Summary: Mr X complained about the Council’s delay in assessing his care needs and the adequacy of his subsequent care and support plan. The Council accepts it delayed in assessing Mr X and failed to carry out a proper assessment. The Council has agreed to apologise to Mr X, carry out a new assessment and make a payment to Mr X to recognise the care costs he incurred as a result of its delay.

The complaint

1. Mr X complained about the Council’s delay in assessing his care needs and the adequacy of his subsequent care and support plan. Mr X says the plan does not meet his needs and the Council have refused to recognise his ME as a medical condition that requires care. He wants the Council to carry out a new assessment and increase his care hours to meet his needs.

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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. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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.
5. 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

6. I have decided there are good reasons to investigate Mr X’s complaint from February 2022, when Mr X first requested a needs assessment. Mr X only became aware of the potential fault following the outcome of the assessment in June 2023.

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How I considered this complaint

7. I have discussed the complaint with Mr X and considered the information he has provided. I have also considered information provided by the Council.
8. Mr X and the Council have 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

Care Assessment

9. 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.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Direct payments

11. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

Adult social care complaints

12. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The Council’s policy is to respond to complaints within 20 working days or agree a timescale with the complainant in more complex cases.

What happened

13. Mr X suffers with ME/CFS (myalgic encephalomyelitis, also called chronic fatigue syndrome). On 1 February 2022 he asked the Council for help with his care needs. The Council made a referral to an occupational therapist. In July 2022 Mr X contacted the Council again. He said he was now paying for five hours of private care visits a week but could not afford to do this. The Council referred Mr X for a care needs assessment but told him it had long waiting times for social care assessments.
14. An occupational therapist from the Council spoke to Mr X in August 2022. They also spoke to Mr X’s carers who explained Mr X struggled to move around his home due to his reduced mobility. The occupational therapist recommended an in-person assessment of Mr X in his home.
15. The Council’s occupational therapist visited Mr X in October 2022. The records of the visit show Mr X refused mobility equipment as he did not think it would help. The occupational therapist referred Mr X back for a care assessment to determine the impact of Mr X’s ME on his care needs.
16. The Council carried out a care assessment of Mr X in February 2023. The Council identified Mr X had eligible care needs and said it would refer Mr X to its assessment panel to decide on an appropriate care package. Mr X wrote to the Council the day after the assessment giving details of his condition and its impact on his quality of life.
17. In April 2023 the Council asked Mr X to provide evidence of his ME diagnosis. In May 2023 it told Mr X if he could not provide the evidence, it would close his case. Mr X explained there was a wait for letters from GPs and asked the social worker not to close the case. Mr X supplied the diagnosis at the end of May 2023 and the Council completed the referral to its panel.
18. The Council gave Mr X five hours a week of direct payments to pay for his care on 12 June 2023. In November 2023 Mr X told the Council the assessment was not a true representation of his care needs and it had failed to properly recognise the impact of ME on him. In December 2023 the Council back dated Mr X’s direct payments to 24 February 2023, the date of its assessment.
19. Mr X continued to ask the Council for a new care assessment and complained to the Council in January 2024. The Council responded in May 2024, it said its assessment properly recognised Mr X’s ME diagnosis.
20. Mr X complained to the Ombudsman. Following Mr X’s complaint to us the Council reviewed Mr X’s case. It accepted there had been a delay in both its social care assessment and occupational therapy assessment of Mr X. It said Mr X’s support plan was too subjective, contained inappropriate language and placed too much emphasis on Mr X proving his condition. The Council said it should not have told Mr X it would close his case if he did not provide proof of diagnosis.

My findings

21. Mr X first requested support in February 2022. The Council completed Mr X’s assessment in February 2023. The Care and Support Statutory Guidance sets out that an assessment should be completed over an appropriate and reasonable timescale. We would normally expect this to be in around six weeks. The Council accepts there was a delay in assessing Mr X. This was fault.
22. Having reviewed the Council’s records of its conversations with Mr X and his carers I am satisfied that, on the balance of probabilities, given Mr X’s health condition, the OT assessments carried out, and feedback it received from Mr X’s carers, the Council would have identified Mr X’s care needs sooner and agreed to provide a care package, were it not for the delay. Mr X has incurred care costs from April 2022 when he started paying privately for a care package to meet his needs.
23. The law says a care assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. The Council accepts it placed too much emphasis on Mr X proving his ME diagnosis, as opposed to his care needs. It also accepted some of the comments in the support plan were subjective and it was not strength based. This was fault. Even on balance I cannot say the extent to which this may have affected the outcome of the assessment, but this has caused Mr X uncertainty. To remedy this uncertainty I have recommended the Council carry out a new assessment.
24. The Council says it normally responds to complaints in 20 working days and will agree a different timescale in more complex cases. The Council took four months to respond to Mr X’s complaint. This was fault and caused Mr X avoidable frustration and uncertainty.

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Agreed Actions

25. Within one month of the final decision the Council has agreed to:
1. apologise to Mr X for the frustration and uncertainty caused by it failing to properly assess his care needs and the delay in carrying out his assessment and responding to his complaint. 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.
2. carry out a new assessment of Mr X’s care needs and amend Mr X’s care and support plan accordingly.
3. pay Mr X the equivalent of five hours per week of direct payments for the period between 1 April 2022 and 24 February 2023.
26. The Council should provide us with evidence it has complied with the above actions.
27. Within three months of the final decision the Council has agreed to provide the Ombudsman with an action plan setting out how it plans to address the long wait times for care assessments.

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Final decision

28. I have completed my investigation and found fault with the Council, causing an injustice, which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman