Summary: There was a delay by the Council in reviewing H’s assessment after Mrs X complained, which caused her frustration and anxiety. In addition, the Council has not considered properly H’s additional expenses incurred because of his disabilities, with the result that he is unable to finance some items. The Council agrees to review his personal expenses allowance.

The complaint

1. Mrs X (the complainant) says the Council took too long to review her disabled son’s needs assessment after she complained about it. She also says the Council will not take into account that he incurs additional expenses as a result of his disability for which it says he cannot claim any allowance but it has not considered increasing his personal expenses allowance.

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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 the 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.
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

Relevant law and guidance

6. 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
7. The Care and Support Statutory guidance says “The local authority must leave the person with a minimum amount of income. This is known as the Personal Expenses Allowance (PEA)”. It says “The purpose of the PEA is to ensure that a person has money to spend as they wish. It must not be used to cover any aspect of their care and support that have been contracted for by the local authority and/or assessed as necessary to meet the person’s eligible needs. This money is for the person to spend as they wish and any pressure from a local authority or provider to do otherwise is not permitted”.
8. The guidance also says, “There may be some circumstances where it would not be appropriate for the local authority to leave a person only with the personal expenses allowance after charges.”
9. Councils can take disability-related benefit into account when calculating how much someone living at home should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included.
10. 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. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.

What happened

11. H is a 24-year-old man with some complex physical and mental health conditions. He has lived in residential care with several other men since 2021.
12. After H’s needs review in July 2024 and notification of his financial assessment in August 2024, Mrs X wrote to the Council to complain.
13. On 12 August Mrs X complained about his financial assessment and said she had not been consulted during the assessment despite asking to be involved. She said his personal expenses had not been properly taken into account. She said his glasses needed replacing frequently because of breakage (due to his challenging behaviours), but he was only entitled to one pair a year on the NHS. He ripped his clothes which needed replacing more often. His clothes were often soiled and needed washing at a higher temperature, so they wore out sooner. He needed specialist footwear but again only had one pair each of shoes and insoles available on the NHS each year.
14. On 18 August Mrs H complained about H’s needs assessment which she said was inaccurate and out of date. She complained in the same letter about his financial situation listing the expenses she had mentioned in her previous letter as well as items like specialist toiletries to prevent outbreaks of eczema. She said every time he needed new clothes, shoes or glasses there was a dispute about who should pay for them. In a telephone conversation with the Council Mrs X requested a change of social worker for H.
15. The Council’s files show a new social worker was allocated at the beginning of September 2024 and spoke to Mrs X by telephone. She told Mrs X she didn’t know if there were other sources of funding available for H’s other expenses. Mrs X said they needed an NHS funding review meeting (to carry out a Decision Support Toolkit – DST – to ascertain if the NHS should fund 100% of his care). The file note dated 06 September 2024 concludes, “DST to be arranged”.
16. The social worker met Mrs X and the care home manager in a Teams meeting on 13 December. Mrs X said H’s needs had changed since his last review and the Council’s records show Mrs X and the care home manager requested a review of his health needs. Mrs X says the care home manager did not request a review.
17. A CHC review meeting was arranged for 30 December. The outcome was no change to the health funding contribution towards the cost of H’s care.
18. The social worker then met with the care home manager on 18 February 2025. The manager expressed concern about the items Mrs X required for H. He said these were more expensive than the standard items.
19. Mrs X complained to the Ombudsman in April. She said the review document received in August 2024 was inaccurate and had not been updated despite promises to do so. She said without an accurate record H might not receive the care he needed.
20. The Council responded to Mrs X’s complaints on 14 May. The team manager apologised for the service received by Mrs X and H from the allocated social worker. He said the social worker had “had a few meetings” with the care provider and would contact Mrs X shortly to arrange a review.
21. A file note for 21 May reads “we need to complete a new assessment and not able to make contact with (Mrs X)”. The file does not show any record of contact attempts with Mrs X since the CHC review.
22. A review was completed on 28 August. The social worker noted, “I explained I had called this review at (Mrs X’s) request”. Mrs X reiterated the issues she had raised previously about H’s glasses, his footwear, his clothing and his toiletries. The social worker said she explained again this was not something the Council would help with. She said “I spoke about DRE but felt this may not be an option – they would need proof and evidence of why”.
23. The notes from the social worker’s supervision on 2 September noted that Mrs X had taken the previous assessment to amend; that she was still asking for finances to replace items but had been told the Council would not do so and she needed to make finance available herself, that Mrs X made regular complaints and the social worker thought she would make another.
24. Mrs X made a number of amendments to and comments on the assessment and returned it at the end of September 2025. At the beginning of January 2026, she received a revised version of the assessment document but said the social worker had not amended it properly but simply cut and paste her comments into it, often in the wrong section. She said she was no closer to finding out if any additional funding was available for H’s needs.
25. The Council says DRE is not something that is included in a financial assessment for long term residential care services.

Analysis

26. The Council has a duty to review care and support plans at least every twelve months. It was therefore inaccurate of the social worker to claim in August 2025 that the reason she had arranged a review was because Mrs X had requested it.
27. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one. It is clear from Mrs X’s contacts and her complaint in August 2024 that she was asking for amendments to be done which were not considered, and an earlier review would have been the appropriate way to move forward. It was fault on the part of the Council to delay so long in putting that in place, and fault to issue a revised assessment document which was not up to standard in its presentation. That caused injustice to Mrs X in the way it devalued her contribution.
28. In addition, there was a failure to progress this case. Periods of weeks and months went by without contact (or if there was contact, as the Council claims in the case recording it had not been possible to contact Mrs X, it was not noted). That was also fault which caused frustration and anxiety for Mrs X who was advocating on her son’s behalf.
29. The Council did not give Mrs X a definitive answer about the additional funding or allowances available for H. It was unhelpful to say DRE might be a possibility, but Mrs X would have to give evidence, without providing the necessary mechanism to proceed. I do not see there was any attempt by the Council to consider whether H’s PEA could be increased to encompass the expenses Mrs X say are necessary. That was also fault which may have led to H losing out on the replacement of essential items.

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Action

30. Within one month of my final decision the Council will reconsider the PEA available to H for the items explained by Mrs X and provide us with details of the review and its outcome;
31. If the review results in an increased PEA the Council will calculate the worth of that over the period from August 2024 when Mrs X first complained and make a payment to H (or to Mrs X on his behalf) for that amount.
32. Within one month of my final decision the Council will make a payment to Mrs X of £300 recognising its delay in dealing with her complaint, and a further sum of £500 to recognise the anxiety and frustration caused by its failure to progress the substantive issues.
33. Within three months of my final decision the Council will consider the way it responds to complaints where the appropriate way forward would be an early review and let me know the outcome of its review.
34. The Council should provide us with evidence it has complied with the above actions.

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Decision

35. I find fault causing injustice which will be remedied by completion of the recommendations at paragraphs 30 – 33 above.

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Investigator's decision on behalf of the Ombudsman