stop the review whilst he was considering whether he could manage his personal care.
34. Whilst there was fault by the Council for the initial delay in arranging the review, there is no fault in how the review was carried out. The Council has evidenced it was working with Mr X to see what support could be provided.
35. The Council spoke with the care provider in June 2023. They said Mr X was able to do housework independently and did not raise any concerns around his personal care. The Council spoke with Mr X and explained it had decided to gradually decrease his support to a weekend. It said it would assess how he was managing. It was agreed that one carer would provide reablement approach support to Mr X to develop strategies to promote abilities and skills to meet all assessed eligible needs. The care provider agreed to this but later issued notice to cease the care.
36. The initial plan to decrease the support was made after the Council had spoken with the care provider about what care it was providing to Mr X. This was a decision the Council was entitled to take. It has clearly evidenced how it reached the decision and it was also discussed with Mr X. I do not find fault by the Council.
37. Shortly after the care provider issues its notice, the Council spoke with Mr X about a reablement package of care, and the Council agreed to look into this. The Council then completed an assessment. It was noted that Mr X’s employment had ended, and he was not managing his personal care. It was also noted that Mr X said the carers were not supporting him as per the care plan. His care was increased to 4.5 hours weekly from the 6 July 2023. On the 14 July 2023, the care provider agreed to take on the reablement package.
38. The Council acted quickly after it received the care provider’s notice. The Council also considered Mr X’s comments around the carers not supporting him. It agreed to increase the care and a reablement package of care was agreed. Therefore, I do not find fault.
39. After the reablement package was agreed, an OT visited Mr X and he was later provided with equipment to support him. There was a reablement review in September 2023. As Mr X was due to start a job, it was agreed that his care would be moved to an afternoon with an additional care visit on a Sunday. But the care provider later said it did not have capacity for Sunday. Mr X was updated and the following month he said things were going well and there was no need for weekend support.
40. There was a review in April 2024. The care provider states Mr X was more able than he thinks and said the carers provided very little support. The care provider also said Mr X had made some inappropriate comments to carers. In response, Mr X requested his care be cancelled. The Council contacted Mr X to see if he wanted two care visits to monitor his skin integrity and a referral for support. But he confirmed he wanted to end his care. Therefore, this evidences it was Mr X’s decision to end his care.
41. Mr X said the Council has discriminated against him. From the evidence seen, the Council has considered Mr X’s needs throughout and this is clearly evidenced. I have not seen any evidence of discrimination.

Back to top

Agreed action

42. To address the injustice caused by fault, within one month of my final decision the Council has agreed to pay Mr X £150 to acknowledge the distress caused to him by the delay in completing his review.
43. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

44. There was fault by the Council. The actions the Council has agreed to remedy the injustice caused. I have completed my investigation.

Investigator’s final decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman