Summary: Mrs D complains about the Council’s delays in reviewing her daughter’s care plan, cutting her number of hours of care and support, not increasing a direct payment and delaying a referral for specialist counselling. We uphold the complaint because of some contradictory record keeping and not sending Mrs D some records, causing some uncertainty. The Council has agreed to our recommendations.

The complaint

1. The complainant (Mrs D) complains about the care the Council provided to her daughter (Miss E) and that:
1. the Council did not carry out a care plan review between 2022 and June 2025. And after the June review, it did not send a new care and support plan until November;
2. Miss E’s hours of support were cut over the course of two years;
3. the Council did not increase the amount of Miss E’s direct payment for three years;
4. a social worker should have made a referral for specialist trauma counselling around January 2024, when Mrs D first asked for it. Instead, the social worker made a referral to a different team, even though Mrs D told the social worker that team could not provide the specialist counselling her daughter needed. So a referral was delayed by over a year.

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The Ombudsman’s role and powers

2. 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)
3. 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)
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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What I have and have not investigated

5. Mrs D complained to us in July 2025, about events going back to around June 2023. We will not normally look at events longer than 12 months before the complaint to the Ombudsman. Mrs D says she was overwhelmed at the time, including by having to support her daughter with multiple issues, including a court case. Given those circumstances, I have used my discretion to look at events back to January 2024, which is when Mrs D says Miss E’s situation started to significantly deteriorate.

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How I considered this complaint

6. I considered evidence provided by Mrs D and the Council as well as relevant law, policy and guidance.
7. Mrs D 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

Legal and administrative background

Care and support for adults

8. 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. 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.
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.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Direct payments

11. 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 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.
12. One of the ways a service user can use their personal budget is via a direct payment. 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.

Counselling support where Miss E’s lives

13. In the area where Miss E lives a Community Learning Disabilities Team (Organisation 2) provides services for adults with learning difficulties. Organisation 2 is a National Health Service funded service. The Council is a partner agency with Organisation 2, so it can make referrals for services. But it has no control in relation to the assessment and timescales of the service.
14. A charitable organisation in the area where Miss E lives (Organisation 3) provides specialist trauma counselling.

What happened

15. The following is a summary of key events. It is not intended to be a detailed chronology.

Background to the complaint

16. Miss E is a young woman with learning disabilities and support needs. She receives a package of care from the Council including 1:1 support, funded by a direct payment and delivered by a care provider that provides some other support to Miss E. Mrs D manages the direct payment on Miss E’s behalf.
17. In 2022 Miss E reported what Mrs D describes as “horrendous”, traumatic events from her childhood, including crimes against her. The events had taken place in a city in another local authority area. South Gloucestershire Council (the Council) reported the issue to the Safeguarding Team of the council in the area where the incidents had taken place.
18. The Council has a record of an August 2022 Care Act review of Miss E’s care and support needs. It also referred Miss E to an organisation that provides support and counselling (Organisation 1). Mrs D reports that Miss E did not have a good experience there, so did not want to use it for counselling support.
19. Also in 2022 Miss E moved away from Mrs D’s home to supported living in a neighbouring local authority area. The Council was providing 14 hours a week of 1:1 support there.
20. During an April 2023 telephone call Mrs D told Miss E’s social worker they had heard nothing from the other council about the historical incident they had reported. The social worker contacted the Safeguarding Team of the council in the area where the incidents had happened.
21. The Council has a record of a June 2023 review of Miss E’s care plan. It notes:
• the social worker had spoken to Miss E about whether she wanted to speak to someone about what had happened to her. Miss E advised she was coping well, she had a contact at Organisation 1 and would let Mrs D or her sister know if she was upset;
• it maintained the amount of 1:1 support it provided Miss E. But once she had established a new routine, including maybe voluntary work, there was a possibility of reducing the amount of 1:1 support.

Events I have investigated

22. Mrs D says around the beginning of 2024, Miss E’s situation started to deteriorate. She dropped out of college and her emotional state worsened. Mrs D says her recollection is that, at the next care plan annual review, she asked the Council to refer Miss E for specialist trauma counselling.
23. In May the Council’s social worker telephoned Mrs D to discuss a review of Miss E’s care and support plan. In August they carried out the review. This noted no change to Miss E’s care and support plan. But they were thinking of Miss E having a trial at a centre providing volunteering opportunities (Organisation 4).
24. In October 2024 the social worker visited Miss E to discuss the fact she was only using eight hours of the 1:1 support the Council was funding via the direct payment.
25. In November Mrs D emailed the social worker to:
• advise she thought Miss E was depressed. She noted Miss E had tried counselling about the historical incidents (see paragraph 18). But she needed specialist help about the issues raised. The social worker replied to say she would need Miss E’s consent to refer to Organisation 2, who could support her;
• advise she had paid outstanding invoices. But she did not have enough money in Miss E’s direct payment account to pay for the following month – she noted Miss E had not received any increase in the amount the Council paid her.
26. The social worker visited in December 2024 to complete a care plan review. Some of the stated aims of the visit were to:
• find out how Miss E was using the 1:1 support hours;
• establish if Organisation 4 was an appropriate form of support. Mrs D and Miss E advised Miss E had had a tour and was going for a trial later in the month;
• get Miss E’s consent for making a referral to Organisation 2, to “see if they can offer counselling/psychiatric support…”.
27. After the visit, the social worker emailed Mrs D to confirm the referral to Organisation 2. She also suggested Mrs D contact Miss E’s GP and ask them to also make a referral for counselling.
28. The Council has a record of a further review of Miss E’s care plan at the beginning of January 2025. This:
• confirmed the referral to Organisation 2 for counselling support;
• noted that Miss E’s support had not been used effectively, leading to her feeling isolated. But the social worker had drawn up a new plan with the care provider and was assisting Miss E to build her confidence, learn skills and build relationships;
• noted Miss E wanted to explore volunteering opportunities. And volunteering at Organisation 4 would be the most suitable option for her.
29. The Council has a case note from January that it had actioned an increase to Miss E’s direct payment.
30. Miss E started to attend Organisation 4 for one day a week. By February, Mrs D spoke to the social worker asking for the Council to fund an extra day there.
31. In March, another review of Miss E’s care and support needs decided to keep her 1:1 hours the same. The social worker noted Miss E’s direct payments had not been increased to match the current rates of her provider. That had led to a shortfall on her account. The social worker requested an increase and a one-off contingency payment into Miss E’s account.
32. In April:
• Miss E’s social worker contacted Organisation 2 asking for an update. Its early April response advised it had made a referral to Organisation 3 and Miss E was awaiting an assessment;
• a further review of Miss E’s care and support plan noted she received 14 hours 1:1 support a week;
• the social worker contacted the care provider who provided Miss E’s care and support, asking for its charges for Miss E’s care including her 14 hours of 1:1 support. Its response noted it had 12 hours of 1:1 support “on its system”;
• the Council agreed to fund Miss E to attend Organisation 4 for a second day.
33. In May a Council manager contacted Organisation 2, expressing the Council’s concerns about its delay in providing Miss E with specialist support. Its response advised she was on the waiting list for therapy sessions from it. And it would clarify with Organisation 3 about its progress.
34. In July, following a complaint by Mrs D, Miss E’s social worker visited. The Council’s record of that visit notes Mrs D said she did not have an up-to-date care plan. So the social worker took one to the visit. The actions from the meeting included that the social worker would review Miss E’s care plan and request funding for an extra day at Organisation 4. The social worker’s record of the meeting recorded Miss E received 12 hours of 1:1 support. The record of the April 2025 review, copied over into the new care plan, recorded Miss E as getting 12 hours 1:1 support.
35. In late August the Council’s panel agreed to fund a third day at Organisation 4, The Council’s records note the social worker telephoned Mrs D shortly after to make her aware of the Council panel’s decision.
36. Mrs D complained to the Ombudsman. In response to my enquiries, the Council said:
• on 1 October 2025 it reduced Miss E’s 1:1 hours to 12 per week. It says its rationale for this was due to Miss E starting another day at Organisation 4. It said it also had concerns there was little or no structure to how Miss E was using her direct payment hours;
• it had not itself made a referral to Organisation 3. Its social worker teams did not have the knowledge or expertise to make such a referral, as referrals were “under the remit” of the National Health Service – whether that would be via Organisation 2 or Miss E’s GP;
• the Council accepted a delay to November 2025 in sending out the 2025 revised care and support plan. This was due to “staff sickness/absence”.

Analysis

No Care Act care plan review between 2022 and June 2025

37. The Council has provided records that it carried out reviews of Miss E’s care and support in 2023, 2024 and 2025. It should have sent a copy of those reviews to Mrs D, acting for Miss E. It seems, more likely than not, that Mrs D did not receive copies of at least some of those reviews. That was fault – although in July 2025 the Council did provide a copy of the previous review, limiting the injustice.

New care and support plan delayed until November 2025

38. The Council has accepted a delay in sending Mrs D a copy of the revised care and support plan. That was fault.

Miss E’s hours of support were cut over the course of two years

39. In response to my enquiries, the Council has explained the rationale for its decision to reduce the Miss E’s hours of support. Looking at the Council’s contemporaneous case notes, I can see a note from 2023 (see paragraph 21) setting out the principle it later implemented.
40. But its records show some inconsistencies about when the reduction took place:
• a care plan review from April 2025 says Miss E’s 1:1 support was 14 hours a week;
• later in that month the care provider advised its records said it was providing 12 hours support;
• a summary of the April care plan review in a further (July) review records the April record as 12 hours, which is what the July review also records;
• the Council’s enquiry response said the reduction happened in October 2025.
41. These inconsistent records are fault. They create confusion and uncertainty. That is an injustice to Mrs D.

The Council did not increase the direct payment for three years

42. The Council did not increase Miss E’s direct payment in line with rising costs. That was fault. The injustice for the earlier period was limited, as Miss E was not utilising the hours of support she did have.
43. Later (from around November 2024) the lack of funds will likely have caused Mrs D some avoidable distress and uncertainty, as Mrs D did not have the funds in Miss E’s account to pay for some of the support.

The referral for specialist trauma counselling

44. I can see the Council made a referral to Organisation 2, after Mrs D asked for counselling for Miss E in November 2024. Its social worker also advised Mrs D to contact Miss E’s GP as another referral route. I cannot see records of an earlier discussion about a referral.
45. Contrary to Mrs D’s understanding, I cannot see any record of the Council’s social worker making a direct referral to Organisation 3. I accept the Council’s explanation of why that is not something it does.
46. Organisation 2 is an NHS-funded and run body and is not a body we can investigate. After the Council made the referral, it did not have any involvement in Organisation 2’s process of allocating support. Nor was it appropriate for the Council to contact Organisation 3 directly.
47. So while Miss E undoubtedly had a long wait for counselling, this was not due to any fault by the Council.

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Action

48. I recommended that, within a month of my final decision, the Council takes the following action.
• Apologise for the faults I have identified. 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 Mrs D a symbolic payment of £100 for the avoidable distress caused by the faults I have identified.
49. The Council has agreed to my recommendations. It should provide us with evidence it has complied with the above actions.

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Decision

50. 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