Summary: The Council was at fault for the delay in assessing Ms X’s needs, producing a support plan and in arranging an Occupational Therapy assessment. This caused Ms X frustration and uncertainty and meant she was without support to meet her needs. The Council has agreed to apologise, complete Ms X’s support plan and make a payment to Ms X to acknowledge the injustice caused. It will also issue guidance to officers.

The complaint

1. Ms X complained the Council delayed carrying out a needs assessment which she initially requested in November 2022 and which was not completed until January 2024. It then failed to agree a support plan or budget. Ms X also complained the Council delayed referring her to Occupational Therapy for support to address the impact her housing was having on her health. Ms X says this left her without support to meet her needs and caused her significant frustration.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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. I have not investigated what happened since Ms X initially requested a needs assessment in November 2022. The restriction set out at paragraph four applies. It was open to Ms X to come to us sooner if she had concerns during 2022 and 2023 and reasonable for her to do so. I have therefore considered what has happened since the Council carried out a needs assessment in January 2024.

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How I considered this complaint

7. I considered evidence provided by Ms X and her representative and the Council, as well as relevant law, policy and guidance.
8. I gave Ms X and the Council the opportunity to comment on a draft of my decision. I considered any comments before reaching a final decision.

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What I found

The relevant law and guidance

Needs assessments

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. The Care and Support Statutory Guidance sets out that the process must be person-centred throughout, involving the person and supporting them to have choice and control.  It says that ‘putting the person at the heart of the assessment process is crucial to understanding the person’s needs, outcomes and wellbeing, and delivering better care and support’.
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.
12. A council must consider whether an adult is unable to achieve two or more ‘outcomes’ when determining whether an individual is eligible for support. The outcomes include:
• managing and maintaining nutrition,
• managing personal hygiene,
• being able to use the home safely,
• maintaining a habitable environment and
• making use of necessary facilities or services in the local community.
13. In relation to the latter, the Care and Support Statutory Guidance says councils ‘do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments’.
14. Councils have a duty under section 18 of the Care Act to meet eligible needs (needs which meet the eligibility criteria).

Support planning

15. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. 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.
16. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs. There are three main ways a personal budget can be administered:
• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment. 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

What happened

17. Ms X has long term health conditions which have a fluctuating impact on her day-to-day abilities, and autism spectrum disorder which impacts her communication.
18. In January 2024 a Council officer visited Ms X at home to complete needs assessment. They noted Ms X needed support with showering and getting dressed, meal preparation, cleaning and paperwork. Ms X also raised concerns about her property being cold. Ms X wanted direct payments to limit the number of different carers who would attend. The assessment recorded Ms X was provided with information about housing support and government support with fuel bills. Following this, in late February 2024 the officer issued Ms X with a draft overview needs assessment. Ms X asked for some corrections to this as she considered some information was missing. The Council says it offered Ms X a reablement package (short term care funded by the Council or NHS usually used to help someone get back to normal function and stay independent) of Council commissioned support in March 2024 which Ms X declined.
19. In late March 2024 the Council officer met with Ms X’s representative to discuss the inaccuracies in the plan. Ms X’s representative followed this up by email and again in April 2024 when the officer said they had not received the comments. Ms X’s representative contacted the officer again in early May for an update. The officer spoke with Ms X and her representative early May during which Ms X asked to complete a self-assessment (an assessment where the person completes the assessment themselves and the council assures itself that this is an accurate reflection of the person’s needs) so she could clearly explain her care and support needs.
20. Ms X completed the self-assessment and sent it to the Council officer in mid-June 2024. Ms X set out her care needs and reported her capacity to carry out tasks varied based on environmental and internal factors such as her fatigue level. She said she could not attend appointments on her own and needed support with this. She also requested two hours a week of support from her representative to help manage her paperwork and other essential affairs. During July 2024 Ms X provided the Council officer with an update on her health and a therapist’s letter.
21. In late July 2024 the Council officer sent Ms X details of the support they proposed for her, which included 45 minutes of support three times a day, on three days a week, to support with meal preparation, personal care, medication prompting and light cleaning plus an additional 90 minutes of support per week for support with shopping and domestic tasks. The email explained Ms X could change how she wished to use the support hours once the plan was agreed.
22. Ms X was unhappy that funding for her representative was not included in the budget nor was funding of support for attending medical appointments which equated to around 3.5 hours a week.
23. Ms X’s representative emailed a safeguarding concern to the Council, raising concerns about the delay in the assessment process and the impact this was having on Ms X. The Council decided there was no risk to Ms X that needed to be dealt with through its safeguarding procedure.
24. In August 2024 Ms X told the Council she was now on medication due to the housing situation which was impacting her mental health. It was six months since her needs assessment, and she still did not have an outcome. The officer told Ms X’s representative they would refer Ms X for direct payments. They said they could arrange a Council managed care package in the meantime, but Ms X declined this. They advised Ms X to contact the NHS for support with attending hospital appointments and said she should contact voluntary agencies for advocacy support. Ms X responded that her representative supported her with administration and calls which free advocacy would not do. Ms X said she needed support at medical appointments and not just transport.
25. In September 2024 the Council met with Ms X virtually to review the direct payment agreement and to discuss managing the direct payment account.
26. The Council also referred Ms X for an occupational therapy (OT) assessment. Ms X was placed on a waiting list. Ms X contacted the OT service in August, September and October 2024 for an update and it confirmed she remained on the waiting list.
27. In October 2024 Ms X complained to the Council raising her concerns about the assessment process. The Council responded in November 2024. Its response included:
• as Ms X was unhappy with the first assessment carried out in January 2024 the officer met again with Ms X and her representative to revise the assessment;
• transport to health appointments was for health services to provide;
• its worker had communicated to Ms X the referral process around advocacy but she had declined stating it took too long.
• it had emailed the GP for help with form filing via a social prescriber and had referred Ms X to its specialist assistance team for help completing forms;
• there was flexibility in the package of care and said Ms X was advised in July 24 of how she could make changes once her support was commissioned via direct payments;
• at the initial assessment Ms X had raised issues with her home being cold but that would not meet the eligibility criteria for an occupational therapy referral; and
• It would arrange a reassessment of her care needs.
28. Ms X remained unhappy and complained to us. She complained the Council failed to take account of all her support needs. It failed to recognise she needed support at hospital appointments and in arranging transport to get there, plus support with administrative tasks.

Council response to my enquiries

29. In response to my enquiries the Council said Ms X could use her direct payments to support attendance at hospital appointments. It said this flexibility was factored into the recommended hours submitted to the direct payments team.
30. It provided evidence to show it sent Ms X information about recruiting a personal assistant in October 2024. It followed this up in November and December 2024 and explained the procedure to follow once an agency was identified. It then met with Ms X in February 2025 to reassess her needs as she did not agree with the previous assessment and it produced a draft assessment in April 2025.
31. It completed the reassessment on 10 June 2025 and sent Ms X a copy of the updated assessment the following day. It agreed a package of 14 hours a week under direct payments. The case was then allocated to a worker in the direct payments team to visit Ms X, finalise the support plan and implement the care package. It said it could offer Ms X a Council managed care package in the meantime, but she had twice refused this previously.
32. The Council says it cannot finalise the support plan until an agency or personal assistant has been identified so that it can include an accurate costing and start date. In addition, Ms X has yet to sign the direct payment agreement which is required for the direct payment to progress.
33. It said the OT case was referred to an external agency to assess for equipment and adaptations. However, the agency had tried to contact Ms X in early May and did not receive a response. As a result, the Council’s OT team had closed the case. In June 2025 the Council asked the OT team to keep the referral open and to contact Ms X by email. Ms X says the external agency telephoned her and so failed to meet her communication needs. When the Council emailed, she was able to reassert her needs. The case therefore remained active.

Findings

34. The Council first visited Ms X for a needs assessment in January 2024. This was not completed until late July 2024. Ms X was unhappy with the initial assessment and therefore sought a self-assessment to ensure her conditions and needs arising from this were accurately communicated to the Council. The Council agreed to this which was appropriate to ensure her needs were properly represented. This contributed to the timescale, however, the Council’s delays in making amendments and responding to Ms X also contributed to the delay. This delay was fault.
35. The Council offered Ms X a Council reablement support in February 2024 and a managed care package in August 2024 but given Ms X’s disabilities and need for consistency she did not want this. Ms X was entitled to decline the Council’s offers as it told her it would progress direct payments as she wanted.
36. Despite an assessment in July 2024 and a reassessment in June 2025, the Council has yet to finalise a support plan or set up direct payments for Ms X, 18 months since the Council first visited to complete start the needs assessment, nearly a year after Ms X submitted the self-assessment and 10 months since the Council said it would refer Ms X for direct payments. Ms X has been without support to meet her care needs but this delay is not all due to Council fault. There was some delay with the Council progressing and completing the reassessment in 2025. However, the records show the Council has actively sought to progress the direct payments since October 2024. Ms X’s health and other issues impacted her ability to fully engage in the process.
37. When it first assessed Ms X’s needs, the Council failed to properly consider her request for assistance with attending hospital appointments. This was not in line with the Care and Support Statutory Guidance and was fault.
38. Ms X also requested payment for her representative. The Council did not agree to fund this and offered alternative suggestions including referrals to voluntary agencies and a referral to the GP for a social prescriber. There was no fault in the way the Council reached this decision so I cannot question it. However, the Council has a duty to meet Ms X’s assessed eligible unmet needs. The needs assessment identified Ms X required support with paperwork and she had an eligible need to maintain a habitable home. The failure to produce a finalised support plan means I do not know what, if any, hours the Council has allocated for support in this area or if the Council considers the needs can be met from a social prescriber or other free/universal services.
39. When the Council officer visited Ms X in January 2024 Ms X raised the coldness of the flat. The Council officer acted appropriately and provided information on government help with fuel bills. Based on the assessment at that time, there was no fault in the Council officer not considering an OT referral. An OT’s role in social care is to assess an adult’s needs for equipment adaptation and the concerns Ms X raised were not for the OT service address.
40. However, the Council later made an OT referral in August 2024. To date an OT assessment has not happened. This delay is fault and leaves uncertainty over whether Ms X missed out on the opportunity for adaptations to support her at home.
41. The Council failed to respond to Ms X’s representative when they raised a safeguarding concern in August 2024. The Council was not at fault in how it decided the concerns did not meet the threshold for safeguarding and should be considered as part of the assessment process. However, the failure to respond to the representative was fault and this added to Ms X’s frustration.

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Agreed Action

42. Within one month of the final decision the Council has agreed to:
1. apologise and pay Ms X £500 to acknowledge the distress and uncertainty caused by having her unmet care needs; and
2. pay Ms X £200 to acknowledge the uncertainty caused by the delay in carrying out an OT functional assessment of her home. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology.
43. Within two months of the final decision the Council has agreed to:
1. finalise Ms X’s support plan, having shared a draft plan with Ms X and given her the opportunity to provide feedback.
2. remind relevant officers, via training or a briefing note, that where a needs assessment identifies support is required for attending medical appointments, it properly considers whether this is an eligible need under the Care and Support Statutory Guidance.
44. The Council should provide us with evidence it has complied with the above actions.

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Decision

45. There was fault causing injustice which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman