Summary: A complained about the way the Council dealt with their request for adult social care. They also complained the Council sent an incorrect invoice for care which was never received. Based on current evidence, we found the Council is not at fault.

The complaint

1. A complains about the way the Council dealt with their request for an adult social care assessment. They say the Council has not correctly considered their needs and has not allowed sufficient hours of care. They say their needs are not being met as a result. They also say the Council sent an incorrect bill, charging for care which was never provided.
2. A is seeking another assessment, to be provided through a third party, the correct care provision, an apology and changes to the Council’s process.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. 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)
4. 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)

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How I considered this complaint

5. I considered evidence provided by A and the Council as well as relevant law, policy and guidance.
6. A and the Council have had an opportunity to comment on my draft decision. I have considered all comments received before making a final decision.

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What I found

What happened

7. A is an adult with numerous medical conditions which make it difficult for them to maintain their life without some support.
8. A initially contacted the Council in October 2023, seeking help to manage their medication. The Council put in place some occupational therapy support. In November 2023, A told the Council they were struggling with general life and asked for an assessment.
9. The Council spoke with A in January 2024, and A repeated the struggles they were having maintaining their health and care. A asked the Council about personal assistant support. The Council requested a social worker assessment for long term care needs.
10. The Council allocated a social worker to A’s matter in February 2024, and an assessment took place at the end of the month.
11. The social worker recommended A should receive 20 hours of personal assistant support each week. He explained to A that his recommendation would be considered by a panel of managers.
12. The panel did not approve the social worker’s assessment and asked for a reassessment to ensure the goals set out in the assessment met A’s needs. This was done in April 2024. The outcome of the reassessment was a recommendation of 8 hours of support per week should be provided to A.
13. The support began in May 2024.
14. In October 2024, the Council sent a bill to A for their contribution to the care provided. A complained to the Council that the bill did not take account of hours which had not been needed during the billing period.
15. The Council responded to the complaint, explaining it assumes the agreed support is provided unless it is informed otherwise. It confirmed the hours of support which had not been provided had been written off.
16. A remained unhappy with this as they feel the Council should keep track of the care actually provided.

Analysis and findings

17. Although A was in contact with the Council earlier than this, it appears the first request for an adult care needs assessment was made at the end of November 2023.
18. The assessment took place three months later, but the review process meant a reassessment was needed. This meant the care was not put in place for approximately six months from when it was requested.
19. 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.
20. 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.
21. The Council did not consider A’s assessment to be urgent, and it was classified accordingly. A’s circumstances and needs were discussed with them before making this decision.
22. There is no prescribed timeline in which a council must complete this process. Although the Council took longer than we would normally expect for care needs assessments, because of the individual circumstances of this case I do not consider the delay amounted to fault. This is because I have seen the Council updated A when it allocated a social worker, when the assessment date was arranged, told A there would be a panel consideration, and then provided a date for this, provided an update following the panel meeting and then gave a date for the reassessment.
23. 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 you disagree with the decision the organisation made.
24. It is understandable that A would be unhappy with, and / or confused by the difference in the social worker’s initial recommendation of 20 hours per week of support, and the panel’s significant reduction of this.
25. However, I am satisfied the Council has considered the appropriate information in line with the Care Act 2014 in reaching its decision. The social worker is entitled to his opinion, but the Council’s process means that the recommendation is subject to a panel review. The panel is entitled to reach its own view. On this basis, the difference here does not amount to fault.
26. With regard to the incorrect bill. The Council explained it bills based on the agreed support provision. It was not made aware that A did not require all of the support during the billing period complained of, and so issued bills it believed were correct based on the information it had at the time.
27. When the Council was informed that the care had not been required, the discrepancy was addressed and any charges for support not required were removed.
28. While I appreciate A’s opinion that the Council should be aware of the care actually received, this is not the Council’s process. The Council has explained it relies on being told if care is not needed. On this basis, when the Council sent its bills, the bills were correct according to the information the Council had at that time.
29. Given the Council adjusted its bill once it was informed of the care not provided, A has not paid for care not received. This is not fault.

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Decision

30. I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman