Summary: Mrs X complained the Council took almost two years to complete a re-assessment of her care needs. And that following the assessment her care hours have been wrongly reduced. Mrs X also complains the Council has asked her to return a backdated payment it made to address a shortfall in her personal budget. We found the delays in completing Mrs X’s assessment and in reviewing her personal budget and direct payments are fault. These faults have caused Mrs X avoidable distress, frustration and uncertainty. The Council will apologise and make a symbolic payment to Mrs X and will not seek to recover the backdated payment. It will also take action to improve its service.

The complaint

1. Mrs X complained the Council took almost two years to complete a re-assessment of her care needs. This caused Mrs X a great deal of uncertainty and stress about the continuation of her care.
2. Mrs X complained that following the assessment she no longer receives a waking night care allowance and her care hours have been reduced. This has also caused her stress and worry.
3. Mrs X also complains the personal budget for her care plan was not sufficient to pay her carers the minimum wage. Mrs X says the Council made a backdated payment for the shortfall which she paid to her carers. She complains the Council has since said this payment was an error and asked Mrs X to return the money, which she is unable to do.

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The Ombudsman’s role and powers

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 cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

8. Although Mrs X complains about delays and failings in the Council’s service since May 2023, I have not investigated events going back that far. We generally expect people to complain to us within 12 months of them thinking the Council has done something wrong. As Mrs X contacted us in September 2025 I have only considered events since September 2024.

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How I considered this complaint

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

Care Act assessments

11. 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.
12. 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. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met.

Personal Budgets

13. 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.
14. 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)

Direct payments

15. 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.

What happened here

16. The following is a summary of the key events relevant to our consideration of the complaint. It does not include everything that happened. I have referred to events prior to September 2024 for context but they are not part of my investigation.
17. Mrs X has a number of medical conditions and requires support with all aspects of daily life. She has received direct payments from the Council for many years which she uses to pay three personal assistants (PA) to support her.
18. Records of Mrs X’s assessments note Mrs X’s direct payments could be used flexibly but were based on a traditional care package which provided for four calls a day:
• Morning call for 2 hours with two PAs;
• Lunch call for 1.5 hours with two PAs;
• Tea call for 1.5 hours with two PAs and
• Evening call with overnight support from one PA with a second on call.
19. Mrs X’s personal budget was £850 per week which allowed her to pay her PAs £8.72 per hour. This is less than the minimum wage.
20. A social worker began a reassessment of Mrs X’s care needs in May 2023 and prepared a draft assessment and support plan in October 2023. The Council’s records show there were discussion about increasing Mrs X’s personal budget so that her PAs could be paid in line with the minimum wage.
21. The Council’s record show officers determined in July 2024 that the direct payment increase from 2023 would be denied as the PAs were self-employed and Mrs X had paid them accordingly. The notes say a direct payment increase backdated to April 2024 was agreed and this should be sent to a senior officer for authorisation.
22. A senior officer reviewed the request and advised the level of care provided needed to be reviewed and justified, particularly in relation to the night time support.
23. In September 2024 the social worker told Mrs X they would need to carry out a whole new assessment detailing the care she required. This took place by telephone on 30 September 2024. The Council then explored whether assistive technology could be used instead of overnight support.
24. On 5 November 2024 Mrs X contacted the Council to ask for an explanation for an extra payment made to her direct payment account. She assumed it was an increase in the hourly rate for her PAs and asked the Council for a breakdown of how it had been calculated.
25. The Council responded the same day and confirmed Mrs X’s direct payments had increased from £850 per week to £1243.75 per week backdated to 1 April 2024. This meant Mrs X was owed £14,062.50 which it had added to her latest payment. Mrs X says she made the backdated payments to her PAs.
26. On 7 November 2024 the Council wrote to Mrs X explaining the increased payment had not been authorised and had been paid to her in error. It noted the care assessment was still underway, exploring her night time needs and whether this was a health or social care responsibility and if it could be supported in another way. The Council said that at present Mrs X’s personal budget and the amount she had to pay for her support needs was £850.
27. The Council apologised for the mistake and said Mrs X would need to repay the money.
28. The social worker dealing with Mrs X’s assessment left the Council in December 2024 and her case was reallocated in January 2025. A new social worker visited Mrs X at home in late March 2025 to discuss her care needs. The records of the visit note Mrs X agreed to a much lower package of supported hours. She had initially requested 97 hours which included night support but they had settled on 58.5 hours per week.
29. Mrs X’s current support plan, completed on 16 May 2025 provides for four visit by two PAs for a total of 7.5 hours each day and an additional 2.5 hours a week for her PAs to take her out to reduce social isolation.
30. Mrs X made a formal complaint to the Council about the delays in completing the assessments of her care needs and being unable to pay her PAs the minimum wage.
31. The Council responded in August 2025 and upheld her complaint.
32. The Council said it noticed in May 2023 that Mrs X’s PAs were not being paid at least the national minimum wage. It said it decided in January 2024 to increase Mrs X’s direct payments to £11.40 per hours so that she could pay them more. However this was not done properly at the time because the assessment was unclear. It upheld Mrs X’s complaint and apologised for the impact this had on her and her PAs.
33. The Council noted Mrs X’s PAs were self-employed so could apply their own rates, including being below minimum wage. It said senior officers had decided in July 2024 not to backdate funding to April 2023 as the PAs could have increased their rates. The Council also noted during an audit in October 2024 that there was a surplus in Mrs X’s direct payment account.
34. In addition the Council reiterated that the lump sum payment of £14,062.50 was made in error. It apologised that this had added to Mrs X’s stress
35. The Council also apologised that the assessment started in May 2023 was not completed properly and acknowledged this was not acceptable. It noted the assessment was now complete and said it was making changes to make sure this did not happen again.
36. Mrs X was not satisfied by the Council’s response and has asked the Ombudsman to investigate her concerns. Mrs X says the delays in completing the assessments and increasing her personal budget have caused her a great amount of stress and worry. She is unhappy the Council has reduced her care hours and says she does not have the funds to repay the Council the backdate increase.
37. In response to my enquiries the Council says the level of the proposed budget increase needed to be signed off by the head of service. It says it was not evident from the assessments that the needs presented were at a level that would need 24 hour support, including waking night support. The Council asked the social worker to explore assistive technology and work with health partners to evidence Mrs X’s needs.
38. The Council acknowledges that the delay in completing the assessment was unacceptable, but notes Mrs X was not left without support. It says her needs continued to be met and the level of risk was low.
39. It says it reassessed Mrs X’s care with Mrs X to provide an appropriate care package which fully meets her needs and promotes a level of independence. Although there was a significant reduction in the number of support hours, the Council says it is evident the care package is meeting Mrs X’s needs.

Analysis

40. The records show there was significant drift and delay in completing Mrs X’s care needs assessment and the process took far too long. We expect councils to complete assessments in a timescale that is proportionate to the complexity of the issues and normally within 4 to 6 weeks. The extensive delay in completing the assessment of Mrs X’s care needs amounts to fault.
41. Mrs X is also unhappy with the outcome of the assessment, particularly the removal of night time support. It is not the Ombudsman’s role to determine the level of care and support Mrs X needs. This is the Council’s job. We look at the process the Council followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether Mrs X disagrees with the decision.
42. The assessment document notes Mrs X needs to be supported to use the toilet throughout the day and night due to her mobility. It also notes that the medication Mrs X takes at night can cause hallucinations, making her believe she can walk, which has led to falls. The Council suggested this could be managed with an additional call ahead of going to bed, rather than by a waking overnight care call. The assessment says Mrs X was in agreement with this.
43. Based on the documentation available there is no evidence of fault in the way the Council assessed Mrs X’s needs and revised her support plan.
44. There was however fault in the Council’s oversight and management of Mrs X’s personal budget and direct payments.
45. The Council’s guide to direct payments states it will ensure the direct payment includes all the costs involved in employing a PA. This includes a rate of pay starting at the National Living Wage as a minimum.
46. Mrs X’s personal budget of £850 allowed her to pay her PAs £8.72 per hour. £8.72 was the National Living Wage between April 2020 and March 2021. It is clear from the documentation provided that the Council had identified that Mrs X’s direct payments needed to be increased and backdated. However it failed to do so, this is fault.
47. The Council appears to have delayed increasing the payments in 2024 pending a new care assessment. This was not appropriate. While any changes to the level of support agreed in a new assessment would affect future direct payments, they would not alter the level of support she had already received.
48. The assessment and support plan in place in 2024 identified Mrs X needed almost 100 hours a support a week. Unless and until this was amended, Mrs X should have received sufficient direct payments to cover the cost of this support, in line with the Council’s policy.
49. The failure to revise Mrs X’s personal budget and direct payments sooner is fault.
50. Mrs X received a backdated payment in November 2024. The Council says this was an error and the money should be returned, but I disagree. Mrs X confirmed the basis of the payment with the Council and then paid her PAs in good faith.
51. In the circumstances I do not consider it appropriate for the Council to require Mrs X to return the backdated payment of £14,062.50.
52. Having identified fault I must consider whether this has caused Mrs X a significant injustice. The significant delays in completing an assessment of her care needs and in increasing her direct payments did not detrimentally affect the care that Mrs X received. Mrs X’s PAs continued to provide care and meet her needs throughout.
53. However, she experienced avoidable distress, frustration and uncertainty as a result of the delays. This was then exacerbated by the Council’s request that she repay the backdated payment due to her PAs. This money is no longer available to Mrs X, and the prospect of having to find and return it caused her worry and stress.
54. The backdated payment means Mrs X’s PAs were paid the National Living Wage between April and November 2024. But the payments then returned to the lower rate until May 2025 when the Council completed the care assessment and support plan. I recognise this is disappointing for Mrs X and her PAs, but this fault did not cause Mrs X an injustice. I have not therefore recommended the Council make a backdated payment for the shortfall between November 2024 and May 2025.

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Action

55. The Council has agreed to:
• Apologise to Mrs X for the faults identified and the distress and uncertainty she has experienced as a result. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Make a symbolic payment to Mrs X of £300 to recognise the distress and uncertainty she has experienced as a result of the Council’s delays and errors;
• Write to Mrs X confirming it will not seek to recover the sum of £14,062.50 paid to her direct payment account in November 2024;
• Review the assessment delays in this complaint and identify what action the Council will take to reduce future delays.
• Remind relevant staff of the need to review personal budgets and direct payments as part of care and support planning. And ensure the method used for calculating the personal budgets produces equitable outcomes.
56. The Council should take this action within one month of the final decision and provide us with evidence it has complied with the above actions.

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Decision

57. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman