Summary: Miss X complained the Council reduced Mr Y’s package of care without properly considering his needs. She said the Council delayed providing adequate care meaning Mr Y’s mother, Ms Z, had to delay surgery causing her pain and distress. Miss X said the Council’s reduced package of care would not meet Mr Y’s needs and place him at risk. There was fault in the way the Council delayed making decisions and did not follow the complaint process. This fault frustrated Ms Z and Miss X was put to time and trouble to complain. The Council will apologise, make a financial payment and remind staff of the importance of effective complaint handling.

The complaint

1. Miss X complained the Council reduced Mr Y’s package of care without properly considering his needs. She said the Council delayed providing adequate care meaning Mr Y’s mother, Ms Z, had to delay surgery causing her pain and distress. Miss X said the Council’s reduced package of care would not meet Mr Y’s needs and place him at risk.

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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We cannot question whether a Council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. If we are satisfied with a Council’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)
5. 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.
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

Back to top

What I have and have not investigated

7. I have investigated Miss X’s complaint about how the Council delayed providing adequate care for Mr Y.
8. I have not investigated any reference to a reduction in Mr Y’s package of care. This is because the Council did not reduce the package of care until after Miss X approached the Ombudsman and it has not had an opportunity to consider this matter.

Back to top

How I considered this complaint

9. I read Miss X’s complaint and spoke to her about it on the phone.
10. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
11. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Background information

12. 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.
13. 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.
14. 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.
15. 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.
16. The Council complaint policy confirmed it would respond to complaints in 10 working days.

What happened

17. This is a summary of events, outlining key facts and does not cover everything that has occurred in this case.
18. Mr Y has complex additional needs. He has a care package from the Council and Ms Z provides additional care. The Council support plan in August 2023 detailed a large package of care providing two carers.
19. In August 2023, Ms Z informed the Council she needed surgery on her knee. She told the Council Mr Y would need 24-hour care while she was in hospital and recuperating.
20. The Council reviewed the support plan in November 2023. The package of care remained the same.
21. Ms Y chased the Council for an update on support for her knee operation in February 2024. She told the Council she wanted the current care agency to provide the 24-hour support and confirmed the operation was booked for March 2024.
22. In March 2023 the care agency confirmed the costs for the 24-hour package. The package was for the six weeks. The Council confirmed Ms Z had money in a direct payment account, also the ongoing package for the six weeks. The Council considered the difference between the cost and available money to be roughly £5,000. The Council asked this extra money at a panel meeting. The panel rejected the application, asking for more information.
23. Ms Z delayed her operation and rebooked it for April 2024.
24. The Council decided to reduce the care package for the six-week recuperation in April 2024. The package would be 24-hour support from one carer, with extra hours for a second carer to support with hoisting and personal care. The Occupational Therapist (OT) and physiotherapist agreed this approach.
25. Ms Z disagreed with this temporary decrease. She said Mr Y needed two carers. The Council said it needed management agreement for this and could not get agreement. Ms Z delayed her operation and booked it again for August 2024.
26. Miss X complained to the Council in April 2024. She complained about the reduction in care and delays. Miss X referenced the six-week recuperation support, and the continuing package of care.
27. The Council responded to Miss X’s complaint in June 2024. The response said Mr Y had equipment to support him. The Council confirmed the OT and physiotherapist agreed with the temporary package of care. The response said the OT reported Mr Z did not always need two carers. The response noted this was a historic agreement while Mr Y recovered from a pressure sore and was no longer needed.
28. Miss X was not satisfied with the Council’s response and has asked the Ombudsman to investigate. Miss X would like the Council to reinstate the two carers in the package of care.
29. In response to my enquiries the Council stated it decided to reduce the support with other professionals involved. The response focused on events after this investigation is considering.
30. Ms Z had the knee operation in August 2024. The Council has recently reduced the package of care. As noted in paragraph 8, I have not considered this as the Council has not had the opportunity to consider this matter.

My findings

Reduction in care and delays

31. The Ombudsman’s role is to review how councils have made decisions. We may criticise a council if, for example, it has not followed an appropriate procedure, not considered relevant information, or failed to properly explain a decision it has made. We call this ‘fault’, and where we find it, we can consider the consequences of the fault and ask the council to address these.
32. However, we do not provide a right of appeal against council decisions, and we cannot make operational or policy decisions on councils’ behalf. If we do not find fault in how a council has made a decision, then we cannot criticise it, no matter how strongly a complainant feels it is the wrong decision. We do not uphold complaints simply because someone disagrees with what a council has done.
33. The Council has assessed the package of care can be delivered by a one-to-one carer, with added carers at times to support with hoisting and personal care tasks. The Council considered the information provided by the OT and physiotherapist. The Council made this decision at a meeting attended by the professionals involved in this case.
34. The Council made this decision with information from other professionals involved in Mr Y’s care. There was no fault in how the Council made the decision, I therefore cannot question whether the decision was right or wrong. The Council was not at fault.
35. However, the Council was aware Ms Z needed an operation on her knee in August 2023 but did not start considering this matter until February 2024. The Council support plans and assessments, detail Mr Y’s needs remained the same. It is reasonable to say, on the balance of probabilities, Mr Y’s needs have not changed, so the Council could have considered this matter earlier. Even though the Council did not have a specific date for Ms Z’s operation, there is no reason the Council could not consider this matter from August 2023. The Council did not act until Ms Z confirmed the date of the operation. This meant there was not enough time to fully consider the request and make a decision.
36. The Council then decided to reduce the temporary package of care. Ms Z disagreed with this decision but as set out above it is a decision the Council can make. However, the delay making a decision caused Ms Z to have to delay her operation. This delay is fault, frustrating Ms Z.

Complaint handling

37. Miss X complained to the Council in April 2024. The complaint policy sets out the Council would respond in 10 working days. It responded in June 2024, a delay of two months. This is fault and Miss X was put to time and trouble to complain.

Back to top

Agreed action

38. To remedy the outstanding injustice caused to Miss X and Ms Z by the fault I have identified, the Council has agreed to take the following action within 4 weeks of my final decision:
• Apologise to Ms Z for the delays in this case. 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.
• Apologise to Miss X for the delays in the complaint response. 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.
• Pay Ms Z £300 as an acknowledgement of the frustration the Council fault caused.
• Remind relevant staff of the importance of effective complaint handling.
39. The Council should provide evidence of the actions taken to satisfy the recommendations.

Back to top

Final decision

40. I have completed my investigation. I have found fault by the Council, which caused injustice to Miss X and Ms Z.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman