Summary: The Council was at fault for not ensuring Ms X received the care in her care plan after it was finalised. This meant Ms X was without care for a period of time. The Council was not at fault for how it carried out its financial assessment and how it considered Ms X’s disability related expenses. The Council agreed to apologise, make a payment for the distress caused, backdate some of Ms X’s disability related expenditure and carry out a service improvement.

The complaint

1. Ms X complains about the lack of care and support provided to her by the Council namely;
1. The Council did not provide her with a personal assistant, and it took a long time for her to start to receive some care.
2. The Council did not provide her with assistance to manage her direct payments and did not provide paperwork to explain how direct payments worked.
3. The Council is charging her too much for her care.
4. The Council did not properly consider some of her disability related expenditure.
2. Ms X says this situation is impacting her wellbeing and she has had to ask friends for help with her care needs.

Back to top

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)

Back to top

How I considered this complaint

6. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
7. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

Back to top

What I found

Law and guidance

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.
10. 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.
11. 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. (Care and Support Statutory Guidance 2014)
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.
13. The gateway to receiving a direct payment must always be through the request from the person. Councils must not force someone to take a direct payment against their will. They should not place someone in a situation where a direct payment is the only way they can get personalised care and support.
14. Councils must tell people during the care planning stage which of their needs direct payments could meet. However, councils must consider requests for direct payments made at any time and have clear and quick procedures in place to respond to them.
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. (Care and Support Statutory Guidance 2014)

Charging for social care services: the power to charge

17. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
18. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
19. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
20. Councils can take disability-related benefit into account when calculating how much someone 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. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.

What happened

21. In February 2024, the Council carried out an assessment of Ms X’s care needs. The Council decided Ms X had care needs and needed help with maintaining a habitable home, personal hygiene and managing good nutrition. The notes from the assessment showed the Council discussed direct payments with Ms X. The Council agreed a care and support plan which included a direct payment for 20 hours care per week where Ms X could employ a personal assistant. The Council assessed this at just under £340 per week.
22. The Council sent the direct payment forms to Ms X who signed and returned them in February 2024. The Council referred Ms X to a provider who would look for a personal assistant for her and carry out the advertising.
23. In April 2024, the Council completed its financial assessment for Ms X and decided she had to pay just over £100 per week towards the costs of her care. The Council sent Ms X its calculation as to how it had arrived at this figure.
24. Between April 2024 and July 2024 telephone notes between Ms X and the Council showed Ms X was yet to receive a personal assistant and was not getting any of the care in her care plan. In September 2024, the Council visited Ms X as she had just moved to a new home. During the visit the Council agreed to give Ms X a one off payment she could use towards a suitable oven. The Council also offered to put in place a package of care for Ms X as she had not got a personal assistant yet. Ms X declined this.
25. In December 2024, Ms X complained to the Council as she had no care. The Council allocated this complaint to someone else’s file in error and it was not responded to.
26. The Council visited Ms X in March 2025, to assess her needs along with an occupational therapist. The notes from the assessment do not mention the issue Ms X had with finding a personal assistant or consider whether her care package was working.
27. In early June 2025, the Council commissioned another provider to provide a personal assistant to Ms X. The Council carried out a further financial assessment to decide how much Ms X should pay towards her care. The Council decided she should be paying just over £110 per week and sent her a letter to notify her of this.
28. In July 2025, Ms X complained to the Council again. Ms X told the Council the costs of her care were too high and she was not getting the care she should have as the provider supplying a personal assistant cannot supply 20 hours per week.
29. At the end of July 2025, the Council responded to Ms X’s complaint. The Council said it assessed Ms X for a direct payment to cover 20 hours of care per week. Initially it asked a provider to supply her with a personal assistant but this provider was unable to do so. The Council said it then commissioned another provider to provide 20 hours of care for Ms X consisting of 13.5 hours for personal care and 6 hours for shopping and cleaning.
30. In early August 2025, Ms X asked the Council to consider her complaint at the next stage of its process. Ms X said she could not afford her care contribution and a lot of expenses she has relating to her disabilities were not included in her financial assessment.
31. The Council reviewed Ms X’s DRE in August 2025. The Council considered payments she was making for assistance dogs and payments for a wheelchair. The Council decided it did not believe the payments for assistance dogs were DRE as they were not linked with her support plan. The Council also said the wheelchair was provided by the NHS so it had the responsibility to service it.
32. In early September 2025, the Council provided its final response to Ms X’s complaint. The Council said the delay getting care was because the provider could not find her a personal assistant. The Council said it would carry out a re-assessment of her needs which would include a new financial assessment.
33. The Council reassessed Ms X’s needs in September 2025. The notes from this assessment showed Ms X was only using a personal assistant for two hours per week and felt she was unable to pay the client contribution towards her care. Ms X was also training two dogs to be assistance dogs for her and purchasing medical cannabis to help meet her needs. The Council decided to keep the direct payment hours at 20 per week and to consider whether the dog training and medication could be DRE.
34. In October 2025, Ms X sent the Council a completed DRE expenses form and evidence of the payments she was making for dog training and medical cannabis.
35. In February 2025, the Council decided the dog training could be treated as DRE but the medical cannabis was an unregulated health expense so it would not treat this as DRE. The Council wrote to Ms X and told her the new weekly contribution she needed to pay towards her care. This was just over £100 per week.

Analysis

Providing Ms X with a personal assistant

36. Once Ms X received a care plan in February 2024, she should have been receiving care. The Council should have initially ensured there was a clear plan for Ms X in the absence of a personal assistant and I cannot see that it did. This was fault.
37. After the Council set up Ms X’s care plan it asked a provider to find her a personal assistant. There were significant delays with this and ultimately the provider was unable to find Ms X a personal assistant. The records showed that the Council was aware from April 2024 that Ms X did not have a personal assistant in place and there are records of telephone conversations over the next months between the Council and Ms X where she raised having no care as a concern.
38. In September 2024, the Council did offer Ms X an alternative package of care, however she refused this. Following this it was not until June 2025, that the Council commissioned another provider to supply a personal assistant. As a result, Ms X spent a significant amount of time without any care.

Providing Ms X with information about direct payments

39. The notes in Ms X’s care assessment said she had received a direct payment for care several years ago so was familiar with the process. The records showed the Council sent Ms X a direct payment form to sign and complete shortly after completing her care assessment. This gave her information and guidance about managing direct payments. I do not consider the Council was at fault for not initially supplying Ms X with information about her direct payments.

Costs of care

40. Ms X said she cannot afford her care costs and believes the Council is charging her too much. It is for the Council to decide on how much Ms X should pay towards her care, not the Ombudsman. Our role it to look at how the Council calculated Ms X costs and see if there was any fault in the process. From the information provided the Council wrote to Ms X in April 2024 setting out how much she had to pay towards her care and provided her with the details of how it came to that figure including how it assessed her income and expenses.
41. After the Council reassessed Ms X’s needs in September 2025 it again wrote to her setting out how it decided how much she would have to contribute towards her care. I do not consider the Council is at fault for how it has calculated how much Ms X should pay.

Disability related expenditure

42. Ms X said the Council has not included some of the disability related expenditure when deciding how much she should pay for care. Initially Ms X sent the Council information about items she wanted considered as DRE in summer 2025, namely assistance dogs and her wheelchair. The Council considered her request and decided not to allow these items as DRE. The Council provided reasons for its decision.
43. After reassessing Ms X in September 2025, the Council decided to include her assistance dogs training as DRE in February 2026. From the records it was not clear why this item was allowed from February 2026 after being previously rejected or whether these costs had been backdated.
44. Ms X also asked the Council to consider her medical cannabis prescription as DRE. The Council decided not to include this as it was not a regulated health expense. I am satisfied the Council has properly considered whether to include this item as DRE.

Complaint handling

45. The Council was at fault for how it handled Ms X’s initial complaint. Ms X complained to the Council in December 2024, however the Council attached the complaint to someone else’s case and as a result it was not responded to. This meant Ms X did not get a response to her complaint and had to raise a further complaint.

Back to top

Recommended Action

46. Within one month of my final decision the Council should carry out the following:
• Apologise to Ms X for the injustice caused to her by the above faults.
• Pay Ms X £200 to recognise the distress and anxiety caused to her as a result of the delays arranging a personal assistant to provide care for her. In coming to this figure I considered the Council offered an alternative package of care several months after Ms X’s care plan should have been in place.
• Offer to backdate Ms X’s costs for training her assistance dogs to when she first asked for this as DRE. If the Council needs further information from Ms X to do this it should write to her clearly setting out what it needs.
47. Within two months of my final decision the Council should:
• Ensure it puts in place measures to monitor whether someone who is in receipt of direct payments is getting offered the care in their care plan after it has passed them to an organisation to find a personal assistant.
48. The Council should provide us with evidence it has complied with the above actions.

Back to top

Decision

49. I find fault causing injustice. The Council agreed to the above actions to remedy the injustice caused.

Back to top

Investigator's decision on behalf of the Ombudsman