Summary: We found the Council was at fault. The care and support plan it created for Mr X did not set out clearly the agreed expectations for the division of his care between paid and informal carers. This caused Mr X’s wife, Mrs X, confusion and uncertainty. The Council agreed to apologise and make a payment to Mrs X.

The complaint

1. Mrs X complained about the direct payment she received to arrange care for her husband, Mr X. She said it was not enough to cover the 24 hours of daily support the Council had agreed he needed. She also complained the Council had capped the direct payment at the amount it would pay for residential care. She wanted the Council to explain how it had calculated the direct payment and increase it to cover Mr X’s agreed care needs.

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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 future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance. I discussed the complaint with Mrs X on the telephone.
5. Mrs X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Legislation, guidance and policy

Intermediate Care and Reablement

6. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.
7. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

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.
9. 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.

Care Plan

10. 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.

Personal Budgets

11. 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.

Direct payments

12. 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.

What happened

13. Mr X has a number of long-term health conditions. After a stay in hospital, Mr X was discharged home in October 2024, with a Council-funded intermediate care package in place. This arrangement continued until the Council completed the Care Act assessment process.
14. The Council involved Mr and Mrs X in the Care Act assessment. During the assessment the Council’s assessor considered whether Mr X’s needs could be met with four care visits per day, by two carers. Mrs X expressed her concerns that she would not be able to manage her husband’s needs the rest of the time. The Council also considered the option of a care home placement.
15. The Council’s Care Act assessment concluded that Mr X needs could best be met by care provided by one person, 24 hours per day, at home. The Council finalised the assessment in February 2025, and issued the care and support plan in March.
16. The support to be provided to Mr X was described in the care plan as “live-in care package but some relief to care is needed when informal […] support is not available”. The support plan did not state how many hours of care the personal budget was intended to cover each day.
17. Mr X’s personal budget included a weekly amount to pay for a live-in carer. It did not break this payment down into hourly amounts, or state whether that payment was intended to include cover for the live-in carer’s breaks. The personal budget also included a payment called “flexible relief to care” that was equivalent to the cost of one hour of care per day.
18. Mr X’s care and support plan included: “[Mrs X] confirmed that she would like to continue providing the following informal support. Cooking, shopping, laundry, and taking [Mr X] to attend appointments”. This support was not quantified, and it was not stated that Mrs X was expected to cover the carer’s breaks.
19. Mrs X wanted to find carers for Mr X herself, so she asked the Council if she could receive direct payments. The Council agreed, and started making direct payments to fund Mr X’s care on 9 April 2025.
20. Mrs X employed a live-in carer for Mr X. The funding included in the support plan covered the carer’s working hours, which Mrs X understood to be 22 hours per day. Mrs X used the “flexible relief to care” payment to cover one hour of the shortfall. She either covered the remaining hour herself, or arranged (and sometimes paid for) other people to care for Mr X during the 24th hour.

The complaint

21. In January 2025, Mrs X complained to the Council about the way it had carried out the Care Act assessment. She said communication had been poor, and she had not been supported to understand the assessment process. She said the assessor had told her that if the Council assessed Mr X as needing 24-hour care, then it would provide that care in a care home. This had led Mrs X to believe that the Council would not pay more than this for care delivered at home.
22. The Council’s stage 1 response to Mrs X’s complaint included that a Practice Supervisor would review Mr X’s assessment before the Council finalised it, after which it would send Mrs X a final version.
23. Mrs X escalated her complaint to stage 2, saying the stage 1 response had not addressed her concerns in any depth. The Council’s stage 2 response was more detailed. The Council apologised for communicating poorly with Mrs X, and said that the support plan that it had created included the need for Mr X to have 24-hour care, at home, including turning up to 3 times overnight.
24. On 3 April, Mrs X complained further that she did not understand how she could pay the carer for 24 hours a day when the funding covered only 22 hours of care, and not the carer’s two hour-long paid breaks. The Council did not respond to this complaint and Mrs X escalated it to the Ombudsman in April 2025.
25. In response to my enquiries the Council said, although it accepted that Mr X needed care 24 hours per day, the value of the personal budget assigned to him was intended to cover his care for only 21 hours, because a live-in carer is entitled to three hours’ break per day.
26. The Council said that it expected Mrs X to provide care for Mr X during the carer’s breaks, and that this had been agreed with her. The Council said its intended use for the “flexible relief to care” payment was to fund an alternative carer on occasions when Mrs X was not available to take over Mr X’s care when the live-in carer took a break. As that might not be needed every day, the Council paid the funding to Mr and Mrs X (as part of the direct payment) to use as they saw fit.
27. The Council said this was all explained in the support plan by the wording “live in care package but some relief to care is needed when informal […] support is not available”.

Analysis

28. The Council considered several ways of meeting Mr X’s eligible needs during the Care Act assessment process, including four care visits per day, a residential placement and a live-in carer. The Council took Mr and Mrs X’s preferences into account and decided that Mr X’s needs would be best met by a live-in carer in his own home. The Council was not at fault in considering a variety of care options during the assessment.
29. I have seen no evidence that the Council sought to cap Mr X’s personal budget in line with the amount it would pay for residential care. The Council told me that Mr X’s personal budget was £170 per week more than its weekly fee for a residential care home bed, which is evidence that it did not cap his personal budget for live-in care. I find the Council was not at fault.
30. Once a council decides a person's care needs can and should be met in their own home, it must issue a care and support plan. This should specify the care, support and adequate personal budget required to meet the person's eligible needs over and above anything provided informally by friends and family. The care and support plan should set out the agreed expectations for family to provide support around that funded by the council. The care and support plan must set out which needs are to be covered by the personal budget and which by family support and/or funding.
31. The informal support that Mrs X confirmed she was willing to provide, set out at paragraph 18, is not consistent with the Council’s account that it was agreed that Mrs X would provide care for Mr X during all of the live-in carer’s breaks. The phrase the Council used to describe the detail of the care package, that I have included at paragraph 27, does not describe a daily split of 21 hours/3 hours between paid and informal carers.
32. The care and support plan created for Mr X by the Council did not set out clearly the agreed expectations for which of Mr X’s needs were to be covered by the personal budget, and which by family support and/or funding. That lack of clarity was fault. The Council’s fault caused Mrs X an injustice in the form of confusion and uncertainty as to how the live-in carer’s breaks were supposed to be covered or funded.
33. The Council was also at fault when it did not respond to Mrs X’s email of 3 April, in which she asked for clarification on this matter. That fault compounded the injustice to Mrs X in that it prolonged the duration of the uncertainty described above.
34. The Council told me that, since Mrs X complained to the Ombudsman, it has carried out a review of Mr X’s needs. The review found that Mr X’s needs have changed, and the Council is now updating Mr X’s support plan. All three hours of the live-in carer’s daily breaks will now be funded by Mr X’s personal budget as it is not safe for him to be left alone, and so it is no longer appropriate for breaks to be covered by family care.

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Action

35. Within one month of the final decision, the Council has agreed to apologise to Mrs X and make her a payment of £300 in recognition of the uncertainty and confusion caused by its actions.
36. 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.
37. The Council should provide us with evidence it has complied with the above actions.

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Decision

38. I found fault causing injustice. The Council agreed actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman