Summary: Ms C complains the Council has not provided support to meet her eligible care needs. The Council is at fault for failing to produce a support plan which identifies what services meet Ms C’s eligible needs. Because of these faults Ms C has the uncertainty that the reablement services offered by the Council will not meet her needs. To remedy the complaint the Council has agreed to apologise to Ms C, produce a support plan, and make service improvements.

The complaint

1. Ms C complains the Council failed to properly:-
1. complete and review Ms C’s needs as a carer;
2. assess Ms C’s care needs in her own right under the Care Act 2004;
3. compile a support plan for Ms C.
2. Because of these failures Ms C says she has had difficulty continuing in her caring role and it has affected her both physically and mentally.

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The Ombudsman’s role and powers

3. 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)
4. 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)
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. Ms C’s complaint is late, but I have exercised discretion to consider it. This is because Ms C’s concerns were part of a joint complaint with her daughter, which involved another organisation. This other organisation did not send a final response letter until May 2024. Until Ms C received this letter she would not have known that she had to contact us. I have however restricted my investigation to events included in Ms C’s complaint letter and therefore will not consider any new matters after August 2023.

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How I considered this complaint

7. I considered evidence provided by Ms C and the Council as well as relevant law, policy and guidance.
8. Ms C and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

What should have happened

Care needs 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. It must also involve the individual and where suitable their carer or any other person they might want involved.
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.
11. Paragraph 6.62 Care and Support Statutory Guidance says, “Where the local authority judges that the person may benefit from such types of support, it should take steps to support the person to access those services. The local authority may ‘pause’ the assessment process to allow time for the benefits of such activities to be realised, so that the final assessment of need (and determination of eligibility) is based on the remaining needs which have not been met through such interventions. For example, if the local authority believes that a person may benefit from a short-term reablement service which is available locally, it may put that in place and complete the assessment following the provision of that service.”

Support 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. 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.
13. Paragraph 10.11 Care and Support Statutory Guidance “There are a number of broad options for how needs could be met, …….. the local authority directly providing some type of support, for example by providing a reablement or short-term respite service”

Carer’s Assessment

14. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
15. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

What happened

16. Ms C lives with her daughter who has health conditions and is eligible for, and in receipt, of free funded care under NHS Continuing Health Care criteria. Ms C provides informal care and support to her daughter and has health conditions which affect her ability to care for herself.
17. The Council says Ms C meets the threshold for a carers’ assessment and she received a payment in May 2021 and following a review a further payment on 27 June 2022. The Council completed a further carers’ assessment in January 2023 where it appears Ms C received further carer support.
18. On 23rd March 2023 the Council completed a care needs assessment for Ms C. This assessment found Ms C eligible in seven areas of the eligibility criteria. The Council referred Ms C to its reablement team to start reablement services for six weeks. Following this the Council said it would decide whether Ms C needed long term support from the Council.
19. Ms C challenged the contents of the assessment and the offer of reablement. The Council amended the assessment but said the reablement service was necessary to decide what hours of support Ms C needed to meet her needs. The Council said this would be alongside a functional Occupational Therapy assessment.
20. On 5 April the Council says it tried to meet Ms C to complete a reablement support plan but Ms C said she wanted to involve her legal advisers. The Council communicated with Ms C’s legal advisors. It apologised for contacting Ms C directly and explained reablement was a proposal and Ms C could be eligible for a commissioned service if reablement did not meet her long term needs.
21. On 16 May the Council visited Ms C to discuss reablement. Ms C refused to engage saying that she understood the meeting to be about care and support planning not reablement services.
22. Ms C complained to the Council in August 2023. The Council responded not upholding her complaint but offering to complete a joint visit with health colleagues.

Was there fault causing injustice?

23. There appears to be no fault in the Council’s consideration of Ms C’s needs as a carer. The Council acted in line with the Care Act and the Care and Support Statutory Guidance as it completed and reviewed Ms C’s carer’s assessment and provided carer’s grants.
24. The Care Act says councils can offer reablement services as a way to meet assessed eligible needs. The crux of this complaint is whether the Council could offer Ms C reablement as a way of meeting her needs without completing a support plan, or mid way during a care needs assessment.
25. While there is no fault in a council offering reablement it is unclear on what basis the Council offered this service to Ms C. If it was proposing reablement to get a better idea of Ms C’s needs it should have paused the section 9 Care Act assessment and considered the results of the reablement before resuming the assessment. It would then have been able to say whether Ms C was eligible for support or not and produced a support plan accordingly.
26. If however the Council’s offer of reablement was to meet Ms C’s eligible needs then it should have produced a support plan identifying this was the case. The Care and Support Statutory Guidance says a Council must produce a support plan when it has completed an assessment. If this was the case the Council was at fault for not completing a support plan.
27. On balance I consider the Council was acting as if it had completed an assessment. This is because:
• Ms C successfully challenged the assessment which could not have been possible had it not been completed;
• the Council agreed to change the assessment and said Ms C was eligible for “significantly more domains”;
• in various documents the Council has said it completed the assessment. This includes the Council’s complaint response and in its response to our enquiries.
28. Ms C has the injustice of not having her needs properly considered and the potential loss of services that she would have had if the Council had acted without fault.
29. In response to my draft decision the Council has confirmed it has reassessed Ms C and she is eligible for over five hours of care per week. While in some circumstances the Ombudsman can consider reimbursement for “lost” services I do not consider it appropriate in this case. This is because due to the passage of time I cannot say now but for the faults identified whether Ms C would have needed the same level of care in 2023.

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Action

30. I have found fault causing injustice. The Council has reassessed Ms C’s needs, I have therefore not included it as part of the action.
31. Within one month of the final decision the Council will:-
1. apologise to Ms C for the uncertainty caused by the Council’s failure to produce a support plan;
2. pay Ms C a symbolic payment of £250 for the uncertainty caused by the Council’s failure to compile a support plan.
32. Within three months of the final decision the Council will:
1. remind relevant staff by a staff circular, team meeting or training; the importance of producing a support plan following a care needs assessment. This includes where reablement has been identified as appropriate to meet assessed eligible needs;
2. remind relevant staff by a staff circular, team meeting or training, that if the Council intends to use reablement services to inform a care needs assessment, it should pause the assessment and resume once the outcome of the reablement is known.
33. The Council should provide us with evidence it has complied with the above actions.

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Decision

34. I find fault causing injustice. I consider the actions above are suitable to remedy the complaint. I have ended my investigation and closed the complaint on the basis of the actions above.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman