Summary: Mr X complained about the Council’s decision to reduce his late mother in law’s care package. There was no fault in the way the Council reached its decision to reduce Mrs Y’s care package.

The complaint

1. Mr X complained the Council wrongly reduced his late mother in law, Mrs Y’s, care support from two care workers to one care worker. Mr X says this caused Mrs Y fatigue and distress.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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)

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How I considered this complaint

4. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
5. I gave Mr X and the Council the opportunity to comment on a draft of this decision. I considered any comments I received before making a final decision.

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What I found

Relevant law and guidance

Care needs

6. 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.
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.

Lasting Power of Attorney

8. The Mental Capacity Act 2005 introduced the “Lasting Power of Attorney (LPA)”. An LPA is a legal document, which allows a person (‘the donor’) to choose one or more persons to make decisions for them, when they become unable to do so themselves. The 'attorney' is the person chosen to make a decision on the donor’s behalf. Any decision has to be in the donor’s best interests. An LPA for property and financial affairs allows the attorney to make decisions as soon as it is registered, with the donor’s permission. An LPA for health and welfare can only be used when the person lacks the mental capacity to make decisions themselves.

What happened

9. Mrs Y lived at home with her daughter and son-in-law, Mr and Mrs X. Mrs X has her own care and support needs and Mr X provided support to both her and Mrs Y. Mr X had LPA for Mrs Y.
10. Mrs Y had physical health conditions which resulted in poor mobility and pain on moving. Mrs Y had capacity to make decisions about her care and support.
11. In spring 2023 Mrs Y was admitted to hospital following a chest infection. She returned home in July 2023 with six weeks of reablement support (short term care funded by the Council or NHS to help someone get back to normal and stay independent). Mrs Y’s health significantly declined and she received 24/7 support from two care providers, one covered the day time (Care Provider A) and the other night time care (Care Provider B) due to her poor mobility, high risk of falls and general decline in health.
12. In late February 2024 an Occupational Therapist (OT) assessed Mrs Y as requiring a hoist for transfers and a hoist was provided. Care provider A said it was its policy for two care workers to hoist transfer and it considered it could not move Mrs Y safely with one care worker. It requested funding for an additional care worker for four one hour visits a day. The Council agreed to fund the additional hours, however it said if Mrs Y was now to be nursed in bed this was pending a review of her care package.
13. In June 2024 Mrs Y’s social worker and an Occupational Therapist (OT) visited Mrs Y to review her care package. The social worker noted Mrs Y had a poor appetite and depending on her mood would be hoisted out of bed but spent most of the day in bed. The social worker completed a decision support tool (a document used to assess whether a full assessment for NHS continuing health care funding is needed) and it was later decided she was not eligible for continuing health care funding (NHS funding for care and support, where an individual’s care needs are primarily health based).
14. The OT assessed Mrs Y could be safely transferred by a single care worker and demonstrated this to the care workers. The OT noted that as long as what was happening was explained to Mrs Y it was safe for one care worker to do the moving and handling. The OT said due to Mrs Y’s levels of pain she should be moved by one rather than two care workers. They noted Mrs Y was in a lot of pain in the mornings and advised the care workers to change her routine and provide personal care later in the evening when her pain was better managed.
15. Care Provider A asked to bring in their moving and handling trainer to assess the risks of using one care worker.
16. The social worker considered one to one care should continue, to support Mrs Y’s pain management. They noted they explained to Care Provider A that care was funded based on need not company policy. Care Provider B advised it was managing Mrs Y’s overnight needs with no issues.
17. The social worker completed Mrs Y’s care plan.
18. The Council notified Care Provider A and Mr X that the second care worker would need to end immediately, and it would look at the possibility of using a different care provider. Mr X contacted the Council to express his unhappiness, particularly at the suggestion of moving from Care Provider A and the Council agreed to discuss with Care Provider A its position. Care Provider A advised it would be happy to provide one to one support subject to the right training and risk mitigation. The Council agreed to remove the second care worker once Care Provider A confirmed staff were fully trained.
19. In mid June Care Provider A’s moving and handling trainer visited Mrs Y then submitted a report to the Council detailing their concerns about the change from two care workers to one care worker. They considered it would be a risk to the care worker and to Mrs Y. The Council advised Care Provider A it would base its decision on specialist guidance from the OT and said Care Provider A could give notice to stop working with Mrs Y if it felt unable to continue.
20. The OT agreed to meet with care staff and Care Provider A’s moving and handling trainer. Mrs Y agreed to be hoisted and the OT demonstrated how to do this single handed. They answered the Care Provider’s queries. They noted tasks may take longer but this may be beneficial as Mrs Y experienced high levels of pain and reducing the pace may help alleviate this. They also said this allowed for increased privacy and dignity, and increased flexibility as care could be provided at any time rather than set times in the day.
21. Care provider A updated the Council following the visit. They considered there was still an increased risk compared to two to one support but they now understood how to mitigate some of the risks. It said staff had attended the office to receive training and it confirmed double up support could end.
22. Mrs Y passed away several days later.
23. Mr X complained to the Council. He considered the change in Mrs Y’s support was risky and was driven by cost.
24. The Council responded to Mr X’s complaint in September 2024. It explained the actions it had taken and that Mrs Y had the mental capacity to understand and cooperate with the process. It said it had agreed to retain two care workers until Care Provider A was satisfied it could support Mrs Y with the recommendations and guidance from the OT. It was satisfied the OT had completed a thorough assessment and that its decision was in Mrs Y’s best interests to ensure she had a safe and comfortable transfer and this was the least intrusive option.

Findings

25. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether someone disagrees with the decision the organisation made.
26. When Mrs Y’s health declined the Council appropriately decided to reassess her need for care and support. It sought input from an OT. The OT sought Mrs Y’s agreement to the assessment. Although Mr X had LPA for Mrs Y’s health and welfare, as Mrs Y had capacity his agreement was not required. Instead, consent was appropriately sought from Mrs Y. When Care Provider A raised concerns the Council took these into account and provided further training and guidance to ensure Care Provider A was satisfied it could support Mrs Y with single handed care. It allowed Care Provider A to continue sending two care workers to Mrs Y’s home in the meantime. There was no fault in how the Council took the decision to remove the two to one care from Mrs Y’s care package.
27. Mr X believes the Council’s decision was motivated by cost but this is not supported by the evidence. The Council considered Mrs Y’s needs were best met with single handed 24/7 care. Mrs Y died shortly after single handed care started but I could not say, even on balance, that the single-handed care contributed to, or hastened, her death given Mrs Y’s age and medical conditions.

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Final Decision

28. I have completed my investigation. The Council was not at fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman