Summary: Miss X complains there were failings in the way the Council carried out an assessment of Miss Y’s eligible care needs and provided her with Direct Payments to pay her carer Mr Z causing distress and financial difficulties. We have found no evidence of fault in the way the Council considered these matters. So, we have completed our investigation.

The complaint

1. I have called the complainant Miss X. She complains for Miss Y and Mr Z. Miss X says there were failings and delay in the way the Council considered a request for an assessment of Miss Y’s eligible care needs and provide her with Direct Payments to pay for her carer Mr Z. This has caused Miss Y distress, uncertainty and concerns that Mr Z may no longer provide care for her for financial reasons. This matter has caused distress, uncertainty, and financial loss to Mr Z.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
3. 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

4. I considered information provided by Miss X. I read documents the Council provided in response to my enquiries.
5. 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

Legal background

Community Care assessments

6. 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.

Care Plan

7. 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.

Direct payments

8. Direct payments (DPs) 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.

Key events leading up to the complaint

9. What follows is a brief chronology of key events. It does not contain all the information I reviewed during my investigation.
10. The Council first recorded contact with Miss X in December 2021 when her GP sent information about her health issues. The Council provided advice and an Occupational Therapist (OT) ordered equipment for Miss X to use. The Council received a request for Miss Y to receive DPs. The Council contacted Miss Y to deliver the OT equipment. Miss X advised there had been a misunderstanding as she was no longer paying Mr Z as a carer and requested a carers’ assessment instead of DPs.
11. The Council carried out a telephone assessment with Miss Y in March and April 2022 to arrange for an in-house agency to provide carers three times a day. The agency carers would enable the Council to see what Miss X’s needs were and progress the needs assessment. Miss X declined as Miss Y did not want agency carers, but only Mr Z for support due to her mental health needs.
12. The Council carried out a carer’s assessment of Mr Z who only wanted to be paid for the care provided since November 2021. Miss X said Miss Y only wanted a virtual assessment and support from Mr Z as her carer. The Council allocated Miss Y’s case to a social worker in July 2022 to carry out a home visit.
13. The social worker visited in August 2022 and noted Miss X wanted to cut the assessment short at times. The social worker contacted Miss Y’s GP. And referred her for a Continuing Health Care (CHC) assessment by the NHS as Miss X said she needed a live- in carer and 144 hours of support a week. The assessment noted Mr Z working without pay as a personal assistant since November 2021. Mr Z lived in with Miss Y and her family 5 days a week Monday to Friday to provide around the clock care. And attended 6 pm to midnight on Saturday and Sunday.
14. The Council discussed Miss Y’s medical records and the care requested with her family in September 2022. Miss Y had a CHC assessment carried out in October 2022.
15. The Council held a DST meeting in November 2022 about Miss Y but suspended her case because of issues with Miss Y’s mental health. The meeting needed more information about her mental health and did not reach an outcome on her eligible needs. The Council referred Miss Y for mental health services to provide support to her and allocated Miss Y’s case to an OT who attempted to arrange a home assessment visit.
16. In February 2023 officers from mental health services and the Council’s social care team carried out a joint assessment visit. Miss Y ended the assessment as she did not want to it to continue. In March 2023 the Council agreed it needed to wait for the outcome of some mental health therapies and assessments on Miss Y. This would help guide any interventions social services made because of difficulties with Miss Y’s engagement and mental health needs.

Complaint to the Council

17. Miss X complained to the Council in June 2023 that Miss Y had undergone two 2 assessments but not received any care package for her carer. Miss X considered Miss Y could not cope with any more face to face appointments, unable to engage with mental health services and was vulnerable. Miss Y needed her carer to continue and be paid. Miss X asked the Council for an urgent outcome of the assessment for DPs as Mr Z could no longer provide care for financial reasons causing difficulties for Miss X.
18. The Council explained it needed to carry out an updated assessment. This was because the previous one was incomplete because of outstanding questions about Miss Y’s care and the process not fully completed. The Council said there had been little opportunity to speak to Miss Y. It had previously proposed for the in-house agency to work with her, assess her and make long term recommendations about her needs. This would mean carers coming in to support Miss Y a few times a day depending on her needs. But Miss Y declined this.
19. The Council confirmed the OT tried unsuccessfully to make contact and so closed the case. The Council said it was important for the OT to work with Miss Y so it could resume the DST assessment with the CHC and other organisations.
20. The Council set up a virtual meeting for social care assessment and arranged a home visit by an OT in July 2023. The OT assessment noted difficulties making recommendations as Miss Y declined involvement and did not fully take part. Miss Y also declined any support aids. But the OT noted for the long-term Miss Y needed a one bed property, fully wheelchair accessible including a level access shower and possible outside space.

Eligibility assessment July 2023

21. The Council carried out a virtual eligibility assessment in July 2023 and recorded that Miss Y unable to engage with the assessing social worker except for short exchanges. Miss X acted on Miss Y’s behalf and confirmed she wanted support through a DP to keep Mr Z as carer and to move to a ground floor flat.
22. The assessment noted Miss Y had a carer attending to her needs through a private arrangement. And supported by Miss X who said Miss Y needed 24/7 support from a carer to help her needs although Miss Y did not receive care from the district nurses. It noted the incomplete assessment from 2022 and the suspended DST meeting with Miss Y’s referral for mental health services. Miss Y was receiving mental health support causing delays in carrying the reassessment.
23. The assessment considered Miss Y’s private arrangement with Mr Z and listed out what Miss Y said Mr Z did as carer. The Council suggested options to reduce visits. Miss Y wanted the Council to take over payment of the package of care and financed it with DPs. The Council considered Miss Y had eligible needs and needed Council support.
24. Miss Y sent in the carers hours she wanted. The Council prepared a care and support plan for the Housing Panel to consider in October 2023. The Panel agreed to fund DPs for 23 hours per week of personal assistance based on Miss Y’s eligible needs.
25. Miss X applied for backdated DPs to November 2021 as Mr Z had been working without pay. The Council advised it could only pay DPs from the date of the agreed care and support plan in October 2023. It said it had not caused the delays but was due to difficulties faced with assessing Miss Y and making appointments. The Council agreed to backdate DPs to October 2023.
26. The Council reviewed the care and support plan in January 2024. But Miss X and Miss Y did not want to meet officers in person. The Council moved the case to annual reviews of the care and support plan.

My assessment

27. The Council can only determine whether Miss Y is entitled to DP support following an assessment of her needs. The documents provided show the Council tried to engage with Miss Y to carry out the needs assessment. The Council wished to use agency carers to support Miss Y to assess her needs. But Miss Y was unwilling to do so and due to issues with Miss Y’s mental health it unfortunately delayed any further assessments until August 2022.
28. The evidence shows that due to limited engagement from Miss Y with the social worker and OT this limited the Council’s ability to assess her needs. The Council was able to carry out a further needs assessment in July 2023 and this led to a decision Miss Y was entitled to 23 hours of support a week and would receive DPs. The Council advised it could only backdate DPs to the date of the care and support plan agreed in October 2023.
29. There is no recorded evidence Miss Y made a request for DPs in November 2021. The documents provided show this was made in January 2022. It has taken some time to complete the needs assessment, but I cannot say it is due to any fault by the Council. Once the Council agreed Miss Y’s eligible needs it backdated the DPs to October 2023. It is unfortunate that as Miss Y has not been eligible for the DPs until October 2023 Mr Z may not have received payments. But he was working for Miss Y under a private arrangement which would need to be resolved with the family. Until the Council could complete the eligibility assessment it could not determine Miss Y’s eligible needs and approve the DPs.

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Final decision

30. I have completed my investigation. I have found no evidence of fault by the Council in dealing with a request for an assessment of Miss Y’s eligible care needs and provide her with Direct Payments to pay for her carer.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman