Summary: There was a delay in completing a support plan following assessment and increasing the funding as a result. There was also some confusion over activities allowed for Mr X under Direct Payments. The Council backdated some payments to the time of the assessment and has sought to complete a further review but so far without success.

The complaint

1. Mr B (the complainant) complains on behalf of Mr X that the Council delayed in carrying out due processes including achieving the outcomes of a Care Act assessment and failing to use accurate information which impacted on Mr X’s budget. Mr B says it is not sensible to progress the Support Plan review until the completion of this investigation.

Back to top

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)

Back to top

How I considered this complaint

4. I considered evidence provided by Mr B and the Council as well as relevant law, policy and guidance.
5. Mr B and the Council had an opportunity to comment on my draft decision. I considered the comments before making a final decision.

Back to top

What I found

Relevant law and guidance

6. 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.
7. 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.
8. 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.
9. 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.
10. 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.

What happened

11. Mr X is a disabled adult who lives with his elderly parents (who provide informal care). He has a funded package of care from the Council which is paid by Direct Payments. Mr X employs Personal Assistants (PA) and has an annual period of funded respite to enable his parents as informal carers to take a break.
12. A social worker carried out the annual review of Mr X’s eligible needs in June 2023. She recommended an increase in support hours from 49 to 56, and an increase in respite from three weeks to six weeks. However, there was a long delay before this was progressed. The social worker took the proposed increase to a meeting of the Learning Disability Forum in November 2023. She then sent a text to Mr B with incorrect details about support hours and respite payments, which did not reflect her recommendations.
13. Mr B says there were further delays and messages from the social worker in February and April 2024 saying that her limited availability and other work commitments were delaying the process. He says this gave the impression that Mr X’s care was not important.
14. In March 2024 Mr B was told that the increase recommended had been approved by the Learning Disabilities Forum, but he says there was no indication of the remit or responsibilities of this group.
15. The revised support plan was issued in June 2024 with the recommended increases from June 2023 included. The support plan also included a section explaining for guidance how the Direct Payments should be used.

The complaint

16. In December 2024 Mr B complained to the Council. He complained about the unacceptable delay in completing the support plan and the incorrect information sent by text by the social worker. He said despite promises to backdate the payments to the review date this did not happen and Mr X’s mother had covered some costs personally. He also said the family was being chased for the return of money for activities not included in the support plan despite these being used for recommended social activities.
17. The Team Manager responded to the complaint. They agreed there was “an unreasonable delay in progressing the outcome of the Care Act assessment on the 8th June 2023, and the social worker taking the recommended support to the Learning Disability Forum for discussion in November 2023, and it was finally increased on the 1st March 2024.” They apologised for that delay and agreed the payment should be backdated to the date of the assessment when the increase in funded care was identified as an eligible need.
18. In terms of the role of the Learning Disabilities Forum, they described the role and function of the Forum and said it was not a funding panel, but it was there to ensure quality of assessment and outcomes as well as consistency across the county.
19. They apologised for the incorrect texts sent. They said that overall there had been a lack of clarity about what Mr X’s Direct Payments could be used for and that had not been set out properly in the support plan. They said that while there should be flexibility in the use of the payments, they noted that there was evidence that some money had been used to pay for expenses which were not agreed or which were for health services such as podiatry, which they could not be used for.
20. The Team Leader said it would be sensible to draw a line under the situation and for the Council not to reclaim any further expenditure except for the health expenses and a trip to Lourdes, described as respite, for Mr X’s parents. They said the “critical next steps will be to work with the social worker to discuss and agree what support will be considered reasonable going forward and that this is clearly documented in (Mr X’s) support plan. The Direct Payment Advice team will also be able to provide support and advice to ensure that there is clear agreement between the Council and (Mr X’s) representatives in future”.
21. Mr B was dissatisfied with the response and made a further complaint in February 2025. He asked for clarity about the backdated payment. He said the Council was being overly restrictive in its definition of what Direct Payments could be used for in contrast to the statutory guidance.
22. The service manager responded. In terms of the backdated payments, he said the backdated payments would be for the difference in the number of additional support hours that (Mr X) received between 8th June 2023 and the increase being added to the support plan on 1st March 2024. He said this equated to 38 weeks of backdated payment at 7 hours per week. He said the respite payments for three weeks of respite a year were already included in Mr X’s budget and not increased to six weeks until March 2024 so there was no requirement for back payment.
23. The Service Manager agreed that the use of Direct Payments should not be overly restrictive and therefore suggested that the Direct Payments Advice Manager and the allocated worker met with Mr B to discuss a way forward. He concluded, “I would recommend that (Mr X)’s future support plan is very clear about what [his] needs are and how these will be met in future, considering all the available and preferred options for meeting need”.
24. The Council records for April 2025 note there was a “Call from (Mr B) to let me know they will be going ahead with complaint to ombudsman to get final decision before wishing to work on Support Plan”.
25. In May 2025 Mr X’s allocated social worker contacted Mr B to offer a review of Mr X’s support plan. Mr B responded that he had complained to the Ombudsman and thought it was “not necessary to start another review without the contentious issues being resolved first.”
26. Mr B complained to the Ombudsman. He said there was still no completed support plan. He said they wanted a clear plan agreed on what specific activities the support plan would or would not fund. He said the situation had caused stress, anxiety and difficulties in managing an unresolved budget.
27. Mr X’s social worker offered a review again in October 2025 and said a review was necessary to ensure Mr X’s support plan continued to meet his needs.
28. The Council maintains it has continued to offer meetings to conduct the outstanding review of Mr X’s support plan, but these have not been accepted.
29. Mr B says every time a review was offered, the Council agreed with him that it was not sensible to continue until this investigation was completed. Mr B has not provided evidence that was said to him. The documentary evidence I have seen is of the social care team offering to meet Mr B, and his refusals.

Analysis

30. The Council acknowledges there were unacceptable delays after the 2023 assessment before its recommendations were properly addressed. That was fault which caused uncertainty and injustice. During that time Mr B says Mr X’s mother was paying some costs herself (twice weekly respite nights at £50) as the recommended increase was not made at the right time. However, the Council has now provided evidence that it made a one-off direct payment of £4042,38 in August 2025 to Mr X’s account, to cover any respite accessed from June 2023 - March 2024 when his long term Direct Payment began
31. There was a lack of clarity about the role of the Learning Disabilities Forum which Mr B says the family was led to believe was a funding panel, which it was not. While I do not see that caused significant injustice of itself, it added a layer of confusion and uncertainty about the process which was unhelpful.
32. The Council agreed to backdate the payments to the point of the assessment which seems to me to be an appropriate response. It also suggested no further attempts to claw back monies over which there had been disagreements because the existing support plan was not always clear about agreed expenses. In my view it was not fault to seek to reclaim monies spent on health needs which should be the responsibility of the NHS.
33. The situation has stalled because there has been no agreement to meet and discuss the support plan and agreed expenditure going forward pending this investigation. However, it is not the role of the Ombudsman to stipulate the contents of the future support plan or the agreements over Direct Payments. That is for the Council to discuss and agree with Mr X’s representatives. The Council has allocated a specialist Learning Disability Social Worker who has contacted Mr X and his family to complete the review process

Back to top

Action

34. The Council has already made a payment for respite to Mr X but says that it will review any other expenses paid by Mr X’s mother for respite during the period June 2023 to March 2024.
35. Within one month of my final decision the Council agrees to offer £500 to Mr X in recognition of the distress and uncertainty caused by the protracted delay in completing the support plan following the June 2023 assessment;
36. The Council should provide us with evidence it has complied with the above actions.

Back to top

Decision

37. I have completed this investigation on the basis that I find some fault causing injustice, which completion of the recommendations at paragraphs 34-35 will remedy.

Back to top

Investigator's decision on behalf of the Ombudsman