Summary: The Council was at fault for failing to adequately assess the late Mrs Y’s needs and in its determination of her personal budget. The Council has agreed to apologise to her representative, Mrs X, for the frustration caused to her and produce an action plan of how it will address the faults identified to improve its service.

The complaint

1. Mrs X complained the Council failed to adequately assess and meet her mother, Mrs Y’s care needs and to explain its decision making. Mrs X says this led to a deterioration in Mrs Y’s condition and placed the family under increased strain. Mrs X also complained the Council delayed responding to her complaints, causing additional frustration.

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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 any comments before making a final decision.

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What I found

Law and Statutory Guidance

Assessment

6. 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.
7. 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

8. 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.

Personal Budgets

9. 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.
10. Councils should have a consistent method for calculating personal budgets and should ensure the method used for calculating the personal budget produces equitable outcomes to ensure fairness in care and support packages (11.22 Care and Support Statutory Guidance).
11. The amount the Council calculates as the personal budget must be sufficient to meet the person’s needs which the Council is required to meet, or decides to meet and must also take into account the reasonable preferences to meet needs as detailed in the care and support plan, or support plan (11.24 Care and Support Statutory Guidance).
12. In establishing the ‘cost to the local authority’, consideration should be given to local market intelligence and costs of local quality provision to ensure the personal budget reflects local market conditions and that appropriate care that meets needs can be obtained for the amount specified in the budget (11.25 Care and Support Statutory Guidance). 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.
13. In all circumstances, consideration should be given to the expected outcomes of each potential delivery route. Decisions should therefore be based on outcomes and value for money, rather than purely financially motivated. (11.27 Care and Support Statutory Guidance)

Direct payments

14. 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.
15. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the council must decide whether to provide a direct payment. In all cases, the council should consider the request as quickly as possible.
16. The council must provide interim arrangements to meet care and support needs to cover the period in question. Where accepted, the council should record the decision in the care or support plan. Where refused, the council should explain its decision in writing to the person who made the request. It should also tell the person how to appeal against the decision through the local complaints procedure.
17. In cases where making a direct payment is a more expensive option to meet needs, the care plan should be reviewed to ensure it is accurate and that the personal budget allocation is correct. The authority should work with the person, their carer and independent advocate (if there is one) to agree on how best to meet their care and support needs. It may be that the person can take a mixture of direct payment and local authority-arranged care and support, or the local authority can work with the person to discuss alternate uses for the personal budget. Essentially, these discussions will take place during the planning process and local authorities should ensure that their staff are appropriately trained to support personalised care and support, and to facilitate decision-making. (Care and Support Statutory Guidance 2014)

What happened

18. Mrs Y had a number of health conditions, she lived at home with her husband and was supported by her family. In 2023 Mrs Y began receiving a Direct Payment from the Council which was used to purchase care from a care provider.
19. The care provider charged more than the Council’s rates. However, at the time the care was arranged there was no care available from providers charging the Council’s rates. Mrs Y’s Support Plan from 2023 said that, if another agency was able to provide support at a lower cost, Mrs Y would have the option to remain with the same provider and pay the difference or for her care to be transferred to the cheaper agency.
20. In July 2024 Mrs Y’s family requested a reassessment of her needs. The Council completed this in September 2024 and found her needs had increased and her requirement for care had increased as her husband’s care arrangements had changed.
21. The Council offered to source care from a different care provider within Mrs Y’s personal budget, but her family wanted to remain with the current provider.
22. The Council discussed Mrs Y’s care needs at the Council’s Care Act Assurance Meeting in September 2024. The Council did not authorise an increased personal budget using the hourly rate of the current care provider. It acknowledged Mrs Y has anxieties and had built relationships with her carers but said Mrs Y, her family and the Council needed to consider other options and the situation could then be discussed again at a future Assurance Meeting.
23. The Council discussed this with Mrs X. It said it would see if it could negotiate with the current care provider but otherwise Mrs X would need to consider Mrs Y or her family paying a top up, source an alternative care provider and explore other creative ways to meet Mrs Y’s needs.
24. In October 2024 Mrs X wrote to Mrs Y’s MP to raise concern about the impact of a change of care provider. The MP contacted the Council and said Mrs Y’s family believed consistent care was essential for her well-being and the uncertainty was causing significant anxiety.
25. The Council sent Mrs X a copy of the assessment it had completed in September 2024 in November 2024.
26. Mrs X contacted the Council in November 2024 to raise concern about the impact of a change in care provider on Mrs Y’s well-being.
27. The Council carried out a re-assessment of Mrs Y’s needs in December 2024 as her needs continued to increase. This generated a new increased indicative budget. The assessment said Mrs Y was anxious with unfamiliarity.
28. The Council again discussed Mrs Y’s care and support needs at the Council’s Care Act Assurance Meeting. It decided a personal budget it considered sufficient to meet Mrs Y’s care and support needs, using the Council’s rates and not the rate of Mrs Y’s current care provider. This was less than the indicative budget generated at assessment. The Council advised the family they would need to consider a different care provider.
29. In December 2024 the Council wrote to Mrs X to apologise for not yet responding to the service enquiry made by Mrs Y’s MP. In response Mrs X made a complaint to the Council about:
• The decision that Mrs Y’s needs could be met by a different care provider.
• The suggested notice period of two weeks for a smooth transition between care providers.
• The discrepancy in the amount of personal budget Mrs Y had been allocated at different points.
• Poor complaint handling in response to the service enquiry made in October 2024.
30. In her complaint, Mrs X requested a reassessment of Mrs Y’s needs and a review of her care plan.
31. In December 2024 the Council sent a response to the MP’s service enquiry. The Council said:
• There were delays in the re-assessment of Mrs Y’s care needs in September 2024 and significant delays in providing the information Mrs X needed to be able to complete Mrs Y’s care and support plan. The Council acknowledged its fault and apologised for the delay.
• It appreciated the need for Mrs Y to receive consistent care but it also needed to provide an equitable offer and to allocate resources fairly. It said Mrs Y’s care had been through the quality assurance process and it considered the personal budget offered was sufficient to meet her needs.
• There were three options to meet Mrs Y’s care and support needs:
1. To use a Council accredited care agency to provide a package of care.
2. To continue to receive Direct Payments and remain with the current provider with Mrs Y or her support network paying the difference between the two costs.
3. To continue to receive Direct Payments and employ personal assistants or a different care agency within the personal budget amount.
• Mrs Y’s personal budget would be temporarily increased to enable her to remain with her current care provider whilst new arrangements were made.
• It would develop a transition plan for any new care arrangement and extend the transition period to 30 days.
• It apologised for the misunderstanding about the response to the contact from Mrs Y’s MP and the consequent delay this caused.
32. In January 2025 Mrs X contacted Mrs Y’s MP again with further concerns. She said:
• There were large variations between the indicative budgets and the personal budgets the Council agreed.
• The costs quoted by the Council were inaccurate.
• The decisions of the Council were financially driven with no person centred care or choice.
• Mrs Y’s family felt railroaded into accepting a new care provider.
• There was delay in response to the previous complaint.
33. In February 2025 Mrs Y had a reassessment of her care and support needs. It noted Mrs Y wanted to remain with the same care provider and found any change of routine very stressful. The assessment generated a new indicative budget.
34. A new Support Plan, developed in March 2025, said Mrs Y had a complex illness. Her personal budget was increased to be the same as the indicative budget. The Support Plan said a new care provider needed to be found but the current direct payment would be paid whilst there was an ongoing complaint.
35. In March 2025 the Council provided a final complaint response to the enquiry made via Mrs Y’s MP in January 2025. In its response the Council included:
• It was unable to investigate the support plan solution Mrs X had suggested due to conflicting cost figures and insufficient information.
• It believed it provided a personal budget sufficient to meet Mrs Y’s eligible care needs in December 2024.
• It was committed to ensure each person receives consistent and equitable care and apologised for errors it made in paying Mrs Y’s care provider.
• The personal budget for Mrs Y’s care at home would be calculated using the Council’s hourly rate.
36. In April 2025 Mrs X complained directly to the Council raising concerns about the Council’s previous responses.
37. Mrs Y moved to residential care following a fall at home in May 2025.
38. In July 2025 Mrs Y’s family met with the Council. The Council then sent a further final complaint response. In this letter the Council said:
• It recognised Mrs Y’s family felt the Council had not provided person centred care, choice or control to Mrs Y when it decided her care needs could be met by a different care provider.
• The transition between different staff within Adult Social Care had caused some discrepancy in the personal budget amounts and led to Mrs Y’s needs not being accurately reflected in assessments.
• The assessments did not reflect Mrs Y’s dependency on consistent staff.
• The transition period of two weeks suggested for the change of care provider was insufficient.
• It apologised for the delay in the Council’s complaint response.
• It had concluded Mrs Y should have been able to remain with her care provider for an extended period of time due to her health deterioration and her ability to engage with new staff. It had requested a learning review of the initial response it had given.

Findings

39. There was a delay of over two months in completing a re-assessment of Mrs Y’s needs between July and September 2024, and a further two month delay in sending a copy of the assessment to Mrs X. This is fault and caused frustration to Mrs X and delayed the development of a care and support plan. In its complaint response the Council acknowledged this fault and apologised to Mrs X, which is a suitable remedy for the injustice caused.
40. Mrs Y began to receive care from the care provider in 2023 when she was discharged from hospital. Mrs Y and her family were made aware at the time that a change of provider may be needed.
41. However, Mrs Y continued to receive care from the provider for over 17 months. Mrs Y and her family were happy with the care provider and Mrs Y had formed a relationship with her carers.
42. After the reassessment in September 2024 the Council did not agree an increase in Mrs Y’s personal budget using the rate of the current care provider. The records from this decision show the Council considered Mrs Y’s anxiety and the relationship she had with her carers.
43. The Care and Support Statutory Guidance allows councils to consider their finances and budgetary position as well as equitable outcomes to ensure fairness in care and support packages across the local population. It was therefore not fault at that point in time to ask Adult Social Care and Mrs Y’s family to consider all available options in how her needs could be met.
44. In the following months Mrs Y’s care needs continued to increase and she had further reassessments and support plans developed. These assessments were completed by different members of staff and resulted in different indicative budgets.
45. At each point Mrs Y’s family were advised they needed to consider a change of provider as the agreed personal budget would not cover the cost of the care package with the current provider. The Council can consider finances and budgetary constraints in its decision making. However, it also needed to consider Mrs Y’s individual needs and preferences. At this point Mrs Y had deteriorating health and complex needs. She had a good relationship with carers who had been supporting her for almost two years and knew her well, and she was known to be anxious with unfamiliarity.
46. There is no evidence to show how these factors were considered when the Council made its personal budget decision at the Care Act Assurance Meeting in December 2024. This is fault and caused frustration to Mrs Y and her family.
47. The assessments and support plans completed between December 2024 and March 20205 appear to add to those previously completed, leading to lengthy documents that did not reflect the complexity of Mrs Y’s current circumstances or her dependency on familiar carers. This is fault.
48. There were significant variations in the indicative budgets calculated in the different support plans and in the personal budgets later determined. This was fault and was caused in part by the number of changes in staff as well as by different interpretations of the information in the needs assessments. This caused uncertainty and confusion for Mrs X.
49. In its final complaint response, the Council acknowledged the assessments did not fully reflect Mrs Y’s needs and concluded Mrs Y should have been able to remain with her care provider for the extended period given the changes to her health. The Council said it would complete a learning review.
50. Between July 2024 and May 2025, the Council continued to consider a possible change of care provider for Mrs Y and it had several discussions with her family. This added to their stress and uncertainty at a difficult time.
51. However, Mrs Y continued to receive care from the same care provider and the Council continued to provide a Direct Payment sufficient to pay for Mrs Y’s care with her current provider until she moved to residential care. Therefore, although there was uncertainty and frustration for Mrs Y and Mrs X there was no further injustice.
52. Mrs Y has since died so I cannot remedy any injustice caused to her by the Council’s faults. However, the faults have caused Mrs X significant uncertainty and frustration.

Complaint Handling

53. Mrs X contacted her MP in October 2024 and in January 2025. The MP then referred these to the Council as service enquiries.
54. The Council took two months to provide a response to the first service enquiry from Mrs Y’s MP. It said this was due to a query about consent to share information. In its complaint response the Council apologised for any confusion or delay caused, which is an appropriate remedy for the injustice caused by the delay.
55. The Council took two months to provide a response to the second service enquiry. This delay was in part due to the Council waiting for correspondence from the MP’s office.
56. Mrs X made complaints to the Council in December 2024 and April 2025. The Council wrote a response to Mrs X’s April complaint after meeting with her in July 2025.
57. There was no separate complaint response to the December 2024 complaint. However, the issues raised are addressed in the December 2024 response to the service enquiry, so I do not find fault in this regard.

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Agreed Action

58. Within one month of the decision the Council has agreed to apologise to Mrs X for the uncertainty and frustration caused by the failure to reflect Mrs Y’s needs in her assessments and support plans and for the variation between her indicative and personal budgets. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology.
59. Within three months of the decision the Council should review the complaint and faults identified around inconsistent indicative and personal budgets and poor quality care plans and produce an action plan of how it will prevent the faults recurring in future. This may be through the learning review it said it would carry out in its final complaint response.
60. The Council should provide us with evidence it has complied with the above actions.

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Decision

61. I find fault causing injustice which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman