Summary: There was fault by the Council in the review of Mr Y’s care and support plan. It said it needed medical evidence and then did not seek this, it failed to take reasonable steps to reach an agreement with Mr Y about changes to the care and support plan and to his direct payment arrangements. The Council also took too long to issue the revised plan. This caused Mr Y avoidable distress and uncertainty. The Council will apologise, make a symbolic payment and complete further reviews of the care and support plan and direct payment.

The complaint

1. Mr X, a representative for Mr Y complained:
1. the Council reduced Mr Y’s direct payment without taking into account his fluctuating condition and took control of managing payments rather than offering him appropriate support to enable him to continue to do so himself.
2. the reviewing officer did not have any expertise in Mr Y’s health condition and visited him without prior notice.
2. He said this cased avoidable distress and a reduction in services which has affected Mr Y’s health and wellbeing.

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The Ombudsman’s role and powers

3. We make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
4. 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).
5. We provide a free service and so use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any injustice is not significant enough to justify our involvement.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

6. 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

7. I investigated complaint (a). I did not investigate complaint (b) because there is no fault in a reviewing officer not being an expert in a health condition and no significant injustice in an unannounced visit.

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How I considered this complaint

8. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
9. Mr 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

Relevant law and guidance

10. The LGSCO’s Principles of Good Administrative Practice say we expect councils to act fairly and proportionately, to be open and accountable and be citizen-focused. This includes:
• Explaining clearly the rationale for decisions and recording them
• Keeping proper and appropriate records
• Dealing with people promptly
• Ensuring they can access services easily.
11. Direct payments (DPs) are money a council gives to an adult to arrange their own care and support.
12. A care and support plan is a document describing a person’s needs identified by the council in their social care assessment. The plan explains if the needs meet national eligibility criteria and how the council intends to meet those needs. If some or all needs are to be met by a DP, the care and support plan sets the amount and frequency of payments. (Care Act 2014, section 25)
13. Councils should keep care and support plans under review (Care Act 2014, section 27). Statutory Guidance explains a council should review a care and support plan at least every year, upon request or in response to a change in circumstances (Care and Support Statutory Guidance, paragraph 13.32)
14. A council should revise a care and support plan where circumstances have changed in a way that affects the plan. Where there is a proposal to change how to meet eligible needs, a council should take all reasonable steps to reach agreement with the adult about how to meet those needs. (Care Act 2014, sections 27(4) and (5))
15. A council must be satisfied the person can manage the DP themselves, with help and support if need be. Councils should take all reasonable steps to provide support. Guidance says many councils contract with voluntary agencies to provide advice and support to DP recipients. (CSSG paragraph 12.21)
16. A council must also be satisfied the DP is being used to meet care and support needs set out in the care and support plan. Regulations say a council must proportionally monitor usage, at least each year, to make sure they remain an appropriate way of meeting needs (CSSG paragraph 12.24)
17. Reasonable adjustments are changes that service providers (including councils) must make to ensure disabled people are not disadvantaged using services. Examples include providing equipment, improving access or changing policies and procedures. (Equality Act 2010, section 20)

What happened

18. Mr Y is eligible for care and support and receives a DP from the Council which he uses to arrange and fund his care and support.
19. Mr Y signed a DP agreement in 2012 saying he needed to keep invoices, bills, bank statements, payroll records and a record of assistance he had paid for with the DP. The agreement does not say Mr Y could use cash to pay personal assistants. The Council told me it had no evidence any of its officers told Mr Y he could pay his personal assistant in cash.
20. Mr Y’s DP was for 18 hours of care and support a week. The Council carried out a review of Mr Y’s care and support plan and of his DP usage in February 2025. The review noted:
• Mr Y did not need any support around communication
• Mr Y said his illness was getting worse with age, he had more frequent episodes of ill health and his memory was declining. He said he just got on with it if he was alone.
• He declined equipment – fall and bed sensors. He said he had learned to manage without them
• Mr Y said he had support to access the community to walk his dogs, with shopping and meal preparation and with managing finances. He said he paid for this support in cash. He said the previous worker told him cash payments were allowed.
• He reported regular seizures, but this was not reflected in ‘Cerner’ (Cerner is the NHS electronic health record)
• Further medical information from the GP was required to support the information gathered in the review
• Mr Y also said he did not invoice PAs.
• There were concerns about mishandling the DP. He would benefit from a council-managed account.
• He had eligible care needs in:
1. Managing and maintaining nutrition
2. Maintaining a habitable home
3. Making use of necessary facilities or services in the local community
21. Mr Y signed a DP agreement in June 2025. It set out the reduced funding of 10 hours a week the Council had agreed from April 2025.
22. Mr X complained to the Council about the matters he has raised with us. The Council’s response in June 2025 said:
• Mr Y has no medical evidence to support his claim his condition had worsened.
• Mr Y said he had several staff who supported him with daily tasks, but he could not confirm who these were. He refused to provide evidence. He said he paid those supporting him in cash. Mr Y said he did not know he was not allowed to pay them in cash.
• The Council could not therefore establish that the DPs were being used for their intended purpose.
• Council officers are not medical experts, but they may use medical evidence to make informed decisions about how much care and support a person requires.
• The reduction in care and support was based on observation of Mr Y. He was observed to be mobile, to be able to transfer without aids and to support pets and children. He was able to complete more tasks than previously assessed. He said he could provide childcare, care for pets, attend appointments independently, manage bills and shopping.
23. The Council issued a revised care and support plan in August 2025. It set out Mr Y’s direct payment which was reduced (because the Council had reduced Mr Y’s hours) from April 2025. The plan summarised Mr Y’s needs and intended outcomes.
24. The Council told me:
• The reduction in hours was not based on medical evidence but on information Mr Y provided in the review.
• Mr Y was offered a council-managed DP account to support him making payments to his PA with a clear audit trail so that he does not have to send in bank statements as evidence of payment.
• There are several ways Mr Y can receive his DP and these can be discussed during his next review which has been scheduled to take place shortly.

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Findings

25. There was fault by the Council in the process of reviewing and revising Mr Y’s DP and care and support plan as follows:
• It failed to seek evidence from Mr Y’s GP despite the reviewing officer stating on the review form that further evidence from the GP was needed. The reviewing officer appears to have accessed unidentified information on the NHS system, but the review form did not note what information they considered. This was not in line with our Principles of Good Administrative Practice which expect full records to be kept of decision-making.
• It decided to provide Mr Y with a council-managed DP without consulting with him about whether he could manage the DP himself with additional support short of a fully council-managed account. This was not taking reasonable steps to reach an agreement before making a revision to the care and support plan and was therefore not in line with the requirements in Section 27 of the Care Act as I have set out in paragraph 14. The Council also failed to consider whether it could make any adjustments to its procedures short of imposing a managed account on Mr Y. This was inflexible, not citizen-focused and indicates a failure to consider making reasonable adjustments in line with section 20 of the Equality Act.
• It took between February and August 2025 to issue a revised care and support plan with reduced hours. The revised plan should have been issued at the same time as the new direct payment agreement Mr Y signed in June 2025. The delay was not citizen-focused.
• It decided to implement a council-managed DP account without first taking reasonable steps to provide Mr Y with support (for example by offering Mr Y a direct payment support service). This was not in line with paragraph 21.21 of CSSG.
26. We cannot reconstruct flawed social care reviews or direct payment reviews. I cannot say on a balance of probability that the outcome would have been any different without the fault I have identified. But there is injustice for Mr Y: avoidable distress and uncertainty about the outcome had the Council acted without fault.
27. I can conclude on a balance of probability that Mr Y was not told he could pay his PA’s in cash as there is no evidence of this in the Council’s records and this is against the DP agreement he signed.

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Agreed Action

28. The Council has already scheduled Mr Y’s yearly review which is an action I would have recommended and is a partial remedy. In addition, within one month of my final decision, the Council will:
• Apologise to Mr Y for the avoidable distress and uncertainty. 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 I have recommended in my findings.
• Make Mr Y a symbolic payment of £250 to reflect the avoidable distress and uncertainty.
• Complete the yearly review of Mr Y’s care and support plan and DP that is now due. In doing so, the Council will:
1. Obtain written information from Mr Y’s GP about his health condition and whether or not it has declined in the last two years and the likely impact of this.
2. Have a discussion with Mr Y about what support he needs to manage his DP and seek to reach an agreement about DP support. If agreement cannot be reached, the Council should write to Mr Y with its decision, giving reasons.
29. The Council should provide us with evidence it has complied with the above actions.

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Decision

30. I find fault causing injustice. The Council has agreedactions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman