Summary: Miss B complained about delays in the assessment of her needs, poor communication and a failure to consider carer breakdown in the assessment. We have found fault in the Council’s communications with Miss B, particularly around the possible outcome of the assessment and the Council’s position on the care provided by Miss B’s partner. The Council has agreed to apologise, provide an explanation and pay a small financial remedy.

The complaint

1. Miss B complained about delays in the assessment of her needs which she said were due to a dispute between the Council or the Community Mental Health Team (CMHT) on who was responsible for funding her care package. She said the Council focussed on diagnosis of health conditions rather than her needs and says the Council failed to consider carer breakdown in the assessment.

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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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What I have and have not investigated

4. Miss B complains about the assessment and communications by the Community Mental Health Team (CMHT). The CMHT is part of the NHS and therefore outside of the Local Government and Social Care Ombudsman’s jurisdiction. The Parliamentary and Health Service Ombudsman investigates complaints about the NHS. I have not investigated any complaints relating to the CMHT.

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How I considered this complaint

5. I have discussed the complaint with Miss B and I have considered evidence she and the Council have provided as well as relevant law, policy and guidance.
6. Miss B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Law, guidance and policies

7. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (CASS Guidance) set out the Council’s duties towards adults who require care and support.

Assessment, care plan and personal budget

8. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.

Eligibility

9. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.

Outcomes

10. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.

Assessment of needs

11. The CASS Guidance says the assessment process must be person-centred throughout, involving the person and supporting them to have choice and control.
12. The  CASS Guidance says an assessment should be carried out over an appropriate and reasonable timescale, taking into account the urgency of needs and considering any fluctuation in them. 

The CASS Guidance says people may have needs that are met by various bodies. Therefore, a holistic approach to assessment which aims to bring together all of the person’s needs may need the input of different professionals.

Where more than one agency is assessing a person, they should all work closely together to prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing.

NHS

15. Whilst local authorities have a duty to carry out an assessment where a person has an appearance of needs and a duty to meet eligible needs, local authorities cannot arrange services that are the responsibility of the NHS.

Needs met by a carer

16. During the assessment, local authorities must consider all of the adult’s care and support needs, regardless of any support being provided by a carer.
17. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case.

Carer’s assessment

18. Where an individual provides or intends to provide care for another adult and it appears that the carer may have any level of needs for support, local authorities must carry out a carer’s assessment. 

What happened

19. Miss B is an adult woman who has mental health and physical health conditions. At the time of the complaint, she lived with her partner, Mr C. Miss B asked the Council to assess her needs for care and support.
20. An occupational therapist (OT) carried out an assessment of Miss B in November 2024.
21. The social worker visited Miss B on 23 December 2024 to start the assessment of Miss B.
22. Miss B sent an email to the social worker on 24 December 2024 and set out the care package that she said she needed. Miss B said she needed a care package of 37.5 hours of support a week from a personal assistant. She said the personal assistant should carry out the following tasks:
• Help with getting ready in the morning.
• Household tasks - cleaning, laundry and tidying the house.
• Studying support.
• Dog training.
• Meal preparation.
• Assist with transportation to social activities, leisure activities and medical appointments.
23. The social worker responded and asked Miss B more detail on how the hours would be filled on each day. Miss B responded and provided further information and thanked the social worker.
24. As Miss B had mental health conditions, the social worker contacted the Community Mental Health Team (CMHT) so that Miss B’s community mental health practitioner could assess Miss B and contribute to the Care Act assessment.
25. The CMH practitioner visited Miss B on 8 January 2025 to carry out her assessment of Miss B and sent an email to the social worker with her conclusions.
26. The CMH practitioner said:
• Miss B ‘did not believe she had mental health problems, she believed she had Autism and ADHD.’
• ‘At this present time, [Miss B] is totally dependent upon her partner, [Mr C] for her emotional, physical and daily living needs, she can however attend to all of those needs herself but chooses not to.’
• ‘[Miss B] seemed to think that her request for a full-time personal assistant had been approved. But it had not been decided who would pay for the package of care, Mental Health or Social Care.’
27. The social worker and the CMH practitioner agreed to carry out a joint visit to Miss B on 23 January 2025. This was cancelled as Miss B was not feeling well and the joint visit took place on 6 February 2026.
28. The OT sent her assessment to the social worker in February 2025 and summarised the assessment in an email which said:
• Miss B did not engage in preparing food. Miss B had the physical capacity (functional, mobility, strength, dexterity) to go to the kitchen and complete the tasks.
• The OT had not completed a kitchen assessment of Miss B as the main issues related to fainting and reported issues. These issues may impact on Miss B’s reported physical, mental, emotional and self-efficacy.
• The OT had provided a shower board and Miss B was fully able to transfer in and out of the bath shower. Miss B showered when Mr C was in the home.
• Miss B was able to dress and undress.
• Miss B did not always take her medication even when prompted. Miss B said that, even with verbal prompts from her AI prompter, she would sometimes not take the medication because she would be distracted or forget to take it. Mr C prompted her to take her medication. The OT suggested a medication device but Miss B had said that putting her pills in a device impacted on her OCD symptoms so she could not use this.

Outreach visit – 25 February 2025

29. The social worker asked the Council’s Outreach service to carry out an assessment of Miss B to determine if Outreach could provide any support to Miss B.
30. The Outreach service visited Miss B on 25 February 2025. Outreach sent an email with its conclusion of the visit. Outreach said:
• It offered Miss B support in gaining skills in the kitchen but Miss B said she could not stand for long. Outreach suggested that Miss B could sit down while she prepared food but Miss B said she had a reaction to chemicals and an eating disorder so she could not be around food.
• Outreach offered support with shopping and community access but Miss B said she could not stand for long.
• Outreach offered support in taking Miss B to appointments via bus or taxi but Miss B said she had incontinence issues so could not travel by bus or taxi.
• Outreach said there was no support it could offer Miss B.

Miss B’s complaint – February 2025

31. Miss B complained to the Council on 26 February 2026 and said:
• There had been excessive delays in her Care Act assessment and this had been ongoing for 2 months with multiple visits.
• The delays were caused by funding issues and a lack of clarity on whether the Council’s adult social care team or the CMHT should fund her care package.
• Eligibility of care should be based on assessed needs, not funding availability.
• Outreach services had confirmed that they could not support her and that she needed a personal assistant.
• During the last joint visit, the CMH practitioner made multiple inappropriate, harmful and distressing statements.

Miss B’s complaint – 5 March 2025

32. The Council responded to Miss B’s complaint on 5 March 2025 and said it had forwarded Miss B’s complaint to the CMHT’s complaint service.
33. Miss B put in a further complaint on the same day. She said her complaint related to the Care Act assessment which was the duty of the Council, not the CMHT. She wanted an urgent response to her complaint and threatened legal escalation of her complaint if the Council did not respond.
34. The Council responded and said it would provide a response to Miss B’s complaint relating to the Council’s role.

Needs assessment – March 2025

35. The social worker completed the assessment of Miss B’s needs for care and support in March 2025.
36. The social worker set out the assessment of the CMHT and said:
• The CMH practitioner ‘called the social worker and reported that [Miss B] was able to complete activities of daily living without difficulty.’
• ‘During a joint home visit with [the CMH practitioner], [the CMH practitioner] expressed to Miss B that she was able to manage all activities of daily living but chooses not to engage.
• ‘[Miss B] did not agree with these comments.’
37. The social worker copied the email from Outreach into the assessment. Miss B had told the social worker that Outreach had advised her that she definitely needed a personal assistant. The social worker had asked Outreach whether this was correct. Outreach said it did not recall providing that advice.
38. The social worker considered whether support with medication could be provided to Miss B. The social worker suggested assistive technology where a virtual care worker would call Miss B to remind her to take her medication and supervise her taking the medication. The social worker said the calls could last 10/15 minutes and it would be a real person calling. Miss B said that would be intrusive and she would have to remember that the person would call her. However, she acknowledged that a phone call to her mobile phone may be helpful.
39. Miss B said her medication had recently been changed and agreed to provide the social worker with updated information about her medical history.
40. The social worker considered the outcomes as set out in the Care Act and said Miss B had one eligible need: ‘maintaining a habitable home environment’ .
41. The social worker noted that Mr C provided support in other areas, particularly:
• Nutrition and food shopping. Miss B said she had executive disfunction issues so she could not initiate the sequence of preparing meals and she was also not able to stand for a long time. The social worker said the OT said Miss B had the physical capacity to prepare the food and Miss B had no cognitive impairment which would impact her ability to prepare food.
• Maintaining personal hygiene. Miss B was able to get in and out of the shower. Miss B said Mr C supervised her while she showered as she was at risk of fainting and falling because of her medical condition. The OT said that Miss B was worried about falls but no recent falls had occurred.
• Being appropriately clothed. Mr C carried out all the laundry. Mr C also supported Miss B in getting dressed as Miss B said as she needed help in organising her clothes and, as her clothes were stored upstairs, she was unable to access them. Miss B said clothes were stressful due to her autism but the social worker noted that Miss B did not have an autism diagnosis.
• Being able to use the home safely. Miss B was able to mobilise around the house. Miss B was concerned about fainting and passing out.
• Developing and maintaining relationships. Miss B and Mr C said that the pressure on Mr C to provide support to Miss B impacted his life and meant the relationship was at risk.

Miss B’s complaint and the Council’s response – 11 April 2025

42. I have summarised Miss B’s complaints and the Council’s responses:
43. Miss B said the Council delayed the assessment because she had complained.
• The Council said there was no evidence of this. The social worker had to work with other professionals to carry out Miss B’s assessment and this meant it took longer to complete the assessment.
44. Miss B said the Council had not properly considered the impact of carer breakdown. The Council said:
• The social worker had involved Mr C throughout the assessment and had signposted Mr C to the Carers’ Trust.
• The social worker ‘acknowledged the level of support your informal carer was providing and had given consideration to a separate carer’s assessment to further explore any concerns they may have, which they had not shared during your assessment’.
• The Council acknowledged that this carer’s assessment had not taken place so it partially upheld the complaint. It said that Mr C was fully involved in the assessment of Miss B and their concerns discussed and considered. The Council noted the relationship had now ended and Mr C was no longer providing support so it would not proceed with a carer’s assessment.
45. Miss B said that the Council had failed to assess her needs on a functional impact rather than a formal NHS diagnosis. The Council said:
• The diagnosis was not the determinant factor in establishing needs, but it played a significant role in confirming eligibility, in line with the Care Act.
• The social worker needed to have a comprehensive understanding of Miss B’s health conditions and the assessment had focused on how Miss B’s health affected Miss B’s strength and abilities. The social worker also relied on the assessments of the OT and CMH practitioner.
46. Miss B said the social worker misrepresented the evidence from the other professionals in the assessment.
47. The Council said:
• The Council had spoken to the professionals involved in the assessment and said that some of the professionals ‘accept they might have advised that you may have care and support needs before completion of your Care Act assessment.’
• The Council upheld the complaint and apologised for the misinterpretation of the assessment process and misleading statements from the OT and the social worker. It said that the OT and the social worker would receive refresher training on the Care Act assessment and communication with service users and the public. Staff would also be reminded of the duties on information sharing around the assessment process.
• The Council had considered the information provided by CMHT and Outreach and their feedback was correctly represented in the Care Act assessment.
48. Miss B said the Council had refused to consider a reasonable adjustment for medication support.
• The Council said this was a health need but the Council would always consider supporting a person with medication if other support was provided. The Council said it had explored options with Miss B which had all been turned down.
49. Miss B complained about the unprofessional conduct of the social worker.
• The Council said it had not spoken to the social worker but upheld the complaint and said the social worker would be spoken to regarding this behaviour and the expected professional standards.

Analysis

50. It is not the role of the Ombudsman to carry out an assessment of a person’s needs for care and support or to say what their care plan should be. That is the role of the Council. I have considered whether there was any fault in the way the Council assessed Miss B.
51. In terms of the complaint about delay, I note that the assessment took over three months to complete. The CASS Guidance does not set an exact time frame for assessments to be completed but generally speaking, more than three months is quite long.
52. However, I note that the social worker involved the OT, CMHT and the Outreach team in the assessment of Miss B’s needs and they all carried out their own assessments. That was good practice and reflected a holistic approach to Miss B’s underlying conditions. The social worker understood that they had to obtain advice from other professionals to ensure that Miss B’s needs were fully understood.
53. I accept it would always take longer to complete an assessment involving different professionals so therefore, overall, I do not find fault in the delay.
54. There was also no indication, from the evidence I have seen, that the delay was caused by a dispute between Adult Social Care and CMHT about who should fund the care package. I could not see any evidence that the Council had ever agreed that Miss B needed a care package and that the funding was in dispute. I could also see no evidence that the Council’s position was affected by Miss B’s complaint. Throughout the process the social worker was gathering information from various professionals who contributed to the assessment process.
55. In relation to the complaint that the Council failed to assess the impact of carer breakdown, I note that the Council partially upheld this complaint and I agree there was fault in this respect.
56. In my view the fault was broader than failing to carry out the carer’s assessment. The Care Act assessment was sometimes unclear and slightly contradictory on what the Council’s position was on the care provided by Mr C.
57. The CASS Guidance says councils should record in the assessment the care provided by a family carer, but it is not required to meet those needs if the carer is willing and able to continue to meet the needs.
58. The Council noted the support that Mr C provided in certain areas. The Council also referred Mr C to the Carers’ Trust and offered him a carer’s assessment. These actions certainly gave the impression that the Council was of the view that Mr C was meeting eligible needs.
59. However, the Council also said Miss B had no eligible needs for support except for ‘maintaining a habitable home’. So the Council’s position was that Mr C was providing support that was not necessary to meet eligible needs. That was certainly the conclusion CMHT and to large extent the OT came to and the Council could rely on their assessments. However the Council should have made its position clearer in the Care Act assessment.
60. The Council’s communication in this respect was poor and I understand why Miss B would have felt that the Council did not properly consider the effect carer breakdown would have.
61. Miss B complained that the Council had failed to assess her needs on a functional impact and was too focussed on the diagnosis.
62. The Care Act says the eligibility threshold relates to needs which arise from a physical or mental impairment or illness. Therefore, if there is no diagnosis of an underlying physical or mental impairment or illness, then the Council would not carry out an assessment.
63. Miss B is also correct in that the physical or mental impairment or illness in itself does not determine whether a person is eligible for support. The question is how the impairment or illness affects a person’s ability to reach outcomes.
64. So I would expect the social worker to establish, firstly, whether an impairment or illness exists and then to determine what the impact was on each outcome. That is what happened in Miss B’s case so I find no fault with this approach. I note that Miss B disagreed with her mental health diagnosis and that she said she had Autism and ADHD, but the social worker could only rely on the diagnoses that had been made by mental health professionals. If Miss B disagreed with these diagnoses, she would need to direct that complaint to the mental health team.
65. Miss B also said the social worker misrepresented the evidence from the professionals involved with Miss B.
66. I could not see evidence that the social worker misrepresented the written assessments or feedback that the professionals provided so I find no fault in that respect. I appreciate that Miss B strongly disagreed with the assessment by CMHT but that would be a complaint that should be directed to CMHT, not the Council.
67. I understand that Miss B’s complaint also related to the verbal feedback the OT and the social worker provided during their assessments. The Council’s complaint investigator spoke to the professionals involved and the professionals accepted they may have advised Miss B that she may have care and support needs. The Council therefore upheld this complaint and apologised.
68. I agree this was fault and this would have raised Miss B’s expectation that she was eligible for a support package before the full assessment had been completed and would have led to distress when she found out that she was not eligible.
69. In terms of the complaint about the provision of medication, I note that medication provision is not an eligible need under the Care Act as it is a health need, not a social care need. Councils do not have a duty to meet health needs, and, are generally speaking, prohibited from providing a service which the NHS has a duty to provide.
70. However, it is accepted that care workers can provide support with medication if a person has eligible social care needs and is already receiving a package of support. It makes good sense for the medication support to be included in the general care package. In this case, the Council assessed Miss B as not eligible for Care Act support so therefore, strictly speaking, it had no duty to meet her medication needs.
71. The assessment is not clear on what the dispute was in terms of medication. It appears to me that Miss B had said that a telephone call, although intrusive, may be helpful. Miss B was going to provide more information on what medication she needed. However, I presume that, as the Council then decided that Miss B was not eligible for a care package, the matter of medication was not further pursued.
72. I have also considered the complaint about the inappropriate comments that were made at the final visit. In the complaint that I have read, the comments were made by CMHT and, as I have explained in paragraph 4, that is outside of this investigation as I have not investigated the actions of NHS agencies.
73. From the Council’s response it appears that the social worker also made inappropriate comments at the final visit although the Council has not specified what the social worker said. So therefore, I cannot make any additional findings outside of what the Council upheld.

Further information

74. In her response to the draft decision, Miss B has explained that she has made a complaint to the CMHT and the ICO about the accuracy of the CMHT’s assessment. She also says that her needs have changed substantially and that they are now related more to physical rather than mental health conditions. She is no longer receiving any support from the CMHT or any other mental health support.
75. I have explained to Miss B that the Ombudsman can only investigate the actions of the Council on what happened at the time. I have explained to Miss B that, if she has new information that may mean that the threshold for a fresh assessment by the Council is needed, then she would have to present this to the Council in the first place. The Council can decide whether this meets the threshold for a fresh assessment of Miss B’s needs.

Injustice and remedy

76. The main fault I have found is in the Council’s communications with Miss B and I accept these may have caused her distress. I recommend the Council apologises to Miss B and provides her with an explanation on what its position was in terms of the support Mr C was providing.
77. In complaints such as this one, where there has been no direct financial loss as a result of the fault, the Ombudsman can recommend a symbolic financial remedy for the distress caused by the fault. I recommend the Council pays Miss B £150.
78. I note the Council has already made service improvements relating to the communications while the assessment takes place so I make no further service improvements in that respect.

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Action

79. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Miss B in writing.
• Provide her with a written explanation on what its position was in terms of the support Mr C provided.
• Pay Miss B £150.
80. The Council should provide us with evidence it has complied with the above actions.

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Decision

81. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman