Summary: We will not investigate this complaint about an alleged failure by the Council to properly assess or meet the complainant’s adult social care needs. The Council has properly considered the complainants’ needs in accordance with the principals of the Care Act 2014 and its related statutory guidance. There is insufficient evidence of fault to warrant an investigation.

The complaint

1. The complainant (Mr K) complains the Council errored in carrying out at reassessment of his adult social care needs. The purpose of the reassessment was to identify the level of care and support he is eligible to receive from the Council. However, Mr K says the Council failed to properly consider two medical reports by professionals involved in his care. He explains the reports confirm he requires 24 hours of funded care, seven days a week. Despite this, Mr K alleges the Council has ignored relevant professional input and has declined to increase the number of funded care hours which the Council meet using direct payments.
2. In summary, Mr K says the alleged fault means the Council is failing to meet his eligible care needs. He also refers to the failings causing him distress, anxiety and uncertainty. As a desired outcome, Mr K wants the Council to reopen his latest care reassessment and increase his funding in line with his needs.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating, or further investigation would not lead to a different outcome. (Local Government Act 1974, section 24A(6), as amended, section 34(B)).

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How I considered this complaint

4. I considered information provided by the complainant and the Council. I also considered the Ombudsman’s Assessment Code.

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My assessment

5. I have carefully considered Mr K’s reasons why he considers the Council’s reassessment of his needs was subject to fault. He says the Council failed to consider relevant opinion from two medical professionals which concern his needs and the areas of his living he requires support with. He explains the two medical professionals referenced have reported that he requires funding for 24 hour case and support. One medical report referred to by Mr K states the nature of his presentation and the risks associated with his needs are such that he will continually need to have 24-hour care. The other report suggests Mr K cannot be left safely at home alone on account of his needs. Both reports however refer to Mr K’s live in carer who provides 11 of daily care. The professionals who produced the report suggest this care provision mitigates the risks identified, such as by managing Mr K’s medication and accompanying him outside the home. In particular, one report states that whilst currently with his live-in carer, the risks associated with Mr K’s needs appear to be safely managed.
6. The Council has declined to increase Mr K’s personal budget to facilitate 24 hour funded care. It says Mr K’s adult social care needs can be met within his existing personal budget. Following Mr K appealing the outcome of the Council’s care reassessment, it considered the two medical reports he provided. The Council responded to Mr K explaining that while the reports did suggest he may benefit from 24 hour care, this is currently mitigated by the fact that his carer lives with him providing 11 hours of funded support daily. The Council says the risks identified in the reports, in so far as they relate to social care, are met by this provision and it considers this sufficient to meet Mr K’s eligible care needs. In my view, the Council’s assessment is consistent with that of the views recorded by the medical professionals who are involved in Mr K’s care. Further, I am satisfied the Council has properly assessed his living activities and needs. I have not seen any evidence relating to additional needs requiring 24 hours of care which cannot be met by existing provision. I have not found any evidence of fault by the Council with respect to the reassessment. I consider this to be consistent with the principals of the Care Act 2014 and its related statutory guidance.
7. The Council has however suggested an alternative means of providing Mr K’s care instead of making direct payments to him so he make his own arrangements. As I understand, the Council has suggested exploring accommodation with onsite care staff with Mr K if he thought this could address his concerns. The Council says this provision is provided directly by its adult social care services and would be an alternative to meeting his needs by making direct payments. Importantly, the Council is not required to meet a service users’ needs using a direct payment if this no longer becomes the most appropriate means of delivery. The Council has and continues to engage with Mr K on this point in order to explore other models of care delivery which may benefit him. This suggests the Council is maintaining oversight over Mr K’s care needs and concerns and I consider there is insufficient evidence of fault to warrant an investigation.

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Final decision

8. We will not investigate this complaint. This is because the Council has properly considered Mr K’s needs to reach a view on what support he is eligible to receive. There is insufficient evidence of fault to warrant an investigation.

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Investigator's decision on behalf of the Ombudsman