Summary: Mr X complained that the Council delayed in completing a needs assessment and then delayed in putting in place the help he needed. Mr X says this caused him stress and caused a deterioration in his mental and physical health. We find fault in the Councils actions for delay in completing the assessment and putting in place the funding for the help Mr X needed. We recommend the Council issues Mr X with an apology, pays a financial payment and completes service improvements.

The complaint

1. Mr X complained that the Council delayed in completing a needs assessment and then delayed in putting in place the help he needed.
2. Mr X says this caused him stress and caused a deterioration in his mental and physical health.

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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. 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)
4. 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

5. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
6. Mr X and the Council were invited to comment on my draft decision. I have considered any comments received before making a final decision.

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What I found

7. 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.

Care plan

8. 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.

Charging for social care services: the power to charge

9. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
10. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.

Direct payments

11. 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.
12. The Care and Support Statutory Guidance sets out how councils should administer direct payments. It states that direct payments arrangements should be reviewed every 12 months, generally at the same time as the care plan review. It should only be terminated as a last resort. Council’s should take all reasonable steps to address any situations without the termination of the payment. It should conduct effective, but proportionate monitoring processes to identify any potential problems before a termination is necessary.
13. A council can stop direct payments temporarily in certain circumstances. Where it does so, it should make alternative arrangements to make sure the person concerned has continuity of support for their care needs.
14. Whenever the council is considering discontinuing direct payments it should discuss it with the recipient, their carers and anyone managing the direct payments as soon as possible to explore all available options before making the decision.
15. If the council decides to withdraw direct payments it must conduct a review of the care plan and agree alternative care and support with the recipient, their carer and independent advocate, if they have one.

What happened

16. The Council received a referral requesting a needs assessment from the hospital following Mr X having an operation in late May 2023.
17. The Council contacted Mr X in late June 2023 and told him it would need to complete a functional Occupational Therapist (OT) assessment. The Council said it would chase this up.
18. The Council says it planned a home visit with Mr X in late July 2023, but this did not go ahead as Mr X was not available. It arranged a further visit in late September following various contacts with Mr X. However, Mr X cancelled this appointment before it took place.
19. The Council contacted the OT between October 2023 and early March 2024 to try to arrange an assessment for Mr X. However, the appointment did not go ahead in that time.
20. The OT completed their assessment in mid-March 2024 and reported Mr X had overnight needs such as needing support with medication or to remain safe.
21. The Council gathered further information and held a professionals meeting in late April 2024 to discuss Mr X’s ongoing needs.
22. Mr X agreed to pay a contribution towards his care needs in May 2024 and asked for some minor changes to his needs assessment.
23. Mr X chased the Council in early July 2024 for a copy of his support plan and to ask for an update. The Council’s sourcing team contacted Mr X in late July to discuss his needs.
24. The Council’s senior managers reviewed the support plan agreed with Mr X in late August 2024 but decided it needed further work to clarify and evidence his needs.
25. The Council completed a Strengths and Needs Assessment in September 2024 and the amended support plan was resent to senior managers.
26. Mr X asked for an update in mid-October 2024 and said he was concerned he would not be able to keep his PA’s if the Council did not make a decision soon.
27. Mr X raised a complaint with the Council about its delays in completing the assessment process. Mr X said the process started in March 2023 and was still ongoing.
28. The Council contacted Mr X in late October 2024 to say it was querying whether his needs would be better met in a residential setting and what the costs would be for this. Mr X told the Council he was very stressed about owing wages to his PA’s.
29. The Council reviewed costs for residential care and then decided to approve Mr X’s support plan for care at home in early-November 2024. It also approved for funding to be backdated to May 2024.
30. The Council responded to Mr X’s complaint in mid-November 2024 and apologised for the delays but said once it allocated Mr X’s matter it progressed it reasonably.
31. Mr X asked for his complaint to be escalated in mid-November 2024. The Council issued a stage two response to Mr X’s complaint in mid-December 2024 which again apologised for the delays but also offered Mr X £150 for the distress caused to him.

Analysis

32. The hospital made a referral for an assessment to be completed for Mr X in June 2023. The Council tried to arrange an OT assessment in September 2023, but Mr X cancelled this.
33. There is a gap between October 2023 and March 2024 where I cannot see the Council progressed Mr X’s Care Act assessment. I understand this was due to needing the OT assessment. While I can see the Council contacted the OT team to chase for an appointment it took several months for this to be completed.
34. I understand during this time members of staff were off and while I understand this is difficult for the Council; it should not mean Mr X’s matter was not progressed.
35. The Council arranged for an OT assessment in March 2024 and held a meeting to discuss Mr X’s needs in April 2024. Mr X’s allocated worker then liaised with Mr X and passed the matter to the Council’s sourcing and placement team in June 2024. The Council progressed the matter as I would expect during this time.
36. Between June and November 2024, the Council referred Mr X’s matter to senior managers several times who asked for more work to be completed on Mr X’s assessment and support plan. This included requesting costs for residential care to see if this could meet Mr X’s needs and what this would cost. There is a period of five months where Mr X was waiting for his care and support plan to be finalised. This is fault and would have caused Mr X distress and inconvenience.
37. Mr X chased the matter several times in this period and explained to the Council he was very worried about losing his PA’s due to not being able to pay them.
38. The Council then agreed Mr X’s support plan in November 2024 and backdated the funding to May 2024.
39. I welcome the Council acknowledging the delays in Mr X’s matter as part of its review of the complaint and the offer of a financial payment to recognise the distress caused to Mr X. However, I do not think the £150 the Council offered goes far enough to recognise the delays in Mr X’s matter.

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Action

40. Within four weeks of a final decision, the Council should:

• Write to Mr X to apologise again for the delays caused in his matter. 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 Mr X £350 to recognise the distress he has been caused.
• In writing, remind officers to complete assessments within a reasonable time frame.

41. The Council should provide us with evidence it has complied with the above actions.

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Decision

42. I find fault causing injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman