Summary: There was fault by the Council which failed to take reasonable steps to reach agreement before revising Mr Y’s care and support plan and failed to give reasons for a decision not to fund Shared Lives. This caused avoidable frustration and uncertainty. The Council has agreed to apologise, make symbolic payments to Mr Y and his relative Ms X and carry out a further review. It will also remind officers the Council has the legal power to fund activity costs.

The complaint

1. Ms X complained for a relative Mr Y. She said the Council:
1. Cut Mr Y’s direct payments for activity costs without consulting him despite no changes to his needs and instead offered four hours of outreach support that is unworkable with the current provider;
2. Refused his request for Shared Lives (a social care scheme matching adults needing care with carers who share their home); and
3. Refused to fund peer mentoring.
2. Ms X said this caused avoidable distress as Mr Y wanted to live independently and Shared Lives would have been a positive step towards independent living

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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. Before considering a complaint, the Ombudsman should be satisfied the Council has had an opportunity to investigate and respond to a complaint. (Local Government Act 1974, section 26(5))
5. 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

6. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
7. Ms 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

8. 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)
9. 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. (Care and Support Statutory Guidance (CSSG), Paragraphs 13.19-21 and 13.32)
10. A council should revise a care and support plan where circumstances have changed in a way that affects the plan. Where there is a proposal to change how to meet eligible needs, a council should take all reasonable steps to reach agreement with the adult about how to meet those needs. (Care Act 2014, sections 27(4) and (5) and CSSG Paragraph 13.27)
11. Direct payments (DP) are cash payments a council gives to an adult or their agreed representative to enable them to arrange care and support themselves.
12. The court confirmed councils have the power to provide financial support for recreational activities under the Care Act 2014. (R(BG) v Suffolk County Council)
13. Councils cannot meet social care needs by providing or arranging health services that are the NHS’s responsibility (Care Act 2014, section 22)

What happened

Background

14. Mr Y is an adult who lives at home with Ms X and receives adult social care and support. Mr Y’s previous social care assessment was done in 2020 when he was in education. The previous care and support plan had six hours of council-commissioned outreach support from a provider and a DP which Mr Y used to fund membership for agreed activities – cinema, gym and a social group.
15. There was a review of the care and support plan in July 2024. Mr Y was receiving six hours a week of council-commissioned care and support over three days, possibly changing to two sessions a week. There were no changes to the care and support needed. He was working towards moving out of the family home and acquiring more independence from Ms X.

Summary of key events

16. The Council carried out a social care assessment in January 2025. Mr Y had told the Council he wanted to move out of the family home. He had finished his education course and was working. The assessment noted:
• Mr Y had recently had some sessions of specialist NHS funded psychology which had shown strong improvements for him. The local Integrated Care Board (ICB) which is an NHS body had rejected a funding request for further sessions. An NHS service noted Mr Y may benefit from a neurodivergent peer mentor (also known as a peer support practitioner).
• Many of his eligible needs were being met by his family
• He was eligible for care and support under the following needs domains:
1. Managing and maintaining nutrition
2. Maintaining personal hygiene
3. Maintaining a habitable home
4. Developing and maintaining relationships
5. Making use of facilities or services in the community
6. Accessing work, training education or volunteering.
17. The Council has a practice forum. The Council has explained this has a governance function to decide whether the proposed Care and Support plan and its associated costs is sufficient to meet the person’s needs, meets best value requirements and makes full use of community, technology and equipment resources to ensure timely, transparent decisions that focus on wellbeing. This forum considered Mr Y’s case in March 2025.
18. The request to the forum was for approval to progress to support planning. One of several points to be discussed was a direct payment to be used on peer mentoring for Mr Y and noted the NHS feedback that Mr Y may benefit from autism peer mentoring to support him moving on and increasing what he can do without support. It was noted there was not a free service locally but there was one in Oxford at £60 per session. It was asked if this could be funded by Mr Y’s DP as it may reduce some of his need for care and support in the future. It was also asked if the DP could be used to fund a regular board games event to try and reduce Mr Y’s isolation. The forum did not approve the new DP request and recommended a referral to the ICB to see if this could be funded by the NHS. It was also noted the current and on-going DP needed to be reviewed and considered if any of this was meeting health needs. If this was the case, this would also require liaison with the ICB. If it was not found to be meeting health needs it was not likely that social care would fund the activities and there would be a need to explore whether Mr Y was on the right benefits and to explore whether there were other community activities Mr Y could access. Once this work was actioned the case should be brought back to the forum for further discussion.
19. The Council made a written request to the ICB for funding on Mr Y’s behalf for a specialist peer support practitioner in May 2025. The ICB refused funding using its own criteria in early June 2025. There is no evidence the case was referred back to the forum for further discussion at this stage.
20. Mr Y’s care and support plan of June 2025 set out his eligible needs, outcomes and provision/funding agreed by the Council. The plan said the weekly DP funding for activities (gym, cinema, and social group) was stopping at the start of June. The plan said the 6 hours of commissioned support was continuing and was focussed on fitness goals so supporting Mr Y to attend the gym as well as support with cooking and cleaning and building friendships.
21. The officer who completed the care and support plan noted on the plan that it was not agreed by Ms X and Mr Y and they had been informed the following:
1. direct payment is being stopped;
2. there will not be funding for overnight stays either through DPs or Shared Lives
3. there is funding available for an additional four hours of support per week to work towards building independence outside the family home.

The plan noted Ms X and Mr Y were not in agreement with the above points (1) and (2) and had not responded to the offer on point (3).

22. Ms X complained to the Council about the matters she has raised with the LGSCO. The Council’s response to the complaint said:
1. It completed a social care assessment in January 2025. At that time, Mr Y had a mixed social care package with six hours a week of outreach support from a provider and a DP used for activities namely cinema, social group and gym memberships.
2. It took into account cost and availability of care and support options as well as the person’s perspective.
3. Mental health support was an NHS responsibility and the Council asked the NHS to fund peer mentoring but this was not agreed
4. It did not communicate the formal decision about the DP until June 2025, but Ms X was aware of changes to the assessment in March 2025 and had an email exchange with the allocated social worker in April 2025
5. A DP has not been refused; it was available as an alternative to the commissioned hours but would need to be used to meet unmet eligible care and support needs as defined in the Care Act assessment and not replace funding that should come from other sources such as personal income.
6. If a person required support to take part in an activity, this would be considered as part of support planning, but the activity itself was not for the Council to fund. The eligible care and support need in relation to an activity, whether that be going to the cinema or the gym, would stem from characteristics of any person in being able, or not, to achieve participation in the said activity rather than the activity itself, if other persons without that characteristic would be able to participate in that activity without care and support assistance, care and support is provided to place the person in the same position. Neither person would be able to participate in the activity for free and would have to fund the cost of the activity themselves.
7. It agreed to increase Mr Y’s outreach support by four hours with a focus on developing skills and independence. If the provider was not available to take on these hours, then the brokerage team would be able to find another provider or Mr Y could have a DP to employ his own personal assistant for those hours.

Information from the Council

23. The Council told me:
1. Mr Y’s situation, care and support needs and outcomes had changed since the previous care and support plan.
2. It used to fund gym, cinema and a social group for Mr Y, but his needs had changed and this was no longer required.
3. It accepted it had not given Ms X reasons for the practice forum’s decision not to fund Shared Lives and apologised
4. In Mr Y’s case, peer mentoring is an NHS function and falls under Section 22 of the Care Act 2014.
24. Unhappy with the Council’s response to her complaint, Ms X complained to the LGSCO in July 2025.

Events since the complaint to the LGSCO

25. The Council provided me with a further record dated December 2025 of the practice forum’s consideration of a funding request for overnight respite care to support Ms X as a carer and give her a break from caring responsibilities. The record noted the Council had completed a carer’s assessment for Ms X and she was providing a high amount of care and support. The officer who completed the request to the practice forum said they felt overnight respite stays would be beneficial to the entire family and would help Mr Y prepare for his goal of moving out.
26. The practice forum agreed the request for overnight respite care and said Mr Y’s case needed to ‘progress to support planning’.
27. Ms X confirmed she had had a carer’s assessment since complaining to us and this highlighted she needed respite. She went on to say that a council officer had suggested Shared Lives, but this had not been taken forward.
28. Ms X brought her complaint to the Ombudsman at the end of July 2025. I have not investigated events after this period as Ms X would need to complain to the Council in the first instance (please see paragraph 4 above).

Findings

The cut to the direct payment and other changes to Mr Y’s care and support plan

29. Before revising Mr Y’s care and support plan, the Council was required to carry out a review (see CSSG paragraph 13.19-21). If the outcome of the review was a revision to the care and support plan, the Council would have needed to take reasonable steps to reach agreement with Mr Y and Ms X before making any revisions (see section 27 of the Care Act and CSSG paragraph 13.32). The Council reviewed the care and support plan in July 2024 and the outcome was no changes were needed. There is no fault in the Council’s actions at this point.
30. By January 2025, Mr Y’s life had changed. He had moved from education and into voluntary artistic work with a university providing him with work space and facilities so he could pursue projects he was interested in. There was nothing preventing the Council from carrying out a social care assessment to determine whether Mr Y remained eligible for care and support. Relying on the complaint response, it appears Ms X was made aware of proposed changes to the assessment and potential revisions to the care and support plan in March 2025. The Council has accepted Ms X did not receive the formal decision that the DP was being stopped for activity costs until June 2025. The Council says there was an email exchange with the allocated social worker in April 2025 and that both parties had the opportunity to seek amendment to the support plan at that stage before it was finalised. However, there is no evidence the Council took all reasonable steps to reach agreement before revising Mr Y’s care and support plan and implementing those revisions. There is a difference between telling a person a decision has been made which means funding will stop and seeking their views before any decision is taken. The Council did not act in line with Section 27 of the Care Act or paragraph 13.32 of CSSG and this was fault. It caused avoidable uncertainty about the outcome had all reasonable steps to reach agreement been sought before taking the decision.
31. In addition, it was fault of the Council to say in the complaint response that activity costs were not for the Council to fund. This could be read as the Council never funds activity costs which is not in line with the legal judgment that councils have the power to fund such costs in individual cases as I have set out in paragraph 12.

Refused to fund peer mentoring

32. The Council is not required to fund services which are the responsibility of the NHS. Based on the circumstances of Mr Y’s case, I am satisfied there is no fault in the Council’s decision that peer mentoring falls within section 22 of the Care Act and so the Council has no duty to fund it.

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Action

33. It is not the LGSCO’s role to reconstruct a social care and support plan review. Our role is to determine fault causing injustice. If we uphold a complaint, we may make recommendations to try and put the person back into the position they would have been had there been no fault. In cases where there is uncertainty about the outcome but for fault, we will recommend a review of the case and a symbolic payment.
34. Within one month of the final decision, the Council will take the following action:
1. a review of Mr Y’s care and support plan. If revisions to the care and support plan are proposed during the review, the Council needs to evidence during the review that it has taken reasonable steps to reach agreement with the adult concerned about how it should meet those needs
2. as part of the review to explore the implementation of overnight respite care as has already been agreed by the practice forum
3. an apology to Ms X and Mr Y
4. symbolic payments of £150 for Ms X and £150 for Mr Y to reflect avoidable distress, frustration and uncertainty
5. a written reminder to members of the practice forum and to officers responsible for approving complaint responses that the Council has the legal power to fund activity costs in individual cases.
35. 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.
36. The Council should provide us with evidence it has complied with the above actions.

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Decision

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

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Investigator's decision on behalf of the Ombudsman