Summary: Miss X complained the Council has not dealt properly with her adult social care. The Council is at fault because there was delay in completing a needs assessment review, finalising a care plan and personal budget, and implementing care. Miss X suffered uncertainty, distress, and missed care provision. The Council has agreed to apologise and pay Miss X £850 for frustration, uncertainty and distress due to delays.

The complaint

1. Miss X complained that the domiciliary care provided to her by the Council, based on an earlier social care assessment, did not meet her needs. The style of care provided made her illness worse and, as a result, this care package broke down in April 2023.
2. Miss X was allocated a social worker who re-assessed her needs in June 2023. This assessment did not result in the implementation of a finalised care plan, and Miss X was without Council-funded care until July 2024.
3. Miss X wanted the Council to complete an accurate assessment and produce an appropriate care plan. She also wanted the Council to reimburse her for the care she has had to fund herself.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. (Local Government Act 1974, sections 26(1), as amended)
5. 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 future, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. Our role is not to ask whether an organisation 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.
7. 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

8. I corresponded with Miss X about her complaint and considered documents she provided. I made enquiries of the Council and considered its response and the supporting documents it provided.
9. Miss X and the Council had an opportunity to comment on my draft decision. I considered the comments received before making a final decision.

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What I found

Relevant Legislation and Guidance

Assessment

10. 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.
11. 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.

Care Plan

12. 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. 
13. Where a LA has determined a person has eligible needs it must meet these needs, subject to meeting the financial criteria.
14. An adult’s needs are only eligible where they meet all three of these conditions:
• the adult’s needs arise from or are related to physical or mental impairment or illness;
• as a result of the adult’s needs the adult is unable to achieve two or more specified outcomes;
• as a consequence, there is, or is likely to be, a significant impact on the adult’s well-being.
15. The specified outcomes are:
• managing and maintaining nutrition.
• managing personal hygiene.
• managing toileting needs.
• being appropriately clothed.
• being able to make use of the adult’s home safely.
• maintaining a habitable environment. 
• developing or maintaining family or other personal relationships.
• accessing and engaging in work, training, education or volunteering.
• making use of necessary facilities or services in the local community including public transport and recreational facilities.
• carrying out caring responsibilities for an adult or child.

Personal budget

16. The Care and Support Statutory Guidance says everyone must receive a personal budget as part of the care and support plan if the local authority is meeting their needs, either because the needs are eligible needs or because it has chosen to meet them. The budget must be allocated “in a timely manner, proportionate to the needs to be met”.

Direct payments

17. Direct payments are a means of paying some, or all, of the personal budget to the person to arrange and pay for their own care. They are intended to provide independence, choice and control over the way needs are met and outcomes achieved.

What happened

18. This is a brief chronology of key events. It does not include everything I reviewed during my investigation.

2022-23

19. Miss X suffers from a long-term debilitating illness that impacts all aspects of her being, including cognition, energy, sleep, mobility, digestion, and sensory processing. Her condition fluctuates between moderate and severe, meaning that she is usually housebound and sometimes bedbound.
20. Miss X asked the Council for help in 2022. A Care Act assessment was carried out in November 2022, and it was determined that Miss X had eligible needs that the Council would meet. A personal budget was agreed and a Council-funded package, including 14 hours a week of domiciliary care, was put in place. The way in which that care was provided did not meet Miss X’s needs. After a second care provider was trialled, unsuccessfully, the Council stopped providing care for Miss X in early April 2023.
21. The Council recognised that a review of Miss X’s needs was required. A second assessment was therefore carried out in June 2023. A multi-disciplinary meeting to discuss the resultant draft care plan and personal budget took place in September 2023. The possibility of a direct payment was discussed at that meeting.
22. Two further meetings between Miss X and the Council took place in November 2023. The purpose of these meetings was to discuss how, with support, Miss X could employ a personal assistant to meet her care needs, funded via direct payments. The social worker assigned to Miss X then went on sick leave and the case was not progressed in her absence.

2024

23. In April 2024, Miss X complained to the Council, stating “I have been in desperate need of support for over a year, and I now seem to have been dropped”.
24. The Council responded to the complaint in May, acknowledging that arranging care had taken longer than expected. The Council said this was due to misunderstandings regarding the direct payment hours, and a lack of continuity with a social worker. It apologised for the length of time it had taken to reallocate Miss X’s case and said a Social Care Assessor would be allocated to her within the next month.
25. Miss X contacted the Ombudsman in May. In June, during the period of our involvement, a new Care Act assessment was carried out by the Council’s Social Care Assessor, and a care plan and personal budget were agreed shortly after that. With support, Miss X has advertised for two or three personal assistants, one of whom is now in place.

Miss X’s account

26. Miss X told me that, during the period where she was without Council-funded care (April 2023 to June 2024), her friends and acquaintances had shouldered the burden of her most urgent care needs, including taking her to appointments, delivering food and making phone calls on her behalf. She had been reliant upon the delivery of takeaway meals, because she wasn’t able to prepare meals herself. This had made her illness worse, because she is sensitive to many of the ingredients in pre-prepared meals. Many tasks simply went undone until her condition improved enough for her to carry them out herself.
27. At the start of the unfunded period, Miss X had been living with a friend. When she later moved into a temporary self-contained flat on her own, she had hired someone to do her washing up, laundry, and cleaning. When she moved into her own council flat, she had hired a new cleaner, and later paid that person to make her meals too.
28. Miss X told me she had got into debt as a result of having had to pay people, using credit, to provide the care she needed. Also as a consequence of paying for these things, she could not afford transport, and had become isolated at home. The stress and worry of not having the support she needed, and having to complain to get it, had also exacerbated her condition.

Information from the Council

29. The Council told me that the social worker who had carried out Miss X’s June 2023 assessment had planned to take Miss X’s case to the Council’s Practice Quality Forum, where proposed care is considered, but as a result of the social worker’s long-term absence this had not happened until June 2024. It noted that the care plan drafted in June 2023 by that social worker had never been finalised, and had ultimately been “abandoned” when it was superseded by the June 2024 assessment.
30. The Council said there was a very high demand for adult social care at the moment, which impacted how long it took for workers to be allocated to assess people.
31. The Council told me that it has agreed to reimburse the care costs that Miss X incurred during the unfunded period. Miss X has provided evidence of her expenditure to the Council and this is currently being considered and processed.

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Analysis

32. The legislation does not say how quickly a council must complete a Care Act assessment. We expect councils to complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 4-6 weeks. I consider that, once Miss X’s care package broke down in early April 2023, it would have reasonable to expect a new assessment to have been completed in mid-May 2023, and for a personal budget to be agreed and care in place from late June 2023. In the event, the June 2023 assessment did not result in a finalised care plan at all, and a personal budget was not approved until June 2024.
33. Had the Council acted without fault, on the balance of probabilities, Miss X would have received appropriate support for her eligible care needs from June 2023, a year earlier than she did. Therefore Miss X lost a year of Council funded and arranged care for her identified needs. This was fault. The loss of provision caused injustice to Miss X in that she was required to arrange and pay for her own care, which she said had a detrimental impact on her physical health and her financial situation. It also caused her significant distress, which is an injustice.
34. The Council suggests the delay was inevitable, as a result of the high level of demand on its services leading to a delay in allocating workers to complete assessments. This may account for some of the timescale, but the delay was nevertheless excessive, and is service failure. In Miss X’s case, the Council was already aware (from the earlier assessments) that she had eligible care needs that it had a statutory responsibility to meet. This makes the duration of the delay a more serious failing than if the Council had been unaware of Miss X’s needs, and is fault.
35. I welcome the fact that the Council has recognised some of its failings and agreed to reimburse Miss X’s care costs. I set out below how the remainder of the injustice caused to Miss X by the Council’s fault should be remedied.

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Agreed actions

36. To remedy the outstanding injustice caused by the fault I have identified, the Council has agreed to take the following action within 4 weeks of my final decision:
• Apologise to Mrs X for her delayed care assessment, care plan, and personal budget. 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;
• Pay Miss X £850 to recognise the avoidable frustration, uncertainty and distress she experienced as a consequence of the 12-month delay in the Council providing support for her eligible care needs. This is a symbolic amount in line with our published guidance on remedies;
• If this has not already been completed, reimburse Miss X for the costs she incurred in funding her own care during the period June 2023 to June 2024 inclusive;
• Provide us with an explanation about how it will ensure that open cases will be reallocated and progressed when social care workers are absent for more than a month.
37. The Council should provide us with evidence it has complied with the above actions.

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Final decision

38. I have completed this investigation with a finding of fault and service failure by the Council, which caused injustice to Miss X. 

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Investigator's decision on behalf of the Ombudsman