Summary: Mr X complained about the Council failure to increase his care package. We have found there was no fault in the actions of the Council. It completed a thorough reassessment which included the views of Mr X and others. We are unable to challenge a professional judgment where there was no procedural fault.

The complaint

1. Mr X complains the Council has failed to provide adequate support to meet his assessed social care needs. In particular, he says:
1. his personal budget (paid via a direct payment) does not pay for the all the care he needs, specifically around bathing and toileting;
2. the Council reduced the care package by one hour without any explanation; and
3. the assessment failed to take account of relevant information, including his carers’ timetable and his mother’s carers assessment.
2. He says this had had a detrimental impact himself and his mother. His mother has to provide additional care, including personal care during the night. This puts a significant strain on her.
3. Mr X is represented by his mother, Miss P, in making this complaint.

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The Ombudsman’s role and powers

4. 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)
5. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
6. 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(i), as amended)

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How I considered this complaint

7. I discussed the complaint with Miss P and considered the written information she provided. I made written enquiries of the Council. I took account of all the information before reaching a draft decision on the complaint.
8. I sent a copy of my draft decision to Miss P and the Council. Any comments received were taken into consideration before I made my final decision.

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What I found

Relevant law and guidance

Assessment of care needs and support plan

9. 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. 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.
10. The High Court has confirmed that an individual’s wishes are not the same as their needs and wishes are not the paramount consideration. A council has to have ‘due regard’ to an adult’s wishes as a starting point, but social workers are entitled to exercise their professional skills and judgement in deciding how to meet eligible needs. (R (Davey) v Oxfordshire County Council [2017] EWHC 354 (Admin))

Direct payments

11. 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.

What happened

12. The following is a summary of the key events relevant to this complaint. It is not intended to provide a detailed account of everything that happened.
13. Mr X is disabled and requires support with daily living. He lives at home with his mother, Miss P. For several years he received a direct payment from the Council. He has used this to employ personal assistants to support him with personal care and accessing the community. The Council funded 48 hours of support per week.
14. In 2021, Mr X and Miss P asked the Council to increase the number of hours. They explained Miss P provided a significant amount of support herself and paid for an extra 8 hours of personal assistant care from other income.
15. The Council reviewed the care package in January 2022, including a review of Miss P’s caring role. Miss P says the Council agreed fund an additional hour to allow Mr X to take a bath. She says this did not happen.
16. In July 2022, Miss P again asked to Council to increase the direct payment. She explained the current allocation of 48 hours was still insufficient to meet Mr X’s care needs, specifically his personal care. Miss P provided the Council with a schedule of Mr X’s activities that explained how the direct payment was spent.
17. The reassessment was carried out in September 2022. This did not lead to an increase in the direct payment. Dissatisfied with this outcome, Miss P complained to the Council. Her complaint was not upheld. She was told the direct payment was sufficient to meet Mr X’s assessed care needs.

Analysis

18. If a person has eligible needs, councils have a legal duty to meet them. This does not mean a council must meet a person’s wants. Wants and needs are different. This is sometimes a tricky area, because service users and councils may disagree about what is a want and what is a need.
19. It is not the Ombudsman’s role to say what a person’s needs are, or what services they should receive. The Ombudsman’s role is to consider if a council has followed the correct process to assess a person’s needs. In doing so we look at what information the council considered. If a council considers all this information properly the Ombudsman cannot find a council at fault just because a service user disagrees with its decision, or outcome of an assessment.
20. I have not found the Council to be at fault in this case. I have reached this conclusion based on the following evidence I have seen from Mr X’s case records.
1. The reassessment involved Mr X, Miss P, Mr X’s personal assistant and an advocate. The social worker recorded a detailed discussion took place about Mr X’s needs, his daily routine and the support he received from both Miss P and his personal assistants. It also covered the areas of need that they believed were not being met. This was the correct approach.
2. The reassessment considered the information provided by all parties. The social worker took into account the statutory eligibility criteria and applied this to what she was told during the assessment visit and what she observed in the home. Again, the Council followed the process I would expect to see,
3. In response to Miss P’s complaint, the Council provided a breakdown that explained how the 48 hours had been calculated. It explained it was based on a traditional care plan structure that was applied equitably to all service users. There was no fault in how the Council decided that 48 hours was sufficient to meet Mr X’s assessed care needs.
4. The social worker considered the schedule of Mr X’s daily activities. It was her professional opinion that the support hours could be managed differently to allow Mr X’s needs to be met in a way that would help Miss P. This was a reasonable suggestion for her to make and in the spirit of what direct payments are meant to achieve.
5. It was reasonable to advise Miss P to contact the continence service about problematic continence pads. The Council does not have to provide care funding to meet continence needs when an alternative solution is available from the specialist health service. The Council had correctly reflected the cost of continence pads as a disability-related expenditure in Mr X’s financial assessment.
6. Mr X was appropriately signposted to other specialist services, including occupational therapy and the wheelchair service. I appreciate Miss P felt these were unhelpful suggestions, but the Council’s responsibility is limited to meeting eligible support needs, not providing specialist services directly.
21. Overall, I am satisfied the Council carried out a thorough reassessment and was aware of the issues that had been raised by Mr X and Miss P. There was no fault.
22. I appreciate Mr X and Miss P do not share the Council’s view that his needs can be met within the allocated budget of 48 hours, but this alone does not give me a reason to find fault for the reasons I have explained. I cannot instruct the Council to disregard its social worker’s professional judgement simply because they do not agree.
23. Miss P has also complained about a failure to increase the support plan by one hour in the previous assessment carried out in January 2022. I have reviewed the assessment and relevant case notes and have seen no evidence that the Council intended to increase the number of hours to 49. The direct payment was slightly adjusted following the assessment, but this was a matter for the Council to determine. In the absence of any evidence to support what Miss P says, I am unable to find fault.

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Final decision

24. I have not found the Council to be at fault. On this basis I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman