Summary: Miss X complained the Council changed the expenses it would allow under direct payments. We found fault as the Council’s communication with Miss X was not in line with our expected standards. The Council will apologise, make a symbolic payment and provide information to Miss X.

The complaint

1. The complainant, Miss X, complains the Council removed and changed items in her sister’s care plan without discussing these with the family or following the correct process. This resulted in the Council disallowing items bought using direct payments and demanding repayment of about £4,500. Miss X also complains the Council did not complete an independent review of her complaint at Stage 2 of its complaint procedure and continued to send correspondence about her direct payment returns during its complaint investigation. Miss X says this has caused her avoidable distress which affected her health and ability to care for her sister.

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The Ombudsman’s role and powers

2. 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)
3. 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)
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(1), as amended)

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How I considered this complaint

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

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What I found

Relevant law and guidance

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.
8. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.

(Care and Support Statutory Guidance 2014)

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. Another adult can manage a person’s direct payment on their behalf.
10. Councils must tell people during the care planning stage which of their needs direct payments could meet. A direct payment can only be used to pay for arrangements to meet the needs set out in the person’s care and support plan. (Care Act 2014, section 33(3))
11. Our Principles of Good Administrative Practice set out our expectations of councils. We expect them to:
• Act fairly. This includes dealing with people consistently.
• Be citizen focused. This means informing people who use services what they can expect and what the organisation expects of them.
• Get it right. This means taking reasonable and timely decisions.

Summary of key events

12. Miss X’s sister, Miss W, has care and support needs. She has received support for her daily care needs, funded by a direct payment, for many years.
13. Miss W’s 2024 care and support plan sets out the following:

‘When [Miss W] first received a direct payment to meet her care and support needs, she and [Miss X] were told that it could be used in any way that met [Miss W’s] needs. As these needs have not changed the following activities and services are covered by the direct payment*:

• Clothes ironing service & clothes alterations – [Miss W] cannot iron her own clothes but likes to look smart, and because of her unique body shape she cannot find clothes that fit her without adjustments.
• Various stationary items for [Miss W] and for [Miss X] to complete returns. Ink, paper.
• Positive social activities such as cinema trips and bowling, go out to eat and to the theatre. Go to the pub.
• [Miss X] employs a cleaner twice per week to keep [Miss W’s home] clean and tidy.

*this is not an exhaustive list’

14. Miss X complained to the Council in mid-January 2025 about it removing items from Miss W’s care and support plan without proper discussion with her family. This had only been identified after completing the direct payment returns when some items were refused despite them being paid in previous years. Miss X said there had been no change in Miss W’s needs since the care and support plan agreed in February 2023.
15. The Council responded to Miss X’s complaint in mid-February 2025. This noted a previous complaint from Miss X in 2021 about direct payment returns not being approved due to a change of the support plan for Miss W without her full involvement. The Council had upheld that complaint in August 2021 and agreed it would continue to fund social activities for Miss W as this had previously been in her support plan and a more comprehensive support plan would be completed. The Council referred to a review in February 2023 with the support plan being completed in 2024. The Council confirmed there was no change to the overall agreements in the plan. The Council explained the items that were not agreed in the direct payment returns related to food items, podiatry, toiletries and meals out which were not included in the support plan. The Council reviewed the relevant receipts and highlighted those it would not fund. The Council noted the annual review of the plan was now due and the use of the direct payment would be written in more detail to prevent items being refused in future as it acknowledged the wording in the current plan was vague. The Council confirmed that previous returns had now been agreed as it acknowledged the plan was not clear enough.
16. Miss X remained unhappy and asked for her complaint to be escalated to Stage 2 of the Council’s complaint procedure at the end of March. Miss X welcomed that all the items previously refused would now be allowed. Miss X sought a different social worker to complete the review of Miss W’s care and support plan and provided reasons why some items should be allowed going forward.
17. The Council provided a response at Stage 2 of its complaint procedure in mid-May 2025. This agreed to allocate a different social worker to complete the review of Miss W’s care and support plan. The Council explained it was expected people would use their benefits to pay for food shopping, toiletries and other personal items. In addition, Social Care funding could not be used towards health care needs such as podiatry. The Council had waived the amount spent on these items to date but would seek to recover any money spent on them in the future or it may reconsider the direct payment arrangement.
18. In her complaint to the Ombudsman, Miss X explained she had simply been spending the direct payment on items as she had done for many years and could not understand why things had changed.
19. In responding to the Ombudsman, the Council explained the direct payment arrangement was over 20 years old and it did not have a copy of the original agreement with Miss X or the information it provided at the time about how the direct payment scheme would work.
20. The Council says that given the age of Miss X’s direct payment it may previously have said that it could be used in a more flexible manner for activities to meet outcomes. However, it considers this has been misinterpreted in terms of eating a meal (which is not a social care eligible need) and which was never the intention.
21. The Council has confirmed it will provide information to Miss X about how to ask for consideration of other items as disability related expenditure.

Findings

22. The Care Act says direct payments can only be used to meet a person’s eligible care and support needs. This is a clear principle. We expect councils to give clear and comprehensive information when delivering services to be in line with the principles I have set out in paragraph 11.
23. The Council has failed to maintain an adequate record of the direct payment agreement and cannot evidence it provided clear and timely information to Miss X about its operation. This is fault.
24. Direct payments are public money and Miss X has been told they are to be used to only meet Miss W’s care and support needs. This general information is correct and there is no fault in the Council saying this. There is some flexibility within this general principle and the Council has previously accepted returns from Miss X over an extended period for items it is now questioning. I am satisfied this lack of clarity is fault as it is not open, accountable or citizen focused. This has caused Miss X avoidable confusion and uncertainty.
25. In the circumstances I would expect the Council to have provided comprehensive written guidance on what the direct payment could and could not be used for when the issue first arose. This should have covered all the items that caused Miss X to complain plus any other items to meet Miss W’s social care needs. I can see why this lack of clarity and change to an apparently ‘stricter’ position created confusion for Miss X.
26. The Council has confirmed a different manager who was more senior to the person who provided the Stage 1 response was appointed to review the complaint at Stage 2 in line with its policy. I see no obvious fault here but, in any event, I do not consider there was any particular injustice caused to Miss X.
27. There are no grounds for me to say Miss X should be paid for any more items in future. The Council is entitled to query items which appear excessive and/or appear not to have been used to meet Miss W’s social care needs because direct payments are public funds.

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Action

28. Within one month of my final decision, the Council will:
1. write to Miss X to apologise for the lack of clarity around what items the direct payment can be used for;
2. make a symbolic payment of £250 to Miss X to acknowledge her avoidable confusion and uncertainty;
3. provide Miss X with clear and comprehensive written guidance on what the direct payment can and cannot be used for; and
4. provide information to Miss X about how to request items be considered as disability related expenditure.
29. 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.
30. The Council should provide us with evidence it has complied with the above actions.

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Decision

31. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman