Summary: The Council was at fault for reducing Ms Y’s care package without carrying out a proper and up-to-date reassessment of her needs. It failed to adequately assess and evidence her night-time support needs, did not complete a clear risk assessment, and made its decision while key uncertainties remained.

The complaint

1. Mr X complains on behalf of his sister, Ms Y. He says the Council reduced Ms Y’s care and support package without undertaking a reassessment of her needs. He says the Council did not give due consideration to relevant and available professional evidence, including information provided by a specialist learning disability nurse at Ms Y’s GP practice.

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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 an injustice, 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 have considered all the information provided by Mr X together with the Council’s response to the complaint and information provided by the Council to this office. I have also taken account of relevant legislation. Both Mr X and the Council had the opportunity to comment on a draft of this document and consideration has been given to the comments made.

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What I found

Relevant legislation

5. A council must carry out an assessment of any adult who seems to need care and support. 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 appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). Having identified eligible needs through a needs assessment, the council has a duty to meet those needs. (Care Act 2014, section 18)
6. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. The care and support plan should consider what 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. 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. The Care and Support Statutory Guidance sets out that authorities should conduct a periodic review of the care and support plan. It says ‘The periodic review 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’.

Background

8. Ms Y is a woman in her thirties with a learning disability and additional health conditions. She lives in self-contained accommodation as part of a supported living scheme. Ms Y maintains regular contact with her family, with whom she has a close relationship.
9. A needs assessment completed by the Council in October 2020 records that Ms Y has a diagnosis of severe anxiety, which is triggered by any disruption to her established routine. The assessment is detailed and comprehensive and identifies that Ms Y requires support across all areas of daily living. It provides a structured breakdown of her support needs in relation to different aspects of day-to-day life.
10. The assessment records that Ms Y can be left alone in her flat for short periods each day. During these times, she frequently uses video calls to contact her mother, which provides reassurance and helps her to feel safe. It notes that, due to Ms Y’s anxiety, any periods spent alone must be carefully planned and tailored to support her emotional and mental wellbeing.
11. Neither the assessment nor the support plan records Ms Y’s overnight support needs.
12. A review of Ms Y’s needs, completed in December 2024, records her needs to be largely unchanged and that her personal budget (direct payment) was being used appropriately. The reviewer noted that Ms Y expressed a wish for additional hours to support her social wellbeing needs and to assist her in developing relationships.

Events from 2025

13. In January 2025, Mr X contacted the Council to request additional hours to support administration tasks for Ms Y. At that time, Ms Y was in receipt of 45 support hours per week, comprising 35 social hours and 10 unsocial hours, together with 63 hours of sleep-in support per week, in addition to transport costs for Ms Y’s personal assistant. The Council declined the request.
14. On 31 January 2025, the Council emailed Mr X requesting clarification regarding Ms Y’s night-time support needs. The Council stated that, in the absence of supporting evidence, it proposed undertaking monitoring of Ms Y during the night to help establish her support requirements.
15. Mr X declined this proposal, stating that it would be intrusive. He also advised that, in his understanding, such monitoring is typically used to assess waking night support needs, whereas Ms Y was in receipt of sleep-in support rather than waking night support.
16. An officer from social services was allocated to undertake a further review of Ms Y’s needs. The officer contacted Mr X to explain her role and requested a meeting with Ms Y to review her support needs.
17. Mr X queried the necessity of a further review, noting that a review had recently been completed in December 2024. He reiterated his concerns that additional assessment activity may cause Ms Y distress and requested that reasonable adjustments be made. In particular, he asked that any enquiries be directed through him or Ms Y’s personal assistants.
18. The officer responded that the Council was required to ensure that funding for a person’s eligible care needs was appropriate. She advised that a more detailed care plan was required to support the continuation of funding.
19. Mr X continued to challenge the need for a further review. The officer advised that the Council could not justify the current level of funding without a clear understanding of how it was being used. The officer requested that Mr X provide medical evidence to substantiate Ms Y’s need for night-time care and asked for details of the healthcare professionals involved in Ms Y’s care.
20. In March 2025, the Council contacted the NHS learning disability service and in April Ms Y’s GP to request health information about Ms Y. The Council says that it did not receive a response from the GP.
21. On 28 May 2025, the Council contacted Mr X to notify him that it intended to reduce Ms Y’s support hours and adjust her direct payment with effect from 2 June 2025.
22. Mr X submitted a formal complaint to the Council, stating that the decision had been made without due process and was therefore unlawful. He referred to the absence of a reassessment and to what he considered a lack of evidence to justify any reduction in Ms Y’s assessed needs .He said the Council had failed to properly consult and to make reasonable adjustments for Ms Y. Mr X said that the proposed reduction in support would risk the breakdown of Ms Y’s care arrangements and leave her without adequate care.
23. Mr X confirmed that he had contacted Ms Y’s GP and the community learning disability nurse to request information relating to her needs and said he would share this information once received. He also expressed the view that the burden of proof lay with the Council, rather than the family, where changes to an existing care package were proposed.
24. In addition, Mr X raised concerns about the conduct of the allocated social worker and requested that a different social worker be assigned to Ms Y’s case.
25. The Council acknowledged Mr X’s complaint and agreed to postpone the implementation of the proposed reduction in care hours until his complaint had been investigated.
26. The Council responded to Mr X’s complaint in writing on 15 July 2025. It concluded that a further reassessment was unnecessary, and that the reduction in support hours was aimed at promoting Ms Y’s independence. This aspect of complaint was not upheld. It said the allocated officer had made efforts to engage with Ms Y but was prevented from doing so by Mr Y. On this basis it did not uphold Mr X’s complaint about lack of consultation and failure to make reasonable adjustments. It said attempts were made to obtain health information from professionals, but no responses were received. It confirmed that Ms Y’s support hours would be reduced from 15.4 to 11.9 hours per day. The Council said the reduction was not significant and the payments could be used flexibly, including for night-time support if needed. It agreed to review Ms Y’s needs again within six months.
27. In early August 2025, Mr X obtained a letter from an NHS learning disability nurse confirming that Ms Y has significant and ongoing physical, mental health, and safety needs related to her learning disability and other conditions. She relies heavily on her current level of support, including overnight care and daily assistance, to remain safe, manage her health, and maintain her wellbeing. The nurse further states that reducing this support could result in a deterioration in her physical and mental health and increase risk and her vulnerability. Mr X says he provided the Council with a copy of this letter at the time. The Council disputes this and says it first became aware of the letter during this investigation.
28. The social worker contacted Mr X in August 2025, to say, as his complaint was not upheld Ms Y’s direct payment would be reduced from 15.9 hours per day to 11.9 hours per day (83.5 hours per week).
29. Mr X then submitted a complaint to this office
30. The social worker contacted Ms X again in December 2025 to say, due to workload pressures, she was unable to complete the scheduled review of Ms Y’s needs and that she would contact him again after Xmas to arrange a review.
31. In response to enquiries from this office, the Council says there was no evidence of a change in Ms Y’s eligible needs, but there was a change in the goals she wished to achieve. It said in coming to a decision to reduce support hours, the reviewer had relied on the evidence gathered during the December 2024 review.
32. It says it did not complete a specific risk assessment in relation to reduced night-time support, as previous assessments had not identified night-time support as an unmet eligible need.

Analysis

33. It is not the Ombudsman’s role to decide what level of care Ms Y should receive. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law.
34. Under the Care Act 2014, the Council is required to carry out a proportionate but comprehensive assessment of need, considering both physical and mental health needs, fluctuating conditions, risks to wellbeing, and the outcomes the individual wishes to achieve. The Council must also ensure decisions are evidence-based and keep care and support under regular review where appropriate.
35. The Council was entitled to review Ms Y’s care package and explore if her independence could possibly be increased, however, that is not what happened here. The Council reduced Ms Y’s support hours without a full assessment of her needs and instead relied on information from a December 2024 review, which recorded Ms Y’s needs not to have significantly changed. Officers failed to establish Ms Y’s wishes and feelings and failed to properly consider the views expressed by Mr X. Officers approved a support plan that was not agreed and then implemented a plan to reduce Ms Y’s support hours which did not have Ms Y’s best interests at heart. It failed to consider the impact the reduced hours would have on Ms Y’s psychological wellbeing. This is a far cry from the person-centred model that is required by the Care Act.
36. The Council failed to complete a risk assessment before reducing the support hours, despite clear evidence of significant vulnerability and anxiety.
37. The information provided by the Council to this office is inconsistent. In its response to enquiries, the Council stated there had been no change in Ms Y’s needs, that the reviewer relied on new goals identified by Ms Y at the December 2024 review to justify a reduction in support hours. If Ms Y’s needs had not changed, it is unclear on what basis the Council considered a reduction in support to be appropriate. Furthermore, the goals identified in the December review did not relate to increased independence at night and therefore do not reasonably support the decision to reduce night-time provision.
38. The Council’s position on Ms Y’s night-time support needs is brought into further question by its statement that the reduced direct payment may be used flexibly, including for night-time support if required. This implies that night-time needs may exist, yet these appear to be left as being met from a reduced and unspecified allocation, without a clear assessment or evidential basis to support that approach.
39. While the Council should take account of Ms Y’s vulnerabilities and make appropriate adjustments to minimise distress, the fact that assessments may be difficult for her is not, in itself, a valid reason to prevent the Council from undertaking necessary reviews. Although it is evident that Mr X is acting in Ms Y’s best interests, preventing the Council from carrying out its statutory duties is unlikely to be in Ms Y’s overall best interests.

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Agreed Action

40. The Council should, within four weeks of the final decision:

• provide Ms Y with a written apology, appropriate to her understanding, for the faults identified in this investigation and provide a copy to this office;
• arrange for a fresh assessment of Ms Y’s care and support needs, to be completed by a suitably qualified and independent assessor not previously involved in her case. This should include input from relevant professionals and those involved in Ms Y’s care;
• review whether Ms Y has been without support she was entitled to receive and, if so, take steps to remedy this, including consideration of any appropriate backdated payments;
• provide Mr X with a written apology for the time and trouble caused in pursuing the complaint.

41. The Council also agreed:

• to review its competency and training framework for staff overseeing care act assessments and reviews within 18 months. The Council will also circulate a staff briefing sharing the specific learning from this investigation.

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Final Decision

42. The Council was at fault for reducing Ms Y’s care package without carrying out a proper and up-to-date reassessment of her needs. It failed to adequately assess and evidence her need for night-time support, did not complete a clear risk assessment, and made its decision while key uncertainties remained.
43. The above recommendations are a suitable way to remedy the injustice caused by the faults identified in this investigation.
44. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman