Summary: We found fault with the Council failing to explain how Mrs X’s reduced care package, following a care review, will meet her needs. The Council agreed to apologise to Mrs X and pay her £250 for the avoidable distress, uncertainty and potential lost opportunity its fault caused. The Council agreed to complete a reassessment of Mrs X’s needs and either explain how the proposed level of care meets her eligible needs, if it maintains the level of care outlined in the 2024 care and support plan, or produce a revised care and support plan. The Council also agreed to remind officers about the importance of providing suitable explanations to service users when reducing a person’s personal budget and about how the new personal budget will meet their eligible needs.

The complaint

1. Mr Z, acting for Mrs X, complained the Council reduced Mrs X’s care package resulting in a decrease of direct payments for care and support. Mr Z says the Council has done this despite no change in Mrs X’s needs.
2. Mr Z says Mrs X can now not access the community as she would like to and the Council is not meeting her eligible care needs.
3. Mr Z says the Council has failed to suitably explain how the proposed reduced care package would meet Mrs X’s needs.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. 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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What I have and have not investigated

7. I have referred to matters in 2023 within this investigation for context and comparison but have only investigated Mrs X’s concerns about the care assessment and care and support plan from 2024. Our investigation solely looks at matter within the last 12 months of Mr Z bringing the complaint to the Ombudsman.

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How I considered this complaint

8. I considered evidence provided by Mr Z and the Council as well as relevant law, policy and guidance.
9. Mr Z and the Council had opportunity to comment on my draft decision before I made a final decision.

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What I found

Rules and regulations

Assessments and reassessments

10. 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.
11. 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.
12. 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.

Personal Budgets

13. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. 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.
14. 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.
  (Care and Support Statutory Guidance 2014)

15. Section 28 of the Care Act says “Having reviewed an independent personal budget, a local authority must:

• if it revises the independent personal budget, notify the adult to whom the independent personal budget relates of the revisions and provide an explanation of the effect of each revision, or
• if it does not revise the independent personal budget, notify the adult accordingly”.

What happened

16. Mrs X had a care and support plan with the Council in which she received a care package paid for through direct payments. Mrs X moved in with her husband who also has a care package and direct payments.
17. In January 2023, Mrs X contacted the Council to request a reassessment of her care and support plan. Mrs X advised she wanted to replace her care provider who was not fulfilling its duties.
18. The Council started a needs reassessment of Mrs X and completed a visit. The Council assessed Mrs X as having the following eligible care needs:
• Managing and maintaining nutrition.
• Maintaining personal hygiene.
• Being appropriately clothed.
• Being able to make use of the home safely.
• Managing toilet needs.
• Maintaining a habitable home environment.
• Developing and maintaining family or other personal relationships.
• Accessing and engaging in work, training, education or volunteering.
• Making use of necessary facilities or services in the local community including public transport and recreational facilities or services.
19. The assessment detailed the support that Mrs X would need to achieve her eligible needs and suggested a potential personal budget allocation of £1,500 per year.
20. In May 2023, the Council updated Mrs X’s care and support plan and provided details in the “strengths and abilities” sections about what Mrs X could achieve for each of her eligible care needs. The Council also detailed what support she needs in meeting these eligible care needs. The care and support plan outlined that Mrs X needed 39 hours per week of support for “nutrition, personal care, medication and accessing the community. Some domestic tasks. Support Mrs X with shopping and getting in and out of her mobility vehicle”.
21. The Council confirmed in August 2023 that Mrs X’s care is stable through the arrangement with Mrs X’s Personal Assistant and that this support is working well.
22. In 2024, the Council completed a visit to start reviewing Mrs X care and support plan. In the care assessment the Council said the reason for the reassessment was to consider whether it could reduce Mrs X’s care package to meet her needs more efficiently given the cross-over of support with her husband’s care package.
23. When the Council completed the care assessment the assessor confirmed Mrs X had the same eligible care needs as detailed in the 2023 assessment. The Council detailed the support that Mrs X would need for each of these care needs and suggested an increased potential personal budget allocation of £4,889.54 per year. The recommendation detailed that Mrs X had enough hours in her plan despite her needs not being met and the support needed to be robust so her needs were met.
24. Near the end of 2024, the Council updated Mrs X’s care and support plan. The Council said that Mrs X’s previous plan combined care for both Mrs X and her husband and this amended plan was specifically for Mrs X’s care needs. The Council allocated 4 hours a day Personal Assistant support totalling 28 hours a week for “support with personal care and accessing the community”. The care and support plan also detailed an annual payment for the Personal Assistant to support Mrs X at sports competitions totalling 168 hours a year.
25. The Council wrote to Mrs X to advise the reduction to her direct payments would take place from 20 January 2025. The Council said it considered the 4 hours each day would provide support at home, going out and for appointments.
26. Mr Z raised a complaint with the Council on 22 December 2024. Mr Z said the Council has reduced Mrs X’s direct payments from 2022 to 2024 despite her needs not changing. Mr Z asked for a detailed explanation about what has changed since the last review and how the Council believes the current care and support plan meets Mrs X’s eligible needs. Mr Z listed the activities Mrs X still needed support with. Mr Z raised a new complaint on 27 December 2024 containing much the same information but added that Mrs X’s care and support plan should be separate from her partner’s.
27. On 5 February 2025, the Council provided a complaint response to Mr Z. The Council said:
• It assessed Mrs X and her husband simultaneously but separately.
• Following a review it identified that Mrs X’s care package had largely remained unchanged since she lived independently in her own property but she now lived with her husband.
• Parts of Mrs X’s care and support plan and her husband’s plan had been combined but this was not best practice.
• Following a comprehensive review it determined the previous level of support provided is no longer warranted based on Mrs X’s identified needs.
• The revised care and support plan continues to support community engagement and access to identified activities such as shopping, markets, festivals and swimming within the personal budget. And, the Council said it now provided an extra annual payment for sports competitions and social events.
• It is of the opinion the personal budget allows for social engagement which is proportionate to Mrs X’s assessed needs.
• The Council said the care package also accounts for Mrs X’s support with transfer, personal care, meal preparation and household tasks which it has factored into the care hours.
• It has reassessed the need for support at night for transfers to decide the most suitable and sustainable care. The Council said it decided dedicated overnight support was not required now that Mrs X lives with her husband, which she previously had in place.
28. On 22 February 2025, Mr Z sought consideration of the complaint at the next stage of the Council’s process. Mr Z said:
• The Council failed to provide any explanation about how it calculated/concluded the reduced amount of hours would meet Mrs X’s needs.
• He needed the Council to explain how the new budget covered Mrs X’s needs including both the weekly amount and annual amount.
• The care assessment outlined there were more activities Mrs X wanted to do but lacked support which prevented her from doing these. Despite this, the Council has reduced Mrs X’s hours.
• The Council has failed to identify how the reduced hours were sufficient to provide support throughout the day/week for transfers, personal care, meal preparation and household tasks.
29. The Council provided a final complaint response on 13 March 2025. The Council said:
• It had granted the £2,436 annual payment to cover social events and sports competitions and if anything else needed to be covered this should be discussed at a care review.
• The review of Mrs X’s care needs was based on her current needs, support available within her household and how best to meet those needs within a suitable care package.
• Its assessment decided the care package was enough to meet Mrs X’s daily living support based on observed routines, available support and the principle of proportional care allocation.

Analysis

30. The Ombudsman is not an appeal body, so cannot comment on the merits of judgements and decisions made by councils in the absence of fault in the process. Neither are we a court, and so cannot determine or define the law.
31. The decision about what provision is suitable for Mrs X is at the discretion of the Council. However, the Care Act makes clear that councils must notify the service user and explain any reasons for the reduction in their personal budget. The ‘Care and Support Statutory guidance’ also says: “The plan must detail the needs to be met and how the needs will be met and will link back to the outcomes that the adult wishes to achieve in day-to-day life as identified in the assessment process and to the wellbeing principle in the Act”.
32. The Council’s 2023 care assessment and subsequent care and support plan is robust in its assessment of Mrs X and her needs and is in line with the guidance. The Council has outlined in detail Mrs X’s strengths and what she can do in relation to each of her eligible needs. The Council has also detailed how the 39 hours of support has been calculated to meet all her eligible needs. The Council has also commented in August 2023 that Mrs X’s care and support plan was working well.
33. The Council’s rationale for wanting to separate Mrs X’s and her husband’s care and support plans is sound. The decision to update a care and support plan because a person’s living circumstances have changed is also a sound rationale for completing a reassessment of need. While Mrs X and her husband moved into together quite a few years prior, the Council noted that it had not suitably updated her care plan to reflect this. I do not find fault with the Council for deciding to complete a reassessment and update Mrs X’s care and support plan because of these factors.
34. However, the 2024 care and support plan does not provide details of Mrs X’s strengths in any detail and does not reference most of her eligible needs. Instead, the plan only references personal care and accessing activities in the community within both the strength section and for what the 28 hours of support covers. Despite the associated assessment confirming Mrs X had many other eligible needs, the care and support plan has not outlined how these will be met. Additionally, the Council has increased the potential personal budget in the care assessments from 2023 to 2024 but then decreased the direct payments in the care and support plan.
35. Mr Z has repeatedly requested an explanation of how the Council calculated, or concluded, how the new care and support plan could meet Mrs X’s needs. Despite these requests, the Council has only provided generic responses that it has assessed Mrs X’s needs and considers the hours are suitable. The Council has failed to explain how it has calculated the reduction and how the current hours will meet all Mrs X’s eligible needs.
36. The Council has failed to provide suitable information either within the care and support plan or subsequently about how the proposed reduced hours would meet Mrs X’s eligible needs; this was fault.
37. The fault has caused an injustice to Mrs X because she has experienced confusion, from the conflicting explanations and information by the Council, and distress, through concerns the support in place is not suitable to meet her needs and the potential lost opportunity of receiving suitable care.

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Action

38. Within one month of the Ombudsman’s final decision the Council will:
• Provide an apology to Mrs X and pay her £250 for the distress, uncertainty and potential lost opportunity its fault, through failing to provide sufficient details and explanation as part of the care and support plan review, has caused her.
• Arrange to complete a reassessment of Mrs X’s care needs. If the Council maintains its decision over the level of support detailed in Mrs X’s 2024 care and support plan, it should discuss the reason for this change, provide its rationale and suitably outline how this proposed level of care will meet Mrs X’s care needs. If the Council decides, on reassessment, that Mrs X needs additional support to meet her care hours, the Council should produce a revised care and support plan providing suitable detail about how the proposed hours will meet Mrs X’s eligible needs.
• Remind officers about the importance of providing suitable explanations about the reasons for the reduction in a person’s personal budget and detailing how the support proposed in a care and support plan will meet a person’s eligible needs as identified in the assessment process in line with best practice as set out in the statutory guidance.
39. The Council should provide us with evidence it has complied with the above actions.

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Decision

40. There was fault leading to injustice. As the Council has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman