Summary: Mx X complained the Council cancelled their Care and Support Plan after 6 months despite no positive change in their circumstances leaving them with unmet care needs. We found no fault with the Council.

The complaint

1. Mx X complained the Council cancelled their Care and Support Plan after 6 months despite no positive change in their circumstances.
2. Mx X says the Council’s actions have caused a Mental Health crisis and left them with unmet care needs.

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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. 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)
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 Mx X and the Council as well as relevant law, policy and guidance.
7. Mx X and the Council had an opportunity to comment on my draft decision before I made a final decision.

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What I found

Rules and Regulations

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.
9. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.
10. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a council has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.
11. 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 Care and Support 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.

What happened

12. In January 2024, the Council discussed Mx X’s situation with them as Mx X had asked for some support. The Council advised them to contact their GP about seeking support for their medical conditions for NHS funding for care.
13. In March 2024, the Council completed an assessment of Mx X for a Care and Support Plan. The Care and Support Plan detailed Mx X had eligible care and support needs. The assessor noted the following eligible needs:
• Accessing the community
• Maintaining a habitable home environment
• Maintaining nutrition
• Maintaining personal hygiene
• Carrying out any caring responsibilities the adult has for a child.
14. The Care and Support assessment noted the Occupational Therapy team had set up a bed for Mx X downstairs to help manage their energy and increase their physical involvement in caring for their children. The Occupational Therapy team had also approved installation of a stairlift.
15. The assessor recommended Mx X should have the support of one carer to help them meet four of the five eligible needs. The assessor said Mx X’s family was suitable support for them to access the community.
16. The Council produced a Care and Support Plan for Mx X which outlined a personal budget to meet Mx X’s needs. The Council decided to provide daily support for Mx X’s personal hygiene and caring responsibilities and two hours each week for completion of admin tasks which covered nutrition, maintaining a habitable home and caring responsibilities. The Council began to provide this support at the end of March 2024.
17. The Council started the six-week review for Mx X’s care in April 2024. The Council arranged to discuss Mx X’s case with relevant professionals to understand Mx X’s care needs.
18. On 14 June 2024, the Council completed the initial review of Mx X’s Care and Support Plan. The Council noted it needed further information about Mx X’s needs before deciding about the Care and Support Plan. The Council got consent to contact Mx X’s mother and relevant medical professionals. The Council contacted Mx X’s mother and various health professionals working with Mx X to get their input about what support the Council would need to provide.
19. On 27 June 2024, the Council visited Mx X to discuss its decision about their care and support needs. The Council said it had been unable to evidence the care and/or support needs it had previously assessed Mx X as having. The Council said it would be looking at removing the care package. The Council explained:
• Taking medication can be covered by use of an app because Mx X only needs prompts.
• Mx X can make a sandwich for lunch and Mx X’s mother cooks for the family most days and Mx X can do this when they have the energy.
• Mx X can complete chores around the house and Mx X’s adult child can complete some or Mx X could hire a private cleaner.
• Mx X can manage their own life admin.
20. The Council agreed to consult with medical professionals again before making a final decision.
21. In July 2024, the Council made further contact with the medical professionals involved in Mx X’s care.
22. Mx X asked the Council for increased support. The Council explained it was in the process of removing Mx X’s care because the Council considered Mx X could meet their own care needs with the support of their family.
23. Mx X entered hospital. In preparation for discharge, the hospital asked the Council to consider any need to increase support for Mx X with meal preparation, medication and personal care. Before an assessment could be completed, Mx X discharged themselves from hospital.
24. The hospital contacted the Council who confirmed they “cannot evidence that Mx X can't do without support or what the carer is doing for/with them” and therefore did not consider Mx X had any eligible care needs. The Council said it considered it made an error in its original assessment of need as this did not look at Mx X’s strengths and what they could achieve for themselves. The Council said Mx X was not using the package of care put in place as directed within the Care and Support Plan.
25. The Council completed a further assessment of Mx X. The Council said:
• Mx X’s carers confirmed they are watching Mx X take medication, carry out chest physio, wash their own face and eyes and youngest child’s face. Mx X’s carers will prompt Mx X to do this but assistive technology is also prompting medication. There is no eligible need for medication or personal care.
• Mx X’s carers load and unload the dishwasher and washing machine and prepare some vegetables. The Council said this could be met in other ways such as through hiring a private cleaner, the adult child living in the home completing these tasks and through use of pre-made microwave meals. The Council also noted that Mx X can complete these tasks with rest in between. The Council considered there is no eligible need for maintaining a habitable home.
• There is no evidence Mx X cannot complete admin tasks themselves and so far has not been willing to share personal information with the carers to help support with this.
• Occupational Therapy was installing a stairlift to enable Mx X to access the first floor and meanwhile Mx X has a bed downstairs.
• Mx X is not using the Care and Support Plan as intended and this support is not appropriate because the level of care is too high. Other options are available to support Mx X to enable them to achieve daily living tasks and independent living.
• Mx X does not have any assessed eligible care and support needs.
26. In September 2024, the Council confirmed with Mx X its decision to stop their Care and Support Plan later in the month.
27. Mx X lodged an appeal against the Council’s decision to stop their Care and Support Plan. Mx X also made a formal complaint to the Council on 27 September 2024. Mx X complained:
• The Council has not told them how to dispute the Council’s decision to stop their Care and Support Plan.
• The Council’s decision to stop the Care and Support Plan was inaccurate and inconsistent and they disputed it.
• The Council had blocked their route to advocacy as the Council told the Community advocate that Mx X was entitled to follow the statutory pathway to dispute its decision.
• There are risks to terminating their Care and Support Plan not just to Mx X but also their children and mother.
28. On 3 December 2024, the Council issued a complaint response to Mx X. The Council said:
• It apologised for the delay in responding to Mx X’s complaint.
• It completed the review of Mx X’s needs in line with the Care Act 2014 and liaised with all relevant professionals when making its decision.
• It has reviewed its records and cannot see that it blocked advocacy at any point. The Council said the Care Act outlines when advocacy should be provided and Mx X did not meet the criteria.
• The outcome of the assessment and review indicates that Mx X had no eligible care and support needs and that Mx X could complete everything with only prompts from the carers.
• Since Mx X had no eligible care needs there was no risk to Mx X or their mother from the Council stopping the package of care.
29. In January 2025, the Council completed a review of its decision to withdraw Mx X’s Care and Support Plan. The Council considered the full circumstances of Mx X’s access to care since March 2024 and concluded that Mx X does not have any assessed care and support needs under The Care Act 2014.

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 Council acted in line with the Care and Support Statutory Guidance by completing a light touch review of Mx X’s Care and Support Plan. When the Council completed this review, it decided it needed to get more detailed information and evidence to substantiate Mx X’s care needs.
32. There is no fault in the way the Council re-assessed Mx X’s needs as part of the extended light touch review process. The assessment is detailed and thorough. The Council consulted with all relevant professionals and people involved with Mx X and considered the evidence.
33. The Council has a focus on a strengths-based approach around independence and capabilities, which is not fault. The Council reviewed relevant evidence, took account of Mx X’s eligible needs and outcomes, and considered the views of Mx X. The Council explained its reasons to Mx X.
34. Mx X asserts there has been no positive change in their needs and circumstances since the original assessment, so there is no justification for stopping the Care and Support Plan. The Council’s decision to stop Mx X’s Care and Support Plan was not because of a change in circumstances but because it considered its original assessment was flawed.
35. In the Council’s view, Mx X did not have eligible care needs. This decision is one of professional judgement. It was a decision the Council was entitled to make. As I have not identified fault in the process, I cannot question the merits of it or say it should have reached a different outcome.

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Decision

36. I have completed my investigation as there was no fault by the Council.

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Investigator's decision on behalf of the Ombudsman