Summary: there is no fault in the assessment of Miss D’s social care needs, and the offer of a retrospective financial assessment is the most appropriate way to progress Mr and Mrs P’s complaint about Miss D’s care charges.

The complaint

1. Mr and Mrs P complain on behalf of their daughter, Miss D, that the Council does not meet her social care needs. Mr and Mrs P complain the lack of support for Miss D means they are unable to attend their own hospital appointments.
2. Mr and Mrs P complain on Miss D’s behalf about a charge of £1,800 for care she received. They say Miss D was not aware she would have to pay for her care, and she did not receive all the care she has been charged for. Mrs P says she complained in February 2017, but the council has not dealt with her complaint.

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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.
4. We cannot question council decisions simply because the complainant disagrees with them. We must consider whether there was fault in the way the decisions were reached. (Local Government Act 1974, section 34(3), as amended)
5. 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)
6. 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)
7. 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)

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How I considered this complaint

8. I have considered:
• information provided by Mr and Mrs P;
• information provided by the Council, including the latest assessment of Miss D’s needs.
9. I invited Mr and Mrs P and the Council to comment on my draft decision.

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What I found

10. At the time of the events Mr and Mrs P complain about, Miss D was under the care of a local NHS Mental Health Trust (the Trust). She had a diagnosis of generalised anxiety disorder. She was highly dependent on her parents, even though they were not providing direct care. This was reported to be having a significant impact on the lives of all three family members.
11. Miss D is also diabetic.
12. The Trust carried out social care assessments on behalf of the Council. The Trust completed an assessment on 19 March 2018. Mr and Mrs P were involved in the assessment.

Complaint 1: Miss D’s social care needs

13. Mr and Mrs P say that Miss D is unable to attend medical appointments on her own. They say they are unable to support her because of their own health needs.
14. Mr and Mrs P explained they are unable to leave Miss D on her own without sedating her. They say this is dangerous because Miss D is diabetic. They say they are unable to attend their own hospital appointments as a result.
15. They are unhappy because they believe the Trust has assessed Miss D’s mental health needs but ignored her diabetes and the impact of her health problems on them.

What her assessment says

16. Miss D’s latest assessment, completed in March 2018, notes that she is able to manage independently in many aspects of daily living. However, her anxiety impacts on the lives of all three family members. The assessment says Miss D wants to move out of the family home, but her parents do not think she will be able to manage independently.
17. Miss D’s assessment says she was offered a two-day, 10-hour appointment for training to use an insulin pump to manage her diabetes, but felt unable to attend as her father, who she wanted to attend, would have to leave briefly to move his car due to parking restrictions at the hospital. She has now been discharged by the clinic offering the pump.
18. She was also receiving cognitive behavioural therapy (CBT) to deal with her separation anxiety, and more recently had been offered an assessment and treatment at a specialist London hospital. The Council reports, however, that Miss D has been discharged without treatment.
19. The assessment says that Miss D previously had a daily care package, but this was stopped because Miss D did not find it helpful.
20. The assessment notes the support provided by Miss D’s parents, but says that the Trust anticipates that with the therapeutic interventions offered, Miss D will be able to manage all daily living tasks independently.
21. The assessment proposed a time-limited direct payment to provide support to enable Miss D to gain independence from her parents. Attending the diabetic service appointment was identified as a priority. The assessment says that if Miss D no longer lived with her parents, a complete reassessment would be needed.
22. The Trust, on behalf of the Council, offered Miss D direct payments but she refused. She did not think direct payments would be helpful and wanted therapy for her anxiety instead. As a consequence, the Trust did not complete a (social) care and support plan. The assessment says that Miss D can reconsider her decision to refuse support at any time.
23. Mr and Mrs P dispute the assessment. Mrs P has complained to the Council and, unhappy with the Council’s response, now complains to the Ombudsman. She says that Miss D was unable to take up the offer of a 10-week programme of assessment and treatment for her separation anxiety at a specialist hospital because she could not take her dog with her. As Miss D has been unable to take part in any treatment for her mental health conditions, Mrs P believes the Council should provide social care support instead.

Consideration

24. The Ombudsman does not assess Miss D’s social care needs or decide how they should be met. This is the Council’s job. Miss D’s health and social care needs are closely related, and so it is logical that the Trust should carry out the assessment on behalf of the Council. The assessment shows that Miss D has care needs, albeit they are short-term care needs while she receives therapeutic support for her separation anxiety. The Trust has offered support, but Miss D has declined a support package. There is no fault.
25. It appears Miss D has been unable to take up the therapeutic support on offer. Miss D should take this up directly with the Trust. She could also ask the Trust to review her social care needs assessment as the assessment says she should if she changes her mind. If Miss D is unhappy with the Trust’s response to her complaint, she can then complain to the Health Service Ombudsman (about the therapy), the Local Government and Social Care Ombudsman (about her care), or both.

Complaint 2: charges for Miss D’s care

26. Mr and Mrs P complain on Miss D’s behalf about a charge of £1,800 for care. They say Miss D was not aware she would have to pay for her care, and she did not receive all the care she has been charged for. Mrs P says she complained in February 2017, but the council has not dealt with her complaint.
27. It is considerably longer than 12 months since Miss D incurred the charges that Mr and Mrs P complain about. This delay makes it more difficult to establish the facts about the circumstances in which Miss D’s care package was set up with reasonable confidence.
28. The Council says it attempted to undertake a financial assessment in November 2016. The Council says it telephoned Miss D on 17 November 2016 to arrange an appointment to complete a financial assessment but spoke to Mr P because Miss D was out. The Council says it sent a financial assessment form to Miss D on 21 November 2016 and a reminder to complete the form on 8 December 2016. The Council made a further visit and sent the form again in December 2016. When the Council had not received the information it needed by 19 January 2017, it decided to charge Miss D the full cost of her care and wrote to tell her.
29. Following Mrs P’s complaint in March 2018, the Council identified a mistake in its 19 January 2017 letter. The letter said the Council had completed the financial assessment. It should have said the Council had not received the information it needed from Miss D within 28 days and so she would be treated as not needing financial assistance and charged the full cost of her care.
30. The Council invited Miss D to arrange a new financial assessment visit or request a new financial assessment form. She did not.
31. I asked the Council whether the financial assessment would consider Miss D’s circumstances at the time she received the care, and whether the assessment was still on offer. The Council confirmed Miss D could still request a financial assessment, and the assessment would consider her circumstances at the time she received the care.

Consideration

32. The efforts the Council made to assess Miss D’s financial contribution to the cost of her care satisfy me that Miss D was aware she would have to pay for her care in November 2016. Had she objected to the charges, she could have complained to the Ombudsman sooner. In the circumstances, I consider it would be most appropriate for Miss D to contact the Council and undergo the financial assessment on offer. She can raise her concerns about the care she says she was told would be free, and for which she says she was charged but did not receive at the same time. It does not appear the Council has considered any evidence she may have.

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Final decision

33. I have ended my investigation. There is no fault in the assessment of Miss D’s social care needs, and the offer of a retrospective financial assessment is the most appropriate way to progress the complaint about Miss D’s care charges.

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Investigator's decision on behalf of the Ombudsman