Summary: Ms X complained the Council failed to meet her assessed care needs. The Council delayed assessing Ms X’s needs, delayed setting up the direct payments and failed to provide interim care impacting Ms X’s health and wellbeing. A symbolic payment is agreed.

The complaint

1. Ms X complained the Council failed to meet her assessed care needs.
2. She says this has impacted on her health and overall wellbeing.

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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. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered all comments made before making a final decision.

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What I found

Assessment

7. 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.
8. 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.

Direct payments

9. 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.
10. The gateway to receiving a direct payment must always be through the request from the person. Councils must not force someone to take a direct payment against their will. They should not place someone in a situation where a direct payment is the only way they can get personalised care and support.
11. Councils must tell people during the care planning stage which of their needs direct payments could meet. However, councils must consider requests for direct payments made at any time and have clear and quick procedures in place to respond to them.
12. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the council must decide whether to provide a direct payment. In all cases, the council should consider the request as quickly as possible.
13. The council must provide interim arrangements to meet care and support needs to cover the period in question. Where accepted, the council should record the decision in the care or support plan. Where refused, the council should explain its decision in writing to the person who made the request. It should also tell the person how to appeal against the decision through the local complaints procedure. (Care and Support Statutory Guidance 2014)

Key facts

14. This section sets out the key events in this case and is not intended to be a detailed chronology.
15. Ms X moved into the Hammersmith and Fulham area on 8 July 2024. She had been receiving a package of social care from the local authority where she used to live. Ms X believed that the former local authority would contact her new council to ensure no break in the care provision. However, there is no evidence this happened. We have advised Ms X that she would need to submit a separate complaint against the former local authority about its failure.
16. On 30 July, Ms X made a self-referral to the Council. The Council contacted the former local authority to seek a copy of Ms X’s care plan. This was provided and showed Ms X had been receiving a package of care for 18.5 hours per week. The former local authority said Ms X had arranged her own transfer with the housing provider and it had not been involved.
17. The Council contacted Ms X to gather more information about her needs. This resulted in the Council ordering equipment such as a commode and toilet frame. It also made an internal referral for a small package of care to be provided to Ms X. The Council also provided information to Ms X about befriending services.
18. The interim package of care was due to begin on 20 August but no care was provided. It is noted that around this time the Council tried to refer Ms X’s case back to the previous local authority. However, this did not happen.
19. The Council completed an assessment of Ms X’s care needs on 23 October. During the assessment the social worker noted that Ms X was entitled to a small package of care and that this could be arranged via the housing provider. Ms X expressed a preference for direct payments as she had used them previously.
20. The Council determined that Ms X was entitled to a package of care for 8.5 hours per week and approved the request for direct payments in mid November . On 18 December the social worker discussed with Ms X how the direct payments worked and how they would be reviewed. The social worker also made a referral to an organisation that would assist Ms X with the direct payments and recruiting a personal assistant.
21. The referral to this organisation was missing information about the indicative budget. It contacted the Council for clarification but did not get a reply until the end of January 2025. The organisation then arranged to visit Ms X on 3 February. It took some time for a suitable personal assistant to be employed. In April the Council recovered unspent monies from Ms X’s direct payment account.
22. A carer was in place by the beginning of May 2025.

Analysis

23. Ms X made a self referral on 30 July but the Council did not complete an assessment of her care needs until 23 October. It then did not approve the care plan, direct payments and notify Ms X of this until 18 December.
24. In response to my enquiries, the Council accepts that it took too long to carry out the care assessment. It explained that there was a wait for a social worker to be allocated. It said that it has a risk rating mechanism in place to determine wait times but that in this case it still took longer than expected. It said the assessment should have been completed within four to six weeks but actually took 12 weeks. It also accepts delays in setting up the direct payments.
25. The Council also accepts that there was confusion regarding the housing provider and whether it could have provided interim care services for Ms X. I consider there was a lack of professional curiosity to get to the bottom of the situation including whether Ms X had arranged her transfer privately.
26. Ms X did not receive any care services from when she moved into the area in July 2024 until May 2025. Not all of this delay is due to fault by the Council. The Council was not aware of Ms X’s needs until 30 July when she contacted it directly. As explained above, any failure by the former local authority to transfer the package of care would need to be a separate complaint and cannot be considered the fault of this council. After the direct payment organisation carried out a home visit to Ms X on 3 February 2025, it took some time to appoint a suitable personal assistant. However, there is nothing to suggest this was due to fault by the Council.
27. The delays meant Ms X was without social care provision for a period of around six months. It is my understanding that some of Ms X’s family were able to assist her during this time but the lack of a package of care did cause Ms X distress and affect her health and wellbeing. I am therefore recommending a symbolic payment to recognise this.
28. I am pleased to note the Council acknowledges there was fault in this case. It has indicated it will be providing staff with training to ensure they are clear regarding commissioning and direct payment processes. Therefore I am not recommending any further service improvements.

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Agreed action

29. To remedy the injustice caused to Ms X as a result of the fault identified above, the Council will, within one month of my final decision, take the following action:
• Apologise to Ms X. 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; and
• Make Ms X a symbolic payment of £500 to recognise her distress.
30. The Council should provide us with evidence it has complied with the above actions.

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Decision

31. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman