Summary: Miss X complained about the way the Council reduced her support from 35 to 14 hours per week. She also complained about the way the Council’s staff treated her during the review meeting. We found fault in the way the Council carried out a review of Miss X’s care and support plan and the way it had responded to her complaint. The Council’s fault caused injustice to Miss X as for many months she did not have adequate support and had to rely on her adult son. The Council has already reviewed its decision on Miss X’s support and reinstated her previous hours. The Council has agreed to apologise, make a payment to recognise Miss X’s injustice and remind its staff of what they should include in the review of care and support plans.

The complaint

1. Miss X complains about the way the Council reduced her direct payments for paid support from 35 to 14 hours. She says it failed to account for her not being able to employ suitable personal assistants. Miss X also complains about the way the Council’s staff treated her at the review meeting.
2. Miss X says the Council’s sudden decision caused her to have a seizure. She says she was caused harm, loss and injury.

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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. When considering complaints 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.
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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How I considered this complaint

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

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What I found

Law and guidance

9. The Care and Support Statutory Guidance (the Guidance) provides details of councils’ duties towards their residents with eligible social care needs and rules for carrying out reviews of their care and support plans.
10. Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan or support plan in the case of carers. (paragraph 10.1)
11. Ultimately, the guiding principle in the development of the plan is that this process should be person-centred and person-led, in order to meet the needs and achieve the outcomes of the person in ways that work best for them as an individual or as part of a family. Both the process and the outcomes should be built holistically around people’s wishes and feelings, their needs, values and aspirations, irrespective of the extent to which they choose or are able to actively direct the process. (paragraph 10.5)
12. The purpose of the care and support planning process is to agree how a person’s needs should be met, and therefore how the local authority will discharge its duty, or its power, to do so. (paragraph 10.10)
13. Local authorities are not under a duty to meet any needs that are being met by a carer. The local authority must identify, during the assessment process, those needs which are being met by a carer at that time, and determine whether those needs would be eligible. But any eligible needs met by a carer are not required to be met by the local authority, for so long as the carer continues to do so. (paragraph 10.26)
14. When the person has fluctuating needs, the plan should make comprehensive provisions to accommodate for this, as well as indicate what contingencies are in place in the event of a sudden change or emergency. (paragraph 10.44)
15. Reviews should be proportionate to the needs to be met, and the process should not contain any surprises for the person concerned. Periodic reviews and reviews in general must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstance. (paragraph 13.33)

Complaint procedure for Adult Social Care

16. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 sets out the process local councils and health care services must follow when responding to certain complaints.
17. The council must provide the complainant with a written response signed by the “responsible person” which includes:
• a report setting out:
1. how the complaint was considered; and
2. the conclusions reached and any action needed;
• confirmation that the council is satisfied than any action needed has been taken or is proposed to be taken;
• the complainant’s right to complain to the Local Government and Social Care Ombudsman (LGSCO).

What happened

Background

18. Miss X is a full-time wheelchair user with complex physical and mental health profile. She is under care of five different consultants. She lives with two sons, one of whom is of compulsory school age. Until October 2024 Miss X was receiving direct payments for 35 hours of weekly support.
19. To manage her direct payments Miss X was using an independent service (the Agency).

Review of direct payments

20. At the end of April 2024 the Council’s Independence and Wellbeing Practitioner (the Assessor) introduced herself to Miss X. The Assessor told her she would be reviewing her care and support plan and direct payments in mid-May.
21. In the third week of May the Assessor held a meeting with Miss X and reviewed her care needs. She found Miss X could not achieve most of her daily living activities without support from her personal assistant (PA) or her son. Miss X had been using her direct payments in line with her care and support plan. Since she had moved to a new house, she could not find a new PA in her area and asked the Agency to advertise for the role. There were weeks when she did not have the PA support. As for a few months Miss X had not been using 35 hours of support she had funding for, the Council considered it should carry out a reassessment of her care needs.
22. From the end of June the Assessor tried to arrange a home visit with Miss X.
23. At the beginning of July Miss X told the Assessor to contact the Agency to confirm she could not find a new PA to help her. Miss X was concerned she had excess funds in her account and wanted the Council to recoup them. The Assessor explained the process to her.
24. The Council’s finance officer (the Finance Officer) sent a direct payments financial review letter to Miss X asking for information from the beginning of the year. In mid-July the Agency sent its calculations. Miss X was receiving direct payments for 35 hours of support per week.
25. At the end of July the Assessor booked a home visit with Miss X for mid-August to discuss her care needs and hours of support needed. During a telephone call the Assessor told Miss X to prepare information about her medical appointments for the meeting.
26. The Council’s panel considered Miss X’s case at the end of July 2024. The continuation of direct payments for 35 hours a week was agreed as a temporary measure until the end of August. The panel asked that the Council’s staff liaise with Miss X and her PA to get a detailed breakdown of Miss X’s daily routine to understand better the use of 35 hours of support.
27. The Finance Officer called Miss X to remind her of the need to send direct payment information for the review. Miss X said she would try to get all documents needed and pass them on to the Assessor during the home visit.
28. At the beginning of August 2024 the Council carried out financial review of Miss X’s direct payments. Two weeks later the Finance Officer confirmed there were no concerns about the use of direct payments. The Finance Officer told Miss X the money in her direct payment account exceeded four to eight-weekly amount of contingency funding. She, therefore, needed to return this excess. The Council also stated that it was reviewing Miss X’s care and support plan.
29. In mid-August 2024 the Assessor and a locum social worker (the Social Worker) visited Miss X. The Council’s case notes hold description of the meeting. We also have Miss X’s account.
1. The Council’s case notes; the visit was to check whether Miss X continued to need 35 hours of weekly support as in the past year she had been using 14 hours a week. Miss X told the Social Worker that the following day a new PA was starting to support her for 35 hours a week. She said how she had found life difficult when she had not had enough support and had struggled to recruit staff. The Social Worker suggested considering the managed service if Miss X had been struggling with direct payments. Miss X said she needed seven hours a day of external help. During this meeting Miss X had a seizure but remained conscious. She declined the Social Worker’s offer to call an ambulance. Miss X’s son came to support her. The Social Worker said she would refer Miss X to an advocacy service and would come back later. The Assessor and the Social Worker waited until Miss X recovered from her seizure. Miss X was visibly upset and told the Council’s staff to leave;
2. Miss X’s account; Miss X was not aware of the purpose of this meeting. She did not know that, besides the Assessor, another person would be attending. The meeting continued despite her stating she was not feeling well. Miss X found the way the Assessor and the Social Worker asked her questions intimidating. Being overwhelmed and stressed triggered Miss X’s seizure. Miss X felt treated without respect and dignity.
30. At the end of August the Assessor referred Miss X to an advocacy service.
31. At the beginning of September the Council told Miss X that although it had recovered the excess funds from her pre-paid card, it left her with a contingency of at least eight weeks’ worth of direct payments funds.
32. An advocate appointed for Miss X contacted the Assessor in mid-September 2024. After talking to Miss X the advocate told the Assessor Miss X was happy to engage with a social care review. She was asking, however, for a change of her social worker (meaning the Assessor). She also asked for the name of the Social Worker as this person had not been introduced to her at the meeting.
33. A few days later Miss X gave consent for the Council to share her personal information with her advocate.
34. At the beginning of October the Assessor sent a reviewed care plan with a starting date of mid-October 2024 to Miss X’s advocate. The plan did not record any changes in Miss X’s needs. The document stated:
• Miss X was using 14 hours of weekly support on average;
• Miss X worried about the impact on her older son of her reliance on his support when PA was unavailable. She needed help with maintaining her home, preparing meals, all personal hygiene, appointment attendance and community engagement.
35. The Council decided to fund support for 14 hours a week for Miss X. The Assessor confirmed the Council would be reviewing Miss X’s request for a change of social worker.
36. The advocate complained on behalf of Miss X as:
• Miss X had a contract with her PA. Reducing direct payments with a short notice would not allow her to give a four-weeks notice to her PA;
• support plan included wrong information and did not accurately reflect her needs;
• Miss X did not have opportunity to take part fully in reassessing her needs. After appointing an advocate for her the Assessor did not set up any further meetings. The support plan inaccurately claimed Miss X’s advocate was involved in the review of Miss X’s care plan.
• reducing direct payments would expose Miss X to the risk of having her needs unmet. Miss X had been receiving 35 hours of weekly support since mid-August 2024.
37. In mid-October the Assessor told Miss X’s advocate:
• Miss X could use the money in her account to give notice of the decrease in weekly hours to her PA;
• the Council would assign a different social worker to Miss X;
• Miss X was fully involved in the review of her support plan. During a telephone call the Assessor told her the Council’s panel had not agreed her current hours of support and this would be discussed at the meeting in August.

Complaint

38. In mid-November 2024 Miss X raised a formal complaint. She complained about the way the Council carried out her recent Care Act review. She said she did not know why the Assessor set up a meeting in mid-August 2024 and that another member of the Council’s staff would be attending. During the meeting Miss X had a seizure and found the Council’s staff response upsetting and unhelpful. Miss X also complained about the short notice of the cut in her weekly hours of support from 35 to 14. Miss X raised the inaccuracy of her new support plan and that her newly appointed advocate could not support her during the review process. Her new care package did not allow any flexibility. Miss X asked for a new assessment of her care needs, a change of her social worker and an apology for her treatment during the meeting in August 2024.
39. A month later a Direct Payments Review Team Manager responded to Miss X’s complaint. She did not uphold the complaint explaining how she considered the Council followed the correct process. The manager stated the Council would comply with Miss X’s request and an alternative practitioner from a different team would review its recent decision on Miss X’s direct payments.
40. Miss X asked the Council to take her complaint further in the third week of January 2025. The Council sent its response nine days later. The response was not signed.

Later events

41. In February 2025 the Council assigned a new social worker for Miss X to replace the Assessor. Miss X’s hours of weekly support started increasing and in July 2025 the Council confirmed she would get direct payments for 35 hours of support weekly from the end of May 2025.

Analysis

Care and support plan review

42. As explained in paragraphs 11 and 12 the process of preparing care and support plan should aim at finding the best way of meeting the person’s needs to achieve the outcomes identified for them. Where relevant, councils should consider the person as part of the family. Councils should also identify which needs are being met by a carer.
43. The review of Miss X’s direct payments was triggered by Miss X using only part of her direct payments to fund her support. This situation lasted for many months. Miss X was using on average 14 hours out of 35 hours agreed. This happened because of her difficulties in finding a PA. In such circumstances the Council acted properly arranging a review of Miss X’s care and support plan.
44. At the end of July 2024 the Council considered Miss X’s case at its panel meeting. It asked the Assessor to liaise with Miss X and her PA to get a detailed breakdown of Miss X’s daily routine to understand better the use of 35 hours. This did not happen. There is no evidence that during the meeting in mid-August 2024 the Assessor and the Social Worker were exploring how many hours of daily support Miss X needed and what happened when she could not find a PA for 35 hours a week. The Assessor and the Social Worker failed to check how the reduced support affected Miss X and her family. It did not explore whether some of her needs were left unmet or were met by her sons. In Miss X’s care and support plan from the beginning of October 2024 the Assessor recorded her concern about putting too much strain on her older son but left this issue unaddressed.
45. The Council’s failings during the review of Miss X’s care and support plan are fault. They caused injustice to Miss X as she was extremely distressed at the reduction of her support. She did not consider she was treated fairly and the due process was followed.
46. If the Council had carried out the process properly, on the balance of probabilities it would have likely decided to keep 35 hours of PA support for Miss X. This is because in July 2025 the Council decided to reinstate 35 hours a week of PA support from the end of May 2025. The lack of the adequate support from mid-October 2024 to the end of May 2025 meant Miss X struggled to get her needs met. She told us she had been unable to attend some of her medical appointments and treatments. She also had to rely too much on her son, which affected his mental health and well-being. Besides Miss X’s PA, who had agreed to support her for 35 hours a week from mid-August 2024, left following decrease in her weekly hours and Miss X again faced difficulties in finding a new PA to replace her.
47. At the beginning of October 2024 the Council told Miss X it would be reducing her PA hours from 35 to 14. This did not allow Miss X to give her PA four-weekly notice and is fault. This fault did not cause, however, injustice to Miss X as the Assessor told her advocate that Miss X could use extra money from her direct payment account to give notice to her PA.

Review meeting in mid-August 2024

48. I cannot decide, even on the balance of probabilities, whether the Assessor and the Social Worker treated Miss X without respect during the meeting in August 2024 or whether this was her perception caused, in some part, by the matters discussed. The Assessor communicated with Miss X from April 2024 and held a meeting with her in May. The tone of any written communication was polite and respectful. The Assessor changed a meeting date a few times to suit Miss X’s other engagements.
49. The Assessor called Miss X at the end of July 2024 to arrange a meeting in August. It is more likely than not that the Assessor would have explained the reasons for this meeting to Miss X.
50. It would have been good practice to advise Miss X in advance that there would be another person attending the meeting but the failure to do so was not significant enough to amount to maladministration.

Advocacy

51. At the meeting in August the Social Worker suggested Miss X’s referral to the advocacy service to support Miss X’s engagement with the Council. Miss X was unhappy the Council had completed the review of her care and support plan without her advocate’s participation.
52. I did not find fault with the Council’s action. There was no concern about Miss X’s mental capacity or ability to express her views and wishes. Up until August 2024 she successfully engaged with the Council. Because of her distress at the meeting in August, the Assessor and the Social Worker were concerned about the potential impact of Miss X’s interactions with the Council’s staff on her health and decided to allow her to have support for the future interactions.
53. The Council failed, however, by not giving Miss X an opportunity to explain all her circumstances and needs. As pointed out under paragraph 29 (a) at the end of the meeting in mid-August the Assessor and the Social Worker said to Miss X they would come back later. This implies the meeting was not conclusive.
54. The Council’s premature completion of Miss X’s care and support review was fault. This fault caused her distress and uncertainty of how the further discussion would have impacted the conclusion of the review.

Complaint

55. The Council’s process for handling complaints about its Adult Social Care services is explained in the “Policy for Adult and Community Services”.
56. The Policy states:
• the statutory timescales for responding to complaint are 65 days;
• usually an initial response would come from a service area manager. The Council will aim to respond within ten working days although it may take up to 20 working days or more for complicated issues;
• if the complaint is not resolved at the initial stage, the complainant can ask for an In Depth Investigation;
• the In Depth Investigation is carried out by an Investigating Officer (and an Independent Person if appropriate) and should normally be completed in 25 working days. This may be extended to a maximum of 65 working days.
57. I did not find fault with the Council’s first response to Miss X’s complaint. The Council’s policy specifies that at the early stage a team manager will respond, and this is what happened for Miss X’s complaint.
58. Councils have some flexibility when deciding how they will consider complaints about its Adult Social Care services. Although the Regulations mentioned in paragraph 16 set out a single stage complaint process, councils may progress a complaint through different internal processes during the six month period to try to resolve matters as quickly as possible.
59. After its first response the Council failed, however, to follow the process described in paragraph 17. Specifically the Council failed to:
• ensure a “responsible person” signed the Council’s complaint response;
• prepare a report setting out how it considered the complaint; and
• confirm it was satisfied than it had taken any action needed or had proposed to take them.
60. The Council’s failings when responding to Miss X’s complaint are fault. Any injustice caused to Miss X was mitigated by the Council completing two of the three actions Miss X asked for. The Council replaced the Assessor with a different member of the Council’s staff to communicate with Miss X. It also undertook to review its decision reducing Miss X’s hours of PA support.

Service improvements

61. Following our decision issued in August 2025 the Council agreed to review its arrangements for responding to Adult Social Care complaints to ensure they were consistent with the expectations we publish. It will take some time for the Council to implement any changes following this review. We will monitor the effectiveness of the Council’s actions through our casework.

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Action

62. To remedy the injustice caused by the faults identified, we recommend the Council complete within four weeks of the final decision the following:
• apologise to Miss X for the injustice caused to her by the faults identified. 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;
• pay Miss X £1,000 to recognise the distress caused to her by the Council’s failing within the review of her care and support plan.

The Council will provide the evidence that this has happened.

63. We also recommend the Council within three months of the final decision remind the members of the Adult Social Care team who carry out reviews of people’s care and support plans of the importance of considering whether any proposed support meets their needs in order to achieve outcomes identified for them. The Council will also remind the staff about the requirement to specify which needs are met by the person’s carer and whether those needs would be eligible. The Council should provide us with evidence it has done so.

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Decision

64. I find fault causing injustice. The Council has accepted my recommendations so this investigation is at an end.

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Investigator's decision on behalf of the Ombudsman