Summary: Miss X complained the Council has wrongly reduced the number of hours of direct payment she receives for her care and support needs. And has failed to properly consider her disability related expenses. Miss X says the Council’s actions have had a detrimental impact on her health and wellbeing. There is no evidence of fault in the way the Council reassessed Miss X’s care and support needs. However the Council’s failure to provide full information and properly advise Miss X regarding disability related expenses is fault.

The complaint

1. The complainant, Miss X complained the Council has wrongly reduced the number of hours of direct payment she receives for her care and support needs. Miss X says the reduction in hours has had a detrimental impact on her health and wellbeing.
2. Miss X also complains the Council has failed to properly consider her disability related expenses and is seeking a contribution towards the care charges that she cannot afford.

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The Ombudsman’s role and powers

3. 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)
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(i), as amended)

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How I considered this complaint

5. As part of the investigation, I have:
• considered the complaint and the documents provided by Miss X;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with Miss X;
• 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

Care assessments and support planning

6. A council must 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 outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
7. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. (Care Act 2014, sections 24 and 25)
8. Statutory Guidance explains a council should review a care and support plan at least every year, on request or in response to a change in circumstances. The purpose of a review is to see how a care and support plan has been working and to decide if any revisions need to be made to it.

Direct payments

9. A direct payment is money a council gives to an adult who has eligible care and support needs. Direct payments let people arrange and pay for their own care and support, as set out in their care and support plan.

Charging for social care services

10. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
11. 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. For example, above average heating costs should be considered.

What happened here

12. Miss X lives alone and requires assistance with most daily activities. She has had a care and support plan for several years and employs personal assistants via direct payments (DP).
13. In April 2023 the Council carried out a financial assessment to review Miss X’s contribution towards the cost of her care. Miss X was unhappy the Council intended to increase her contribution and provided details of the costs she wanted the Council to consider as DRE. This included significant sums for taxis, increased electricity costs, higher food costs due to dietary requirements, non- prescription medication, and pet insurance.
14. The Council wrote to Miss X in July 2023 advising that from 13 August 2023 her contribution would be £160.52 per week. It advised DRE would only be included if Miss X provided receipts. The current calculation only allowed DRE in respect of laundry costs.
15. In August and September 2023 Miss X provided further details of her expenses and copies of invoices and receipts. The Council advised it would not consider expenses related to her dog as DRE as it is not an assistance dog. It did not comment on any other claimed expenses.
16. The Council reviewed Miss X’s care and support plan in September 2023. At that time she had a care plan of 45.5 hours support a week. Following the reassessment the Council considered Miss X’s needs could be met through a reduced package and proposed 35 hours a week.
17. An officer spoke to Miss X on 22 September to explain the decision to reduce the support package and advised her of her right to appeal the decision. The officer also told Miss X the hours would remain as they are until the Council had taken her feedback into consideration.
18. The officer then wrote to Miss X confirming the outcome of the reassessment and suggested how the hours could be used. This included reducing the morning support from three to two hours each day and cancelling the lunch call as carers prepared Miss X’s lunch in the morning and left it in the fridge.
19. Miss X appealed in November 2023. The Council held a Direct Payment Appeal Hearing the following month. During this meeting the Council identified it had mistakenly reduced Miss X’s DP prior to the appeal. This was contrary to its policy, so the Council reinstated Miss X’s DP to 45 hours a week. It also identified Miss X had not paid her contribution towards the cost of her care.
20. The Council did not uphold Miss X’s appeal. It was satisfied the reduced hours could meet Miss X’s care and support needs and achieve her desired outcomes. It wrote to Miss X confirming its decision on 19 December 2023. It also confirmed the reduced hours would begin on 12 January 2024 so that she had time to implement the new care arrangement.
21. As Miss X continues to dispute the Council’s decisions regarding the amount of care she needs and her DRE, she has asked the Ombudsman to investigate her concerns. Miss X complains the Council reduced her care at a time when she needed it most. She says the reduced morning call means she does not have time to shower and as a result has a bad rash. Miss X says the Council has exacerbated the problem by failing to take account of her DRE and asking for a contribution of £160 per week which she cannot afford.
22. Miss X also says she is missing out on NHS care and her treatment is being delayed as she cannot afford the taxis fares to visit her GP. Miss X lives in a remote area and needs to travel in a specialist taxi. She says the Council has also refused to provide additional care when she needs someone to stay with her overnight following hospital procedures.
23. The Council reassessed Miss X’s contribution towards the cost of her care in March 2024 and allowed DRE in respect of gardening costs. This reduced Miss X’s contribution to £154.42 a week with effect from 13 August 2023.
24. In response to my enquiries the Council says it contacted the agency that supports Miss X of a weekend in late November 2023 to confirm they were able to continue to support Miss X. It also asked for a breakdown of the care provided during their visit. The company set out the support they provided which included assisting Miss X to shower, which they noted took around 50 minutes. The company confirmed they would be happy to continue to support Miss X.
25. The Council says the way Miss X organises her care appears to be complicated due to her personal assistants’ other commitments. It says it suggested Miss X used a commissioned service but she declined. The Council says it has no record of Miss X informing the Council that the reduction of her morning personal care call had resulted in her developing a rash. It considers the hours are sufficient if Miss X used the recommended or revised approach.
26. In relation to Miss X’s financial assessment and DRE the Council notes it has received several emails from Miss X detailing the costs she has incurred. The Council says it considered Miss X’s taxi receipts but her claim was unsuccessful as Miss X receives an enhanced Personal Independence Payment (PIP) which supports travel costs.
27. As Miss X lives in a remote area it also suggested the possibility of moving to accommodation in a more accessible area. The Council says Miss X declined as she wanted a garden for her dog. The Council did not accept costs related to Miss X’s dog were DRE as it is not an assistance dog.
28. In addition the Council says it required evidence to substantiate other costs, such as chiropody, hairdressing, specialist foot wear and specific dietary costs.
29. The Council acknowledges it could have provided Miss X with more information and further advice regarding the specific dietary costs, footwear costs and chiropody costs. It says it will undertake a thorough review of Miss X’s DRE. It will also review her care needs and DP.

Analysis

30. The Ombudsman does not act as an appeal body. It is not the Ombudsman’s role to decide the level of care and support Miss X needs, or what should be accepted as DRE; that is the Council’s job. We can only consider whether the Council assessed her care needs and DRE claims correctly. We cannot criticise a council where officers have followed the correct procedures and reached a reasoned decision.
31. The Council has reassessed Miss X’s care needs and reduced her care package. Miss X disagrees with this decision and exercised her right of appeal. The appeal panel upheld the reduction in support hours and set out how the hours could be used to meet Miss X’s needs.
32. While the reduction in hours may not allow Miss X to organise her care in the way she would prefer, the Council is satisfied the revised allocation of direct payments can meet her needs. This is a decision the Council is entitled to make and there is no evidence of fault in the way it was taken. The documentation shows the Council confirmed with the care agency what care it provided during the morning visit and that it could be completed in two hours.
33. The Council has also completed a financial assessment to review Miss X’s contribution towards the cost of her care. Miss X disputes the level of contribution as she asserts she has significant DRE which should be taken into account. Miss X set out a detailed breakdown of her expenses and provided receipts for many of these expenses.
34. The outcome letter sent to Miss X following a review panel meeting in October 2023 says cost associated with Miss X’s dog were declined as it is not an assistance dog. There is however no reference to any of the other costs Miss X claimed as DRE. There is no evidence the Council explained to Miss why other expenses would not be considered DRE or what specific evidence she would need to provide to support her claim. I consider this failure to provide full advice and support regarding DRE claims to be fault.
35. The Council provided Miss X with a copy of its DRE factsheet but acknowledges it could have given Miss X more information and advice regarding specific dietary, footwear, and chiropody costs. To address this the Council will now undertake a thorough review of Miss X’s DRE. This is an appropriate remedy.

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Agreed action

36. The Council has agreed to:
• apologise to Miss X for the failure to provide a full explanation in relation to her Disability Related Expenditure claims; and
• undertake a thorough review of Miss X’s Disability Related Expenditure. Any assessment should include a detailed explanation of the reasoning behind any decision taken.
37. The Council should take this action within one month of the final decision on this complaint and provide us with evidence it has complied with the above actions.

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Final decision

38. There is no evidence of fault in the way the Council reassessed Miss X's care and support needs. However the Council's failure to provide full information and properly advise Miss regarding disability related expenses is fault.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman