Summary: Miss X complained the Council’s 2024 review of her care and support plan did not properly consider her medical conditions, care needs and personal circumstances. She said the Council decided to reduce her care package before carrying out a proper assessment. We found no fault in the Council’s review process or its consideration of her objections.

The complaint

1. Miss X complains the Council's 2024 review of her care and support plan did not properly consider her medical conditions, care needs and personal circumstances. She says the Council decided to reduce her care package before carrying out a proper assessment.
2. Miss X says the reduction in support has negatively affected her physical and mental health and caused financial hardship.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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)
4. 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

5. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
6. Miss 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 legislation and information

Assessment

7. 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.

Care Plan

8. 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.

Reviews

9. 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. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Direct payments

10. 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.

Equality Act

11. The Equality Act 2010 provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. It offers protection, in employment, education, the provision of goods and services, housing, transport and the carrying out of public functions.
12. The Equality Act makes it unlawful for organisations carrying out public functions to discriminate on any of the nine protected characteristics listed in the Equality Act 2010. They must also have regard to the general duties aimed at eliminating discrimination under the Public Sector Equality Duty.
13. The ‘protected characteristics’ referred to in the Act are:

• age;
• disability;
• gender reassignment;
• marriage and civil partnership;
• pregnancy and maternity;
• race;
• religion or belief;
• sex; and
• sexual orientation.

Direct discrimination

14. Direct discrimination occurs when a person treats another less favourably than they treat or would treat others because of a protected characteristic.

What happened

15. Following a period of hospital treatment, the Council assessed Miss X's care and support needs and prepared a care and support plan. It assessed her as requiring 25.5 hours of support each week. This included four daily care calls, six hours of community access support and one hour of support for laundry. Miss X chose to receive a direct payment so she could employ a personal assistant (PA) to meet her assessed needs.
16. In October 2024, the Council completed an annual review of Miss X’s care and support plan. The review concluded Miss X continued to require support with daily living activities but found some areas where she was able to manage more independently. The Council decided to reduce her support package from 25.5 hours to 15.25 hours per week.
17. The revised package provided three daily care calls, two hours of community access support for shopping and one hour of cleaning support each week. The Council recorded that Miss X required support with personal hygiene, grooming, dressing, meal preparation, changing into nightwear, medication prompting and household tasks.
18. The Council recorded the reduction was appropriate because Miss X had become more independent in several areas. It noted she was able to mobilise and transfer independently, no longer required hoist transfers, could feed herself, prepare drinks and snacks independently and did not require support to administer medication.
19. Miss X disagreed with the proposed reduction. She said she continued to require her existing level of support because of her ongoing health conditions and return to work. The review records show her objections were documented and discussed with a manager, who agreed with the proposed reduction.
20. During discussions with the Council, Miss X reported a deterioration in her health, financial hardship and problems with a broken boiler.
21. The Council explained the reasons for the reduction and maintained that the revised package was sufficient to meet Miss X's eligible Care Act needs. It provided information about services that could assist with financial hardship and housing issues and offered a referral to its reablement service to explore ways of maximising her independence. Miss X declined the referral.
22. In March 2025, Miss X complained to the Council about the October 2024 review. She said it contained inaccuracies, failed to reflect her medical conditions and care needs and had been conducted in a biased and discriminatory manner. In particular, she said:
• the Council relied on outdated medical information and failed to consider additional medical conditions diagnosed after 2023;
• she had been told before the review that her support hours would be reduced, leading her to believe the decision had been made before her needs were assessed;
• the review overstated the support available from friends and family and incorrectly suggested her return to work reduced her social isolation;
• the Council failed to take account of difficulties arising from pain, fatigue and episodes of hot and cold sweats, including the need for additional personal care and changes of bedding;
• the Council had unfairly relied on her ability to drive on some days when assessing her needs; and
• the reduction in support had negatively affected her health, wellbeing and financial circumstances.
23. In May, the Council responded to the complaint and did not uphold it. It said the review had been completed using the information available at the time, including information held on NHS systems, and that the revised support package remained sufficient to meet Miss X’s assessed needs.
24. The Council said there was no evidence of fault in the conduct of the reviewing social worker or in the decision-making process. It explained the proposed reduction had been considered and approved by a manager and the reasons for the decision had been explained to Miss X on several occasions.
25. The Council acknowledged some information in the review could be updated and invited Miss X to provide her GP records so it could ensure its records accurately reflected her medical conditions. It also provided further information about sources of financial support and encouraged Miss X to seek medical support for the deterioration in her health.
26. In September, a newly allocated social worker completed a further face-to-face review. Following consultation with an occupational therapist, the Council referred Miss X to its reablement service for a six-week programme to assess her functional abilities and determine whether an increase in support hours was required.
27. Miss X declined reablement support, explaining that fatigue would prevent her from benefiting from the programme. Council records show officers explained that any consideration of increasing her support hours would be informed by the outcome of the reablement assessment. Despite this, Miss X chose not to participate.
28. Following the review, the Council updated Miss X’s care and support plan. The Council recorded that her assessed needs and medical conditions remained unchanged from those identified during the October 2024 review.
29. In October, Miss X brought her complaint to the Ombudsman.
30. Since the complaint was brought to the Ombudsman, the Council has allocated a further social worker and started the process of completing another annual review.
31. Miss X has confirmed she did not provide the Council with the medical records it requested following its complaint response.

My findings

32. Miss X says the Council's October 2024 review did not accurately reflect her medical conditions and support needs and the Council had already decided to reduce her care package before completing the review.
33. The Ombudsman is not an appeal body. We cannot substitute our judgement for that of a council or decide what level of care a person should receive. Our role is to consider whether there was fault in the way a decision was reached.
34. The records show the Council carried out an annual review of Miss X's care and support plan in October 2024. The review considered her ability to complete daily living activities and recorded the reasons the Council considered a reduction in support hours appropriately. These included improvements in her mobility and transfers, her ability to prepare drinks and snacks, feed herself and manage some tasks independently.
35. The review records also show Miss X disagreed with the proposed reduction. The Council recorded her objections and discussed the proposed changes with a manager before reaching a final decision.
36. Miss X says the review failed to take account of additional medical conditions and aspects of her day-to-day difficulties. The Council considered these concerns through its complaint process. It explained the information available to it at the time of the review supported its assessment and invited Miss X to provide updated medical records so it could ensure its records accurately reflected her current health conditions.
37. Miss X has confirmed that she has not provided the Council with the medical records it requested. In the absence of updated medical evidence, I am unable to conclude the Council acted with fault by relying on the information available to it when carrying out the review.
38. The Council also carried out a further review in September 2025. Following consultation with an occupational therapist, it referred Miss X to its reablement service to assess her current functional abilities and whether an increase in support hours was required. Miss X declined the reablement assessment.
39. The Council was entitled to seek further assessment of Miss X's abilities before considering whether her care package should be increased. As Miss X declined the proposed assessment, there is limited evidence available to challenge the Council's view about the level of support required.
40. Miss X believes the Council's decision was discriminatory. However, I have seen no evidence the Council reduced her support because of any protected characteristic or that it treated her less favourably for that reason. The records indicate the Council based its decision on its assessment of her care and support needs.
41. While I appreciate Miss X remains dissatisfied with the Council's decision and considers her support package insufficient, the evidence available does not indicate fault in the way the Council reached its decision.

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Decision

42. I find no fault.

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Investigator's decision on behalf of the Ombudsman