Summary: Ms X complained about the Council’s decision to reduce her care and support hours. We do not find fault in the Council’s decision making.

The complaint

1. Ms X complained about the Council’s decision to reduce her care and support hours. She says this has severely impacted her health, and it has caused her distress and upset.
2. Ms X is represented by her friend, Mr Y, in bringing her complaint to the Ombudsman.

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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 may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), 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(1), as amended)

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How I considered this complaint

6. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
7. Ms X, Mr Y 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

Assessment

8. 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

9. 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.

Reviews

10. 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.

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.

NHS Continuing Healthcare Assessments

12. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.

What happened

13. This chronology includes an overview of key events in this case and does not detail everything that happened.
14. Ms X has eligible care and support needs. The Council has provided Ms X with direct payments for several years so she can arrange her own care and support. It previously funded 17 hours and 30 minutes per week of care and support for Ms X.
15. The Council visited Ms X in June 2024 to review her care and support hours. Ms X provided an overview of her needs and the support her carers provided.
16. The Council contacted Ms X’s care agency to get an understanding of Ms X’s needs and the tasks the carers completed. The agency explained carers supported Ms X with an extensive cleaning regime and they supported Ms X with her meals.
17. The Council contacted Ms X and explained it did not fund the carers to clean. Instead, it funded them to provide her with personal care. However, she was not utilising this.
18. The Council visited Ms X at home in August to continue its review. It explained the hours it was funding were not being used in the most effective way. It agreed to observe one of Ms X’s morning calls so it could understand what the carers were doing.
19. Ms X contacted the Council and said she was cancelling the observation as she wanted it to be impartial.
20. Ms X said her health was deteriorating. She asked the care agency to review her needs. The Council decided to wait for this review before it updated Ms X’s care and support plan. It also encouraged Ms X to seek medical advice.
21. The care agency completed its review in November. It emailed the Council and provided feedback.
22. The Council contacted Ms X in mid-December. It said it had completed a reassessment of her needs and decided to reduce her care and support hours to 7 hours and 45 minutes per week.
23. Ms X’s friends have Lasting Powers of Attorney (LPAs) to deal with Ms X’s financial affairs. 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. They complained to the Council that it had unfairly reduced Ms X’s care and support hours without considering her medical conditions.
24. Ms X appealed the Council’s decision to reduce her hours. She said her condition had deteriorated. The Council agreed for Ms X’s original hours to stay in place while it reviewed her appeal.
25. The Council visited Ms X at home in January 2025 to complete a further review. The Council said it had reviewed the care notes, and the carers were completing cleaning tasks. This was not an eligible care and support need. Ms X said she was struggling with pain and poor balance. The Council went through Ms X’s needs from her care and support plan. It agreed to make a referral for an occupational therapy (OT) assessment to look at how Ms X was transferring and if any aids could support independence.
26. The Council emailed Ms X and said 12 hours and 30 minutes per week was sufficient to meet her eligible care and support hours. Ms X sent a detailed email on why she disagreed. She said her morning tasks would take approximately 76 minutes, rather than 45 minutes, to complete.
27. The Council responded to Ms X’s complaint. It said since its original assessment, Ms X’s needs had increased. At the previous review, Ms X was managing her personal care needs independently. She now needed support with toileting and personal care. Therefore, it would not reduce the care to 7 hours and 45 minutes per week. However, it would still reduce her care compared to the previous level. It said it would allow the occupational therapist to complete their assessment before it reduced her care and support hours.
28. The occupational therapist completed their assessment at the end of January. Ms X mentioned during the visit she was struggling with speech. The therapist decided there were no moving and handling recommendations that would impact how much care Ms X was receiving. However, they agreed to contact relevant services about a replacement shower chair for Ms X and help with her wheelchair. They also said they would liaise with Ms X’s GP about a speech and language assessment.
29. The Council contacted a medical professional involved in Ms X’s care to understand her needs further.
30. The Council visited Ms X in February to discuss her concerns about the reduction in her care and support needs. Ms X said she needed further time for carers to prepare smoothies for her. The Council explained the doctor confirmed the smoothies were not essential for Ms X’s treatment. Ms X provided further information about her health conditions. The Council agreed to complete a CHC referral to see if Ms X was eligible for health funding. It also agreed to consider Ms X’s views and complete its assessment.
31. The Council issued its final response to Ms X’s complaint in March. It said it would meet with her again once it had reduced her hours and she had some time to settle. However, it was satisfied the 12 hours and 30 minutes per week it had agreed to fund would meet her eligible care and support needs.
32. The Council and a CHC nurse practitioner visited Ms X at home to complete the CHC assessment. Ms X raised concerns about her medication administration. The Council said this was a health rather than a social care need. It agreed to contact the Integrated Care Board (a statutory NHS organisation) to request health contribution hours.
33. The Council finalised Ms X’s care and support plan at the end of March.
34. The NHS contacted Ms X in early April. It said she did not have a primary health need, and she was not eligible for CHC.

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Analysis

35. It is not the Ombudsman’s role to decide what services or support a person is entitled to receive. The Ombudsman’s role is to establish if the Council has assessed a person’s needs properly and acted in accordance with legislation.
36. The Council visited Ms X, considered her concerns, reviewed the carers notes, and made appropriate referrals to other professionals. It decided Ms X’s previous care package included non-eligible domestic tasks such as cleaning and housework. Its view was Ms X’s eligible care tasks could be delivered within 12 hours and 30 minutes per week. That was a decision it was entitled to take.
37. I understand Ms X disagrees with the Council’s decision. However, there is no evidence of fault in the way the Council made its decision. Therefore, we cannot question the outcome.
38. Ms X is concerned the officer that completed her assessment is not medically trained and does not understand the complications of her condition. There is no requirement for officers who complete assessments to be medically trained as they assess social care needs, rather than medical treatment, diagnosis or clinical interventions. When medical concerns arise during an assessment or review, it is the officer’s responsibility to refer the individual to the appropriate healthcare professionals so the medical aspects of their care can be fully explored. That is what happened in Ms X’s case. I do not find fault.

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Decision

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

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Investigator's decision on behalf of the Ombudsman