Summary: Miss X complained the Council failed to respond when she told it the care provider was increasing its hourly rate for her sister, Miss Y’s, care. Miss X said Miss Y’s care reduced and the family are in debt. There was fault in the way the Council delayed reviewing and increasing the direct payment amount and complaint handling was poor. This distressed Miss X and Miss Y was placed at risk of harm. The Council agreed to apologise, make a financial payment, take the actions it agreed to to increase the direct payment rate and remove the debt and evidence its service improvements.

The complaint

1. Miss X complained the Council failed to respond when she told it the care provider was increasing its hourly rate for her sister, Miss Y’s, care. Miss X said Miss Y’s care reduced and the family are in debt.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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)
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

6. I read Miss X’s complaint and spoke to her about it on the phone.
7. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
8. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Background information

9. 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.
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.
11. 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.
12. 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.
13. 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 council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. 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.
14. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.
  (Care and Support Statutory Guidance 2014)

15. 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.
16. The Council complaint policy says it will acknowledge the complaint within five working days and provide a response within 20 working days of the acknowledgement.

What happened

17. This is a summary of events, outlining key facts and does not cover everything that has occurred in this case.
18. Miss Y has care and support needs. She lives with her family. Miss X, and her family, supports her. The Council meet Miss Y’s care and support needs with a direct payment package totalling 61 hours per week. This funding enables carers from the care provider to support Miss Y at home, and to access activities in the community. The provider has worked with Miss Y for a number of years.
19. In the middle of April 2024, the provider told the Council it was increasing its hourly rate by approximately £5.
20. Miss X told the Council the provider increased its hourly rate in May 2024.
21. The provider contacted the Council in July 2024. The provider said the Council had not increased the hourly rate for Miss Y’s support package. The provider asked the Council to increase the hourly rate urgently as they had an overdue invoice. The Council agreed a one-off payment to clear the overdue invoice.
22. The Council reviewed the direct payment at the end of July 2024. The Council noted the difference between its payment and the providers hourly rate on the 61 hours per week support package.
23. The Council reviewed the support plan in December 2024. It confirmed Miss Y needed 61 hours of care per week to meet her needs. The plan kept the previous hourly rate.
24. The provider contacted the Council in April 2025. The provider asked about the increased rate and explained there was approximately a £1,500 per month shortfall. Miss X told the Council she could not pay the provider invoices because of this shortfall.
25. Miss X complained in June 2025. She complained the Council refused to increase the hourly rate and now said the family must pay the increased cost.
26. The Council reviewed Miss Y’s assessment in July 2025. The assessment confirmed Miss Y needed 61 hours support per week to meet her assessed needs. The Council noted the family reduced the support from the provider as they could not afford the full hours because of the increased rate. The assessment recorded Miss Y needed 244 hours per four weeks, but the family were only purchasing 193 hours.
27. The Council issued its complaint response in August 2025. The response said the personal budget allowed flexibility to purchase services and if the providers rate changed, the family had the option to pay the difference.
28. In September 2025 the Council recorded the family could not manage on lower hours. The Council continued to discuss this matter.
29. Miss X was not satisfied with the Council’s response and has asked the Ombudsman to investigate. Miss X would like the Council to increase its rate and pay off the debt accrued because of the difference in hourly rate to the payment amount.
30. After the Ombudsman sent the enquiries to the Council, it reviewed Miss Y’s case. The review noted Miss Y was having less support because of the increased hourly rate.
31. In response to my enquiries the Council confirmed the debt was approximately £11,500. It recognised Miss Y needed consistent skilled carers and disruption would pose a risk to her wellbeing. The Council agreed to increase the direct payment hourly rate to the new provider rate. It agreed to increase this amount immediately and remove any debt from Miss Y’s direct payment account. The Council also confirmed it was implementing new guidance to ensure events in this case do not happen again.

My findings

Care and support

32. The Council assessed Miss Y needs 61 hours of support per week to meet her care and support needs. The provider has supported the family for a number of years. The provider told the Council it was increasing its hourly rate by approximately £5 per hour in April 2024. Miss X told the Council about the increase in May 2024. The Council did not act.
33. The Council reviewed the support plan at the end of 2024. The support plan repeated Miss Y needed 61 hours of support per week but kept the same hourly rate.
34. The Council reviewed the support plan in July 2025. The review confirmed Miss X needs 61 hours of support per week. The review recorded the family had reduced the hours of support from 61 hours per week to approximately 48 hours per week, because they could not afford the provider’s new rate. The Council did not increase the rate or offer any alternative.
35. The Council considered the complaint and did not increase the hourly rate or offer alternatives, instead telling the family to contribute to the costs.
36. The Council reviewed the support plan again in December 2025. The review repeated Miss Y’s needs and the 61 hours support needed to meet them. The Council did not increase the hourly rate or offer alternatives.
37. When the Council received the notification of the increase, it should have reviewed the case. The review should identify if the family could secure the correct support for Miss Y within the hourly rate it was paying. It would then have either:
• explained the availability of other services to meet needs within the current hourly rate. This would allow the family to either change providers or make an informed decision to pay towards the care; or
• increase the rate to enable Miss Y to continue with the full number of hours in the care plan with the current care provider.
38. It did neither. The Council had five significant opportunities, set out above, to fully consider this matter further. It also had several other opportunities following various communications with Miss X, the provider and internally. The Council did not act for over two years despite several opportunities. This is fault. As a result of the Council fault, the family accrued a significant debt, Miss Y had to reduce her support hours and this significantly distressed Miss Y’s family.
39. The Council only acted when the Ombudsman approached it during this investigation. It should not have taken the Ombudsman involvement to fully consider this matter.
40. The Council assessed Miss Y needed 61 hours of support per week. It knew, for a significant amount of time, she was not receiving this support and did not act. The Council acknowledged not receiving appropriate care was a risk to Miss Y’s wellbeing. Miss X did not receive appropriate care because the Council assessed she needed 61 hours of care and knew she only received 48 for a significant amount of time. This is fault and left Miss Y at risk of harm.
41. I would usually make service improvement recommendations in a case such as this. The Council has detailed the actions it is taking in response to this complaint. This is:
• Finalising the implementation of a standardised agency rate for all direct care packages, with planned annual reviews; and
• Strengthening internal guidance to ensure timely escalation where cost changes risk care delivery.
42. It is not the role of the Ombudsman to oversee the Council's progress against its actions. However, we will monitor the oversight of the new actions.

Complaint handling

43. The Council complaint policy says it would acknowledge the complaint within five working days and respond within 20 working days of the acknowledgement. The Council should have responded within 25 working days. It issued its response after 46 working days, a 21 working days delay. This is fault, frustrating Miss X.

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Action

44. To remedy the outstanding injustice caused to Miss X and Miss Y by the fault I have identified, the Council agreed to take the following action within 4 weeks of my final decision:
• Apologise to Miss X for the distress caused from not promptly reviewing the package of care and delaying the complaint response. 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.
• Apologise to Miss Y for placing her at risk of harm. 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.
• Ensure the debt is removed from the account and increase the direct payment amount, as detailed in the response to the Ombudsman.
• Pay Miss Y £500 to acknowledge she was placed at risk of harm.
• Pay Miss X £2,000 to recognise the distress, frustration and uncertainty caused by the Council not reviewing the direct payment account and for the avoidable strain placed on the family.

Within three months the Council should:

• Evidence the relevant committee has had oversight of the Council actions it said it would take in its response and set out in paragraph 41 and considered the progress made against those actions.
• The Council should confirm the ongoing monitoring arrangements against progress.
6. The Council should provide us with evidence it has complied with the above actions.

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Decision

46. I have completed my investigation. I have found fault by the Council, which caused injustice to Miss X and Miss Y.

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Investigator's decision on behalf of the Ombudsman