Summary: Mrs X complained that the Council stopped her direct payments and significantly reduced her care support. We did not find fault in the way the Council carried out Mrs X’s care and support review process and stopped her direct payments.

The complaint

1. Mrs X is disabled and receives a council-funded care package. She complained about the Council’s decision to end her care and support. It carried out another assessment and reinstated her care, but it provided fewer hours than she had been getting.
2. Mrs X said this affected her mental health, caused avoidable distress and a loss of care and support services in January 2025.

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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. 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)
5. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as the National Health Service (NHS) (Local Government Act 1974, sections 25 and 34(1), as amended)
6. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. 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 or care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
8. 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

9. I have investigated events from the beginning of May 2023, when the Council began its re-assessment of Mrs X’s care needs, up to September 2024, when the Council provided its final complaint response. Any events before or after these dates are referred to only for context. As explained in paragraph seven we would normally investigate only events which happened within 12 months from when the complainant came to us.
10. I have not investigated Mrs X’s concerns about withdrawal of the NHS funding for her joint package of care. This is a separable part of Mrs X’s complaint and should be addressed by the NHS. If Mrs X is not satisfied with the NHS response, she should complain to the Parliamentary and Health Service Ombudsman.

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How I considered this complaint

11. I considered evidence provided by Mrs X and the Council and relevant law, policy and guidance.
12. Mrs 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

Relevant law and guidance

Care needs assessments and plans

13. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan if a person is assessed as having eligible needs. 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 assessment must also involve the individual and where suitable their carer or any other person they might want involved.
14. 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. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)

Reviewing care and support plans

15. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The Care and Support Statutory Guidance (the Guidance) says councils should review plans at least every 12 months. Councils should also consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget.
16. It says other than reviews that are planned annually, a care and support plan may be reviewed due to a change in needs or circumstances that the council becomes aware of, or where a review is requested by the person with care and support needs.

Disagreement with care plans

17. If the plan cannot be agreed with the person, or any other person involved, the council should state the reasons for this and the steps which must be taken to ensure that the plan is signed off.
18. People must not be left without support while a dispute is resolved. If a dispute remains and the council feels that it has taken all reasonable steps to address the situation, it should direct the person to the council’s complaints procedure. (section 10.86 of the Guidance)

Personal budget

19. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)

Direct payments

20. A person can also choose to receive direct payments to arrange the care and support themselves.
21. The amount of direct payment is derived from the personal budget set out in the care and support plan. Direct payments can only be used in accordance with the support plan and any ‘unauthorised use’ of the money will need to be repaid.

What happened

22. Mrs X has multiple health and care needs. Mrs X also has dyslexia. In 2012 the Council provided her with a personal budget delivered through direct payments so she could arrange her own care by employing personal assistants (PAs).
23. In February 2014 Mrs X signed a direct payment agreement in which she agreed to keep records of all income and spending from the direct payment account for three years. The Council would carry out regular reviews. Direct payment agreements should be signed every year. Mrs X had not signed a new one since 2014.
24. Mrs X says in 2014 the Council told her she would not have to carry out the administration side of the direct payments.
25. Mrs X employed live-in carers to provide 24-hour support for a number of years. She funded them by her direct payments.
26. The Council started to investigate Mrs X’s direct payments in July 2023, as it had no evidence of how they had been used. The Council asked Mrs X to provide statements for the direct payments account by the end of August 2023.
27. In mid-April 2024 the Council sent another letter to Mrs X with a final request for documents in relation to her direct payments with a deadline of the end of April. The Council confirmed it was also sending the letter by post.
28. At the beginning of May 2024 the Council told Mrs X it would stop her direct payments as she had failed to comply with its direct payments policy. The Council said it would bill Mrs X for the full weekly direct payments since August 2024 and Mrs X’s personal budget would be managed by a care agency. The Council would also invoice Mrs X for her assessed contributions.
29. The Council contacted Mrs X again at the end of August 2024. It referred to its letter from the beginning of May 2024 where it had told Mrs X her direct payments would be stopped as she was in breach of her direct payment agreement. The Council stated it had offered many opportunities to discuss Mrs X’s needs but did not get evidence supporting the package of 24-hour live-in care. The Council proposed to support Mrs X’s care needs within 2 hours 45 minutes per day, with some extra hours for community support and 24 hours call service. The Council said Mrs X’s direct payments would stop in mid-September 2024.
30. In the second week of September 2024 the Council amended Mrs X’s care and support plan. It replaced her live-in care funded by direct payments with the managed service.
31. A week later the Council increased Mrs X’s package of support by seven hours a week.
32. At the beginning of October 2024 an Occupational Therapist (OT) held a meeting with Mrs X as part of the reablement service. Following this meeting the Council decided to end the reablement service for Mrs X. At the end of October the Council sent a letter to Mrs X explaining it had inconsistent information about Mrs X’s needs. It also stated the unsuccessful tries to engage with her meant it was impossible to decide on the level of Mrs X’s needs and the support package the Council should offer. Mrs X denied she had failed to cooperate with the reablement service.

Complaint

33. In mid-February 2024 Mrs X complained about the Council’s actions. She objected to the Council asking her to provide bank statements for the direct payment account as it implied she was misusing direct payments. She did not keep all the relevant documents as had been told she would not need to manage her accounts. She confirmed she could manage direct payments but needed help with administration. Her care needs were due for another annual review, for which she would be supported by a trusted solicitor.
34. The Council called Mrs X to get a better understanding of her complaint at the end of May 2024. Mrs X said that previously the Council had funded a solicitor who had supported her at the reviews of her care plan. The Council stopped this provision now.
35. At the end of August 2024 Mrs X’s solicitor asked the Council not to change any support arrangements until the complaint process was completed.
36. At the beginning of September 2024 the Council told Mrs X it:
• would end the complaint process as Mrs X had kept postponing meetings arranged to discuss the issues of her complaint;
• would send a separate response to Mrs X’s solicitor;
• had applied discretion to allow Mrs X’s participation in the complaint process and offered many opportunities to provide requested information;
• sent several letters detailing the information it needed but Mrs X failed to engage;
• would replace direct payments with managed service;
• would not accept any new complaints about the same issues and directed Mrs X to the Ombudsman.

Analysis

37. Direct payment agreements regulate the arrangements between the Council and the person whose care services are funded this way. As explained in paragraph 21 councils are expected to monitor how direct payments are spent and keep an oversight of the direct payment accounts.
38. Mrs X manages her own affairs and has been consistently supported by a solicitor, who is her friend. When signing direct payment agreement she should have been aware of the responsibility to keep records of any spendings. We cannot say, even on the balance of probabilities, if the Council told Mrs X in 2014 that she would not need to carry out the administration side of her direct payments. Nevertheless even if it did happen, at the Council’s request she should be able to show how she had been spending direct payments from her separate account. The lack of cooperation on Mrs X’s part meant the Council could not verify how the money sent to Mrs X’s direct payment account was used.
39. I found the Council had followed the correct process before it stopped Mrs X’s direct payments. Specifically the Council:
• kept asking Mrs X to provide evidence for the way she spent her direct payments;
• explained the consequences of not providing evidence;
• held meetings and offered various support;
• gave Mrs X many opportunities to engage as the process lasted for a year.
40. The Council was not at fault in the way it ended Mrs X’s direct payments.
41. After reviewing Mrs X’s care and support plan in August and September 2024 the Council decided to decrease her support package. As explained in paragraph four we do not look at the merits of the Council’s decision but the way it took it.
42. After taking a decision to stop direct payments, the Council offered Mrs X the reablement service and reviewed her care and support plan. I am satisfied the Council involved Mrs X in the review of her care plan and was exploring the extent of her needs using the reablement service. The Council was adjusting a new care and support plan throughout the autumn 2024 which shows its focus on ensuring Mrs X’s care needs were met.
43. The Council decided many services provided by lived-in carers were not necessary to support Mrs X’s care needs. It proposed a different model of support. The Council was not at fault for changing Mrs X’s care and support plan after its review as it had followed the right process.

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Decision

44. I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman