The Ombudsman's final decision:
Summary: Mr F’s children complained about the way the Council decided that he would have to pay a contribution towards his care package. The Ombudsman found fault with the way in which the Council communicated with the family and recorded decisions. The Council has agreed to provide an apology for the distress it has caused and share the lessons learned with its adult social care staff.
- The complaint to the Ombudsman was made on behalf of the (late) Mr F. The complaint was made by Mr F’s children, whom I shall call Ms X, Ms Y and Ms Z. Mr F’s children complain the Council failed to carry out a comprehensive and appropriate needs assessment before her father was discharged in August 2015.
- Ms X also complains the Council failed to explain to her father, and his family, that there would be a financial assessment to determine what contribution he would have to pay towards the cost of the care package.
- As a result, they say their father was forced to accept and pay for a care support package that he did not want or need, in order to be allowed to go home from hospital.
The Ombudsman’s role and powers
- 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)
- 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). I used my discretion to investigate the events that happened in 2015, because the family received a letter in 2017 from the Council’s debt collection team to say Mr F owed £6,038.97 in unpaid care fees. The family believed the matter had been closed in early 2016.
- If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
How I considered this complaint
- I considered the information I received from Ms X and the Council, and the records I obtained from the hospital where Mr F stayed, before he returned home. I also carried out a telephone interview with a staff member who was involved at the time. I shared a copy of my draft decision statement with the family and the Council and considered any comments I received, before I made my final decision.
What I found
- The Government’s “Care and Support Statutory Guidance” says that:
- Information and advice is fundamental to enabling people, carers and families to take control of, and make well-informed choices about, their care and support and how they fund it.
- All reasonable efforts should be taken to ensure that information and advice provided meets the individual’s requirements, is comprehensive and is given at an early stage. This should include: information about how the care and support process works, eligibility for different types of support, and financial information. Financial information is fundamental to enabling people to make well-informed choices about how they pay for their care and how best to meet their needs, immediately or in the future. A council needs to provide information to help people understand what they may have to pay, when and why and how it relates to people’s individual circumstances.
- The needs assessment and eligibility process must be person-centred. The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. The assessment must also consider if any other support might be available in the community to meet the person’s needs, such as support from family members.
- An assessment must be person-centred, involving the individual and any carer that the adult has. The assessor needs to take a holistic view of the person’s needs in the context of their wider support network.
- Following their assessment, individuals must be given a record of their needs assessment.
- Once the assessment has determined that the person has eligible needs which the Council will meet, it must then carry out a financial assessment to determine how much the person can contribute towards the cost of their care.
- There appears to be a lack of clarity, at least within the records, as to where Mr F’s children where living at the time. Several documents from the Council and the hospital state that, while both of Mr F’s daughters provide care during the day, he only lived together with his wife and son. However, Ms X told me (and some documents mention that) she and her sister also lived at the property. All three siblings were in their 60s. Ms X explained that she and her siblings would provide a significant amount of support to both parents throughout the day, meeting all of their needs. As such, they had developed a system to ensure there was always the support available that their parents needed.
- Mr F went into hospital in May 2015. He was discharged one week later with a free reablement care support package of three visits a day, to try and increase his independence. This included support with personal care, which was working well according to his family.
- Mr F went into hospital again at the end of June 2015. While in hospital, Mr F was receiving daily rehabilitation support from OTs and Physiotherapists to improve his mobility. Hospital records show he was often reluctant to engage / mobilise.
- A hospital record from July 2015 states that Mr F’s daughters reported they were living at their parents’ home. The record concludes: ‘very good family support available. He and wife are never left alone’.
- The hospital felt in July 2015 that Mr F would be suitable for a period of free reablement support after his discharge from hospital, because he had ongoing rehabilitation goals to improve his mobility and independence. However, the Council’s Enablement Team said on 22 July that it would not accept him, because he had not sufficiently engaged when he had received reablement support before. I obtained this information from the hospital’s records, because the Council was unable to provide me with a record that showed why this decision was made. I have seen no evidence within the Council’s records that it explained this to Mr F’s family. The family confirmed to me that the Council did not tell them.
- As Mr F would not receive reablement support, the Council needed to carry out a needs assessment with Mr F to determine what long-term support he would need after going home. Mr F’s hospital OT said Mr F would need support with transfers and mobilising from one carer. The OT recommended a care package consisting of two to three visits per day from one carer.
- The social worker organised a visit to Mr F in hospital; Ms X’s brother and sister were also invited and present. The social worker told me she explained at the start that the needs assessment took place because enablement had been turned down. She also said she explained the assessment was to determine Mr F’s long-term support needs and there would be a financial assessment to determine his contribution. However, I have not seen evidence of this within the records provided by the Council.
- Ms X told me her brother and sister say the social worker did not explain this during or before the visit. She said the social worker talked with her father about other things and did not establish what support he wanted and/or needed. Ms X says the social worker did also not explain there would be a financial assessment. The only reference to finances that I have found in the needs assessment form is: Mr F and his wife manage their own financial affairs and are very private in this area. Family (…) are unaware of their parents’ financial situation.
- The social worker acknowledged that:
- It would have been good to have clearly recorded what she discussed and explained about reablement and the financial assessment.
- She failed to provide a copy of the needs assessment to the family.
- She should have offered to carry out a carer’s assessment to each of the children.
- He lives with his son and wife. His two daughters visit daily and provide support. The social worker told me that Mr F’s children reported this to her at the visit. Ms X told me this was not true, as all three children lived at Mr F’s home.
- I would like support in the morning, midday and evening to support me to get myself out of bed showered and dressed, to transfer and mobilise to eat my evening meal and to get undressed and ready for bed at night. Ms X told me these were the words of the social worker, not her father.
- Ms X’s sister said her father could do a lot himself. However, he would need a lot of prompting and encouragement with his personal care. This would take up at least one hour in the morning.
- Mr F is supported by his son and two daughters on a daily basis; they also care for their mother. They support him with meal preparation, laundry, housework and shopping. There is always family around, but limited in the morning because both daughters need to provide full support to their mother. However, Ms X told me that the family would have been able to continue to successfully provide all the support both parents needed.
- Support from family:
- Personal care: no support in the morning; during the day; evening. Ms X told me the family has always helped with personal care.
- Medication: no support in the morning; during the day; evening. Ms X told me this was wrong, because there would be no reason why the family would not be able and willing to support their father with his medication.
- Presence / supervision: no support in the morning; during the day. Ms X told me that this did also not make any sense, as they would always ensure at least one of the children would be at home.
- There was fault in the way the Council communicated with the family and explained things.
- The Council’s records are unclear about what information and explanations it provided to the family, and when they provided this. I have found no evidence in the records of the Council telling Mr F’s family that it had decided in July 2015, and again later in August 2015, that the Enablement Team would not accept Mr C as a client. There is also no evidence in the records that it explained why it made these decisions. This is fault.
- I have also found a lack of evidence in the records what the Council explained to the family, and when, about the need to carry out a financial assessment. This is fault.
- After the Council carried out the needs assessment, it failed to provide a copy of the assessment to the family. This would have enabled the family to provide comments on it, to ensure it was accurate and comprehensive in the family’s view. The family has told me there were several key errors in the form, including about Mr F’s home situation, where his children lived, and the support his family would be willing and able to provide going forward. This is fault.
- The social worker also failed to offer a carer assessment to each of Mr F’s children. This is fault. This was also a missed opportunity to further discuss and record the support each of the family members could provide.
- Even though the Council was aware as early as 22 July 2015 that Mr F would need a financial assessment to determine what his contribution would be, the Council had not yet started the process as of 14 August 2015 when Mr F left hospital. While I understand that Mr F’s children did not have access to their parent’s financial information, the Council could have contacted his wife.
- The Council sent a letter to Mr F’s home address on 7 August that said there would a financial assessment to assess his contribution. However, Ms X says the family did not receive this.
- The Council failed to organise a best interest meeting, after a mental capacity assessment concluded that Mr F did not have capacity to make decisions about his care arrangements. This should have been a meeting chaired by the Council, who in this case would have been (what is known in the Mental Capacity Act – Code of Practice as) ‘the decision-maker’. Instead, there was a discharge meeting chaired by the hospital.
- It is clear from the records I have seen that the professionals involved in Mr F’s care (the Council, hospital staff, Mr F’s GP), felt that it would be in his best interest to have a care package at home on discharge, to provide support at home with the more physical aspects of his care. On that basis, I have concluded that, on the balance of probabilities: if the Council had organised a best interest meeting, which it should have done, the Council would have decided that Mr F would need a support package in place on discharge of (initially) two carers.
- At the important discharge meeting, the Council failed to ensure it kept records of the views expressed by the family and the discussions that arose. As such, it is not possible to conclude what was discussed and whether the family objected to the care package at the meeting.
- There was fault in the way in which the Council responded to Ms X’s letter of 1 October 2015. In the letter, Ms X expressed the family did no longer want or need the support from one carer. The Council subsequently failed to carry out an urgent review, and it took until 18 January 2016 before it stopped the package. This is fault.
- The complaints team did not contact Ms X as promised, following the return of the complaints manager.
- I recommended that, within six weeks of my decision, the Council should:
- Provide an apology to Ms X and her siblings about the faults identified above and the distress these have caused them.
- Remind its staff involved in needs assessments, of the importance to:
- Update a client whenever an important decision has been made, to explain to them why the decision was made, and to clearly record this.
- Share a copy of the needs assessment as soon as possible.
- Offer a carer assessment
- And the other faults and lessons learned identified above.
- For reasons explained above, I decided to uphold the complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case
Investigator's decision on behalf of the Ombudsman