Summary: We uphold Mr X’s complaint about his son’s care. We found fault with the way the Council planned Mr Y’s care when he moved to new accommodation. As a result, Mr X and Mr Y experienced additional distress during an already stressful period. The Council will apologise and pay a total of £750.

The complaint

1. Mr X complain about the care and treatment provided to his son, Mr Y, by the London Borough of Harrow (the Council) and Central and North West London NHS Foundation Trust (the Trust).
2. Specifically, Mr X complains that the Council and the Trust:

• failed to provide Mr Y with adequate support or choice when he needed to move to a new accommodation and care provider in January 2022;
• failed to provide Mr Y with adequate support following the review of his needs in January 2022;
• inappropriately assessed Mr Y as needing to financially contribute to his care;
• suggested an appointeeship, which Mr Y is opposed to; and
• threatened Mr Y with court action over unpaid care contributions of over £1,800.

3. As a result, Mr X says his son had to move into an unsuitable placement due to lack of options and did not receive adequate support. This has also caused Mr X and his wife a significant amount of stress, which has impacted on their health. This has been made worse by recent communication from the Council about debt recovery action.
4. Mr X would like the Council to stop debt recovery action.

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The Ombudsmen’s role and powers

5. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

8. I discussed the complaint with Mr X and Mr Y and considered the information they provided in support of their complaint. I have also received information from the Council and the Trust, including the social worker’s case notes, Mr Y’s mental health records and Mr Y’s care assessments. I have carefully considered all the written and oral evidence submitted, even if it is not all mentioned within this decision statement.
9. I have shared a draft decision with Mr X, Mr Y, the Council and the Trust and they had the opportunity to comment. I carefully considered the comments I received.

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What I found

Key legislation and guidance

Autism Act 2009 – March 2015 Statutory Guidance

10. ‘Health and social care services need to recognise the impact that autism has on an individual’s life and consider this alongside any additional needs such as…a mental health condition…ensuring that there is a personalised approach with targeted support.’ (Statutory guidance for local Authorities and NHS organisations to support the implementation of the Adult Autism Strategy, section 4.5)

Charging for social care services: the power to charge

11. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

Disability Related Expenditure

12. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included. What counts as DRE should not be limited to what is necessary for care and support.

What happened

13. Mr Y has schizophrenia and is autistic. Social care in Harrow for people with primary mental health needs is managed by the Trust, on behalf of the Council. Therefore, the Trust took overall management of Mr Y’s health and social care.
14. Mr Y had been living happily in his previous supported living placement for seven years. His placement was jointly funded by health and social care. Mr Y received 25 hours of 1:1 support a week. Support workers would, among other things, help Mr Y by cooking healthy meals, doing his laundry, cleaning his flat and doing grocery shopping.
15. In October 2019, Mr Y was assessed as needing to contribute £92.44 a week towards his placement. Mr Y disagreed and said he could not afford to pay the contribution. The Trust says it had no arrangements for collecting social care contributions at the time, so no action was taken to obtain payments from Mr Y when he declined to pay.
16. In November 2021, the Trust reviewed Mr Y’s mental health care plan. It noted that Mr Y was increasingly anxious that he may need to move from his accommodation due to having an extra bedroom and his Consultant Psychiatrist was concerned about the impact of the stress on Mr Y’s mental health.
17. In December 2021, the Consultant Psychiatrist wrote a letter to the Council’s housing department. She said it was her view that Mr Y needed a stable long-term placement which offered the same level of care as he was currently getting. She said without this there was a risk of Mr Y relapsing and being admitted to hospital. The letter also included the support worker’s view that without his current care package, Mr Y would become very stressed and depressed. The support worker noted that Mr Y needed help with shopping, cooking and cleaning. She felt Mr Y would continue to need this level of support if he moved to new accommodation.
18. In January 2022, Mr Y had to leave his previous placement as the building was being sold. There was only one option in Harrow for supported accommodation with self-contained flats. As Mr Y did not wish to leave the area, he decided to move there.
19. Mr Y’s new accommodation is owned and managed by the Council. Residents are supported by an agency, commissioned by the Council, to provide ‘floating 1:1 support’. The support aims to promote independence by helping residents to develop their daily livings skills and complete tasks for themselves. This was a social care placement, although Mr Y continued to receive separate mental health support from the Trust.
20. The change of accommodation led to Mr Y’s needs being reviewed by his social worker. The social worker’s review concluded that Mr Y’s previous 1:1 support had ‘mostly been to accompany him to shops and coffee bars’ but that Mr Y was actually able to access the community himself without this level of support. The review also concluded that Mr Y was able to complete most daily living tasks for himself, although it noted that he struggled with motivation and needed encouragement and support to do so. Following the review, Mr Y’s social care support was reduced from 25 hours a week to 12 hours a week.
21. Mr Y complained about the significant reduction in his support, both in terms of hours and the type of support provided. He said his autism had not been taken into account and that he needed more practical support with tasks such as cooking, cleaning and prompting for personal care.
22. In February 2022, Mr Y’s care was increased to 12.5 hours a week to allow for accessing the community and leisure activities plus additional welfare checks on weekends.
23. In March 2022, the Council’s Joint Assessment Team completed a new financial assessment. Mr Y’s placement was partly funded by the Council and his housing benefit. Mr Y was assessed by the Council as needing to contribute £107.15 per week towards his care, effective from 18 January 2022.
24. Mr Y again said he was unable to afford the contribution. Mr X submitted an appeal on Mr Y’s behalf, on the grounds that approximately £300 of monthly Disability Related Expenditure (DRE) had not been taken into account. This included a significant amount of spending on cigarettes. Mr X says Mr Y smokes to manage his anxiety and his autism makes it very difficult for him to cut down or quit. Due to lack of evidence of expenditure, the appeal was unsuccessful.
25. Mr Y continued to decline to pay the contribution to his care, saying the care provided was inadequate and that he was being asked to contribute more than he could afford. Mr Y was over £2,500 in arrears. This remains the situation at the time of writing this decision statement.
26. In August 2022, the Council raised concerns about the outstanding contributions and discussed options such as a payment plan or an independent appointee (a person who handles someone’s financial affairs on their behalf), in an attempt to resolve the matter before the Council took legal action. Mr X maintained his view that Mr Y was unable to reduce his spending on cigarettes and electronic devices due to his autism, and this had not been properly considered by the Council.
27. As Mr Y was unhappy with the care being provided and the request for financial contributions, he began to look for alternative accommodation.
28. In November 2022, the Council’s Resource Allocation Panel agreed to proceed with debt recovery action, on the grounds that Mr Y had been assessed to have sufficient funds to pay his client contribution towards his care package.
29. In December 2022, the social worker completed a capacity assessment in relation to Mr Y’s capacity to manage his finances. Mr X currently manages Mr Y’s finances on his behalf. The assessment found Mr Y was able to understand relevant information and weigh it up to make a decision. It noted that Mr Y has a history of making some unwise financial decisions and chooses to spend a lot of money on cigarettes and electrical items, but this does not mean he is incapable of managing his finances. It noted that Mr Y had not had much opportunity to try to manage his own finances, although he was likely to continue to need some support in this area. The Council proposed that an independent appointee took on the role of supporting Mr Y’s financial management. At the time of writing this decision statement, both Mr X and Mr Y are opposed to this. It was agreed that debt recovery action would be put on hold until the Ombudsmen reach a decision about the complaint.
30. Mr Y remained unhappy with the support he was receiving and the contributions he was asked to pay. In February 2023, he moved into independent accommodation where he had more choice over what type of support he receives. The dispute over Mr Y’s financial contributions towards his care remains unresolved.

Analysis

New accommodation and care planning

Lack of choice

31. Mr Y complains he was not given a choice about where to move, as there was only one option available in the borough for supported accommodation with self-contained flats.
32. The Care and Support Statutory Guidance for the Care Act 2014 (the Care Act) states that a local authority must ensure the person has a genuine choice of accommodation. It must ensure that at least one accommodation option is available and affordable within the person’s personal budget and it should ensure there is more than one of those options. It does not state that these options must be in a particular area. I have reviewed the records and I can see that other accommodations options were discussed with Mr Y, such as placements in neighbouring boroughs.
33. Mr Y had been settled in his previous accommodation in Harrow for several years. It is understandable that Mr Y wished to remain in the area. However, if there was only one suitable placement in the borough of Harrow, then the Council could only offer additional options in other areas which were out of borough.
34. I can see that these other options were discussed with Mr Y, and he decided to remain living in Harrow. I appreciate why Mr Y did not feel the other options were suitable, however he was offered a choice. I have not found fault on this point.
35. However, the records contain limited information about the discussions with Mr Y about the available options. For example, I have seen nothing to suggest that it was clearly explained to Mr Y that the support provided with his new accommodation was “step down” support which would be limited to encouraging him to develop daily living skills himself, and that the care provider was unable to offer the hands-on support to complete these tasks for him, which he had received from his previous care provider. The Council owns and manages the new accommodations and would have known that the commissioned care provider only provided a maximum of 12 hours support as standard for all residents. Therefore, at the time of arranging the placement, the Council would have known that Mr Y’s package would reduce significantly with the move yet did not discuss this clearly with him. This is fault.
36. Mr Y was clear that he did not wish to move out of the area. We cannot know if he would have reached a different decision if the change in support in the Harrow placement had been discussed more thoroughly with him. However, I have found that this was a lost opportunity to ensure Mr Y was able to make an informed decision when choosing his accommodation and support.

Review of Mr Y’s needs

37. Mr Y complains about the Council’s review of his needs in January 2022, which led to his weekly care hours being reduced by half.
38. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
39. When Mr Y moved to new accommodation, his social worker reviewed his needs. As explained above, the review concluded that many of Mr Y’s hours were used to accompany him in the community, and the social worker felt Mr Y did not need 1:1 support with this. The review also noted that Mr Y was able to complete many daily living tasks, such as cooking and cleaning, but needed encouragement to do so.
40. Similarly, the Trust’s complaint response of 24 October 2022 states that a lot of the previous 1:1 time was used to accompany Mr Y to coffee bars and shops, and he did not need to continue with 25 hours of 1:1 support a week as he was able to function in the community without this level of support. The Trust said it was clinically appropriate for the new provider to provide less 1:1 support than previously.
41. The evidence I have seen shows that Mr Y’s previous support workers did regularly accompany him in the community. However, they also provided regular hands-on support to complete daily living tasks. Mr Y would participle at times, but the support workers often completed these tasks on his behalf.
42. I have also considered the Consultant Psychiatrist’s letter, sent to the Council’s housing department in December 2021, which states her view that Mr Y needed to maintain his current care package. His support worker at the time echoed the same view in that letter.
43. Mr Y complains that he is not receiving support for his needs arising from autism. He says it has not been recognised that he is unable to complete many daily living tasks himself and needs additional support in this area.
44. The National Institute for Health and Care Excellence (NICE) guidance for Autism Spectrum Disorder in adults: diagnosis and management (June 2021) says “All health and social care professionals providing care and support for autistic adults should have a broad understanding of the potential discrepancy between intellectual functioning as measured by IQ and adaptive functioning as reflected, for example, by difficulties in planning and performing activities of daily living….”
45. The Council’s needs review notes that Mr Y is a capable adult and is physically able to complete these tasks. In line with the NICE guidance, it also acknowledged that Mr Y’s anxiety and poor motivation, resulting from his schizophrenia and autism, impacts on his ability to complete daily living tasks. As a result, it made provision in his care plan for additional support and encouragement to help Mr Y to achieve these tasks.
46. The Council told us the needs review was completed by the social worker who discussed Mr Y with the mental health Multi-Disciplinary Team and consulted the clinical notes including the Consultant Psychiatrist’s letters.
47. The review includes details of Mr Y’s mental health history. However, I have seen no record of conversations with the mental health team as part of the review process. The review also does not make any reference to the Consultant Psychiatrist’s December 2021 letter, written just a month before the review, expressing views that Mr Y needed to maintain his existing level of support.
48. The social worker is entitled to reach a different view to the Consultant Psychiatrist and the support worker in relation to Mr Y’s needs and the support he required. As outlined earlier, we do not question the merits of a decision that has been properly taken. However, we would expect to see documented evidence of how the social worker considered information from the mental health team and the Consultant Psychiatrist, and documented reasoning for reaching a different view. I have seen no evidence of this, and therefore I am not satisfied the review was properly carried out, taking into account all relevant evidence. This is fault. This leaves Mr X and Mr Y with uncertainty about whether Mr Y’s reviewed care package may have been different, had the Consultant Psychiatrist’s letter been considered as part of the review process.
49. Further, as I will address next, there was no plan in place to help Mr Y transition to receiving less hands-on support and a significant reduction in hours.

Lack of care in transition period

50. Mr X complains that Mr Y’s support was suddenly and significantly cut, without any transition period to help him adjust. Mr X says this also put a significant amount of stress on him and Mrs X to try and support Mr Y.
51. The strategy for adults with autism in England, ‘Think Autism – Fulfilling and Rewarding Lives (2014)’ says ‘Changes such as… moving home… can have a significant effect on someone with autism…. When services do not meet people with autism’s needs, the result can be that they spiral into a mental health crises with parents/carers left to pick up the pieces.’
52. Further, the NICE guidance for Autism Spectrum Disorder in adults says ‘When discussing and deciding on care interventions with autistic adults, take into account the importance of predictability, clarity, structure and routine for autistic people.’
53. In May 2021, Mr Y was receiving 42 hours of support a week, including overnight care. In July 2021, Mr Y’s care was reduced to remove the overnight care. He was then entitled to 5 hours a day 1:1 care, for a total of 25 hours a week, to ‘work slowly towards achievable goals and promoting independence’. The support workers provided hands on support with cleaning, laundry and meal preparation, although Mr Y was encouraged to participate in these tasks and could prepare himself some simple meals.
54. In January 2022, Mr Y’s change in accommodation led to the social worker reviewing his needs. In addition to reducing Mr Y’s hours, the new care provider would not be able to provide the same level of support as Mr Y’s previous provider as this was ‘step down’ supported accommodation. Step down accommodation is intended to support people while they work towards moving on to independent accommodation. As such, the support provided is primarily focused on increasing a person’s independence and living skills.
55. This reduction in support hours happened at the same time Mr Y was having to adjust from his long-term placement to new accommodation and a new care provider. These are significant changes for any person to deal with, even more so for someone who is autistic. Mr Y’s care had also, in total, been reduced to a quarter of his previous entitlement, over a six-month period. This was another substantial adjustment for him over a relatively short period of time. Mr Y’s autism and anxiety means that these major life changes would have been particularly challenging for him.
56. I have not seen any evidence the Council properly considered the impact of halving Mr Y’s hours at the same time as a significant accommodation and care provider change, or that the Council put in any additional support to help Mr Y gradually transition to his new reduced level of care. This is fault. This would have caused additional stress and anxiety, during an already stressful period in Mr Y’s life.

Care provider

57. Mr X and Mr Y complain that the care provided in the new accommodation was inadequate. Specifically, they complain it does not take into account that Mr Y struggles to engage and find motivation to complete daily tasks as a result of his autism. Mr Y also says he did not receive anywhere near the 12 hours of weekly 1:1 care he has been asked to financially contribute towards.
58. I have reviewed the care provider’s daily records. I can see that Mr Y received several contacts a week from staff, including in person visits from his support worker, telephone calls, texts and additional welfare checks on the weekend.
59. During the visits, Mr Y’s support worker discussed a range of topics with Mr Y including his wellbeing and mood, his medication and medical appointments. A range of support was offered to encourage Mr Y to tackle cleaning and decluttering of his flat. This included offering to help Mr Y buy cleaning supplies, purchasing cleaning supplies and bin bags when Mr Y did not buy them, offering to work with Mr Y to clean his flat, setting goals and timeframes for decluttering, and offering to drive Mr Y to charity shops to donate unwanted clothing.
60. Mr Y was offered support with his nutrition including cooking courses, accompanying him to the shops to buy ingredients, and helping him learn how to order groceries online. He was offered support to learn how to use the washing machine and to sort and reduce his large amount of clothing.
61. The NICE guidance for Autism Spectrum Disorder in adults says to ‘encourage autistic adults to participate in self-help or support groups or access one-to-one support and provide support so they can attend meetings and engage in activities’. Mr Y’s support worker acted in line with this guidance by offering to attend the local autism group with him and making suggestions for various other social outings, such as snooker halls and an art exhibition, although Mr Y declined to go.
62. From the evidence I have seen, the care provided was in line with Mr Y’s care plan. The care provider is contracted to provide ‘step down support’ to encourage residents to become more independent. The care provider does not have the capacity to complete cooking and cleaning duties on Mr Y’s behalf, but did offer to work alongside him with these tasks. The care provider has monitored Mr Y’s health and wellbeing and made numerous efforts to encourage Mr Y to achieve daily living goals.
63. Mr Y missed some pre-arranged appointments or would sometimes ask to rearrange meetings or end support visits early as he was feeling unwell or tired. The social worker made repeated efforts to engage Mr Y in attempting daily tasks or an activity, although these were usually unsuccessful. Mr Y would often decline, saying he would prefer to do it another day or not at all. Mr Y is an adult and is legally assumed to have the capacity to decide whether he wishes to engage with activities, unless there is evidence to the contrary. The care agency could not make Mr Y engage in an activity if he chose to decline.
64. I acknowledge that the type of support on offer was not the support Mr Y wanted and that he struggled to engage with tasks and activities when suggested. I also recognise that his anxiety and autism impacted on his ability to engage. However, the full 12 hours of support were available to him, had he wished to participate with the support offered. As such, I have not found fault with the care provided, which was in line with Mr Y’s care plan. However, as noted above, there were flaws in the care planning itself.

Monitoring of care

65. Mr Y lived in his new accommodation for just over a year. In that time, he made little progress with decluttering his flat, cleaning or completing his laundry. He also did not manage to engage with developing his cooking skills or trying new social activities.
66. As mentioned above, Mr Y is an adult with the capacity to decide what activities he wishes to engage with. I acknowledge that the care provider could not make Mr Y engage with activities if he chose not to.
67. The Council told us that once it became apparent Mr Y was not engaging with social and daily living activities, the social worker reviewed his needs and identified that Mr Y may benefit from additional care hours more tailored for an autistic person whose functioning is impacted by anxiety and lack of motivation. The social worker contacted other care providers, but the social worker ultimately decided that the current care provider would provide more intensive, hands-on and creative support. Mr Y’s care hours were increased slightly to allow for social activities. The social worker also arranged for an Occupational Therapist to review Mr Y’s needs. The social worker also asked the care provider to send him weekly updates outlining the support offered to Mr Y and the outcomes.
68. I am satisfied, from the evidence I have seen, that the Council reviewed Mr Y’s care when he was struggling to engage with support, explored various options, made appropriate referrals and arranged for the care provider to adapt their approach. Following this, there was some improvement, for example Mr Y managed to sort some of his possessions and dispose of a small amount. However, I note that most attempts to engage Mr Y in activities continued to be unsuccessful.
69. There was a clear conflict in views between Mr X and Mr Y and the Council about Mr Y’s ability to engage with daily living activities. The Council recognised that Mr Y struggles with motivation, but took the view that he is able to complete daily living activities with additional support. Mr X and Mr Y say that Mr Y’s autism impacts him to the extent that he is simply unable to complete these tasks.
70. I cannot comment on Mr Y’s full capabilities as there are many factors involved and no definitive answer. However, I have not seen any evidence that Mr Y’s lack of engagement is solely due to his anxiety and autism. It is accepted that Mr Y’s diagnoses impact on his motivation, but it is difficult to quantify the extent of that impact. The Council also had to take Mr Y’s autonomy into account and respect his right to choose not to engage.
71. I also cannot say whether extra support or a different care package would have been more successful in engaging Mr Y. I note that many of the concerns such as his living environment, laundry and dental health are long standing issues which existed when Mr Y had much higher levels of support. In addition, while Mr Y found the situation stressful, I have not seen any evidence that this significantly impacted on his mental health. The Consultant Psychiatrist raised concerns in December 2021 that a reduced care package could increase Mr Y’s anxiety and potentially cause a mental health relapse. However, the mental health reviews throughout 2022 noted that, despite the reduction in care, Mr Y was stable and had not reported any increase in his anxiety.
72. I recognise Mr X and Mr Y’s views that the care package should have included the completion of domestic tasks on Mr Y’s behalf. However, The Care and Support Statutory Guidance (the Guidance) for the Care Act 2014 states ‘supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act’. Similarly, the statutory guidance for the Adult Autism Strategy states ‘it is critical to the vision of the Care Act that the care and support system works to actively promote wellbeing and independence…It will be vital that the care and support systems…help people retain or regain their skills and confidence and…delay deterioration in such needs wherever possible.’
73. Although he finds it challenging, Mr Y has demonstrated that he is able to complete laundry, some decluttering and preparing simple meals at times. The Council was acting in line with the relevant guidance by promoting Mr Y’s independence. I note that this goal was part of Mr Y’s previous care plan too.
74. The Guidance further says that ‘promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them.’ Mr Y partly decided to move to independent accommodation so he could choose to purchase the type of support he wanted. The care provider supported Mr Y to access the property bidding system, place a successful bid, and provided free transition support in his new property.
75. Overall, when considering the type of support to provide Mr Y, the Council acted in line with the relevant guidance and legislation which focuses on the importance of promoting a person’s independence. From the evidence I have seen, the care provided was adequate and I have not found fault with the way the Council managed and reviewed Mr Y’s package.

Mental Health care

76. Mr Y complains that his mental health care was inadequate, specifically that he is not receiving any support for his autism.
77. The Trust told me that its staff have the knowledge and skills to work with autistic people. Mr X disagrees with this. The Trust also said Mr Y had been signposted to a local autism group but chose not to attend.
78. Mr Y said his autism and obsessive thoughts prevent him from being able to meaningfully engage with daily living tasks and personal care. Mr Y said he needs more practical support with cooking, cleaning and personal care as part of his autism support.
79. I have looked at Mr Y’s mental health reviews from July 2022 to February 2023. These reviews considered Mr Y’s wellbeing, mood, medication and physical health. These reviews are thorough and the Consultant Psychiatrist liaised with social services and the Council housing department to support Mr Y, where appropriate.
80. The support Mr Y is seeking in relation to his autism is social care, and I have addressed this separately above. I have not found any fault in relation to Mr Y’s mental health care from the Trust.

Social worker contact

81. Mr Y complains he rarely saw his social worker. I have reviewed the records and can see that Mr Y was contacted by his social worker roughly every two months. This was a mix of phone calls, face to face visits and additional contact with Mr X.
82. While Mr Y would have preferred more contact from his social worker, the records show there was adequate contact. Mr Y had regular monitoring and support from the care provider, who was able to escalate concerns to the social worker if required. I have not seen any evidence that Mr Y attempted to contact his social worker or asked for more frequent contact.

Financial management

Assessment for financial contributions

83. Mr X and Mr Y complain about the Council’s financial assessment and the outcome that Mr Y should contribute £107.15 per week towards his care. Mr Y says he is unable to afford this amount and his Disability Related Expenditures (DRE) have not been properly considered. In particular, Mr X says Mr Y’s significant expenditure on cigarettes has not been taken into account. He says the Council has advised Mr Y to cut down or quit smoking, but due to his mental health and autism he is unable to do so.
84. Where a local authority arranges care and support to meet a person’s needs, it may charge the adult, except where the location authority is required to arrange care and support free of charge. I have not seen anything to suggest that Mr Y is eligible for free care.
85. Following a financial assessment, a person may be asked to contribute towards their care. Mr Y has an outstanding debt for care provided since January 2022. I have looked to see whether Mr Y’s financial assessment was conducted properly, including the consideration of Mr Y’s claimed DREs.
86. Mr Y was first asked to contribute to his care in 2019, but he did not pay. Mr Y has not been asked to pay this outstanding debt for care provided between October 2019 and December 2021, and has benefited from this care.
87. In December 2022, Mr Y’s Consultant Psychiatrist said Mr Y would find it very difficult to reduce his smoking as he used this to manage his anxiety. This is recorded in Mr Y’s Care Plan Review dated 7 December 2022. As part of my enquiries, the Trust maintained this view, which supports Mr X’s position. However, the Trust’s Care Plan was written after Mr X submitted the DRE claims in March 2022 and would not have been available to the Council at the time.
88. The Council told me it had been unable to consider the DRE claims due to a lack of receipts. The records show the social worker advised Mr X at that time that the DREs were unlikely to be accepted without more evidence. Mr X had been able to supply bank statements which showed regular transfers to Mr Y’s accounts, but did not confirm the actual expenditure on items. Mr Y was unwilling to share copies of his own bank statements and did not keep receipts for his cigarettes. As such, this expense could not be included in the financial assessment. The Council also confirmed it had not seen information from the Consultant Psychiatrist confirming that Mr Y would find it difficult to stop smoking and attempts to do so would be detrimental to his mental health.
89. The Council went on to say that, due to the harmful effects of smoking, this would not usually be included as a DRE. However, the Council also accepts that there are exceptional circumstances where harmful things can be considered beneficial.
90. The Council told me it would consider cigarettes as a DRE providing it has an official letter from Mr Y’s psychiatrist confirming that he needs them due to his disability, and receipts for a period of three months to establish how much Mr Y spends on cigarettes. Once the Council has received these, it will back date this expense to an appropriate date.
91. As the Council did not have sufficient evidence of DRE to take these costs into account, I have not found fault with the financial assessment. The Council has also demonstrated that it is open to considering the cost of cigarettes as a DRE once it has received the relevant evidence. This offer is open to Mr Y, if he wants to pursue it.
92. Mr X says Mr Y does not agree to share his bank statements with anyone and has never kept receipts, therefore this evidence is not available. He wishes the Council to exclude cigarette expenditure based on anecdotal evidence. While it is accepted that Mr Y spends a significant amount on cigarettes, the Council cannot properly assess his expenditure without evidence of the actual amount spent. If Mr Y wishes to accept the Council’s offer to reconsider his DRE and potentially recalculate his contributions, it is open to him to collect and retain his receipts over the next three months.
93. Mr X says the care provided to Mr Y was so poor that he should not be required to pay for it. As explained above, while I have found fault with the care planning, I have not found fault with the care provided. Mr Y received support and further support was available to him, although he did not access it. I have found no grounds to recommend that Mr Y should not pay his care fees based on the quality of the care.

Appointeeship

94. Mr X and Mr Y complain the Council wanted to arrange for an appointee to support Mr Y with his finances, instead of Mr X. Both Mr X and Mr Y are opposed to this. This is partly due to the care contributions remaining unpaid while the dispute about the level of contribution is ongoing.
95. The decision about whether to put an appointee in place has been put on hold while the Ombudsmen consider this complaint.
96. Mr X said he will decide whether to pay the contributions once he has seen the outcome of this investigation. The Council has offered to further review the DREs, if more evidence is provided. Mr Y is also trialling having more control of his own finances with larger lump sums. All of these may impact on the decision about who is best placed to support Mr Y with his finances. As such, I consider this matter ongoing. Until a final decision has been reached, this is not something I can take a view on at this time. Once the Council has completed its consideration of the matter, it is open to Mr X and Mr Y to return to us if they remain unhappy.

Debt recovery action

97. Mr X and Mr Y are unhappy that the Council has decided to proceed with debt recovery action. The Council’s decision was based on the financial assessment, which found that Mr Y had sufficient funds to pay a contribution towards the cost of his care. I have not found fault with the way this assessment was completed and the Council is entitled to choose to take action to recover unpaid debts. This is not something we can become involved with.
98. The Council has decided to pause debt recovery action, pending the outcome of this investigation. I note that the Council has indicated it may accept Mr Y’s DREs (such as cigarettes) if it receives sufficient supporting evidence. This could impact on the contributions Mr Y is expected to make, and I suggest it would be sensible for the Council to continue to pause debt recovery action until Mr X and Mr Y have decided whether to submit further evidence and this has been fully considered.

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Agreed actions

99. Within one month of my final decision, the Council will apologise to Mr X and Mr Y for the failings identified in relation to the January 2022 needs review. This includes not properly discussing and preparing Mr Y for the significant reduction in support, not recognising the additional impact of the change due to Mr Y’s autism and the extra stress this caused Mr X and Mr Y.
100. Within one month of my decision, the Council will pay
• Mr Y £500; and
• Mr X £250 in recognition of stress and inconvenience

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Final decision

101. I found that the Council failed to properly plan Mr Y’s transition to his new accommodation, care provider and care package, taking into account his anxiety and autism. This caused unnecessary stress for both Mr X and Mr Y.
102. I have not found fault in relation to the other concerns raised and I note that the Council has agreed to reconsider Mr Y’s DRE claim, if further evidence is provided. I ask that the Council allow Mr Y time to collect this evidence over the next three months. I have now completed my investigation.

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Investigator's decision on behalf of the Ombudsman