Summary: There is no fault on the part of the Council. The physiotherapy required by Mr X is a health need not an eligible social care need. The issues Mrs C experienced in July 2025 with her pre-paid card affected all users and were resolved at the time.

The complaint

1. Mrs C (the complainant) says the Council stopped paying for physiotherapy for her son Mr X as it said it was a health need, but the local NHS will not fund the same physiotherapy. As a result, he is paying privately for the physiotherapy. She also complains that the pre-paid card she used to access Mr X’s direct payments was stopped in July 2025.

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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.
3. 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

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

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What I found

Relevant law and guidance

6. 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.  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.
7. 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 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.
8. 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.
9. Section 22 of the Care Act says:

"A local authority may not meet needs under sections 18 to 20 by providing or arranging for the provision of a service or facility that is required to be provided under the National Health Service Act 2006 unless—

(a) doing so would be merely incidental or ancillary to doing something else to meet needs under those sections, and

(b) the service or facility in question would be of a nature that the local authority could be expected to provide."

10. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness

What happened

11. Mr X is a disabled man who lives on his own and is supported by a package of care funded by the Council. He can mobilise using a walker, crutches or wheelchair.
12. Mr X attends twice-weekly neuro-physiotherapy sessions. Until 2023 he funded these through his direct payments from the Council. At Mr X’s annual review in September 2023 his social worker identified that his use of Direct Payments to fund a health care need was not lawful and requested an eligibility check to ascertain if Mr X was eligible for NHS CHC funding.
13. In December 2023 an NHS CHC checklist was competed at Mr X’s home and it was concluded that he was not eligible.
14. Between December 2023 and November 2024 there were numerous contacts (for which the Council has provided documentary evidence) between the Council, the local NHS and Mrs C about the funding for Mr X’s physiotherapy sessions. The Community Learning Disabilities Team told Mrs C that it could not provide physiotherapy at the level she wanted.
15. The Council made a referral to the local NHS which assessed Mr X’s needs and offered hydrotherapy. The NHS manager acknowledged this was not the same as Mrs C requested but said the Occupational Therapist considered it would offer similar benefits. Mrs C would not sign the support plan which included this option.
16. Mrs C says Mr X is paying privately for physiotherapy but cannot continue to do so.
17. The Council has responded to Mrs C’s complaints that it will not fund Mr X’s physiotherapy sessions as before. It has explained that this is a health need which it cannot lawfully fund. Mrs C points out that physiotherapy is mentioned in Mr X’s support plan: “With the support of my PAs …. I attend the much-needed weekly neuro-physiotherapy sessions, in order for my limbs not to seize up. Without this, it will hinder my ability to walk with a walker, and my legs would become scissored, and I would end up permanently in a wheelchair.”
18. Mrs C also complains that the pre-paid card she used to pay Mr X’s expenses was stopped in July 2025.
19. The Council says the prepaid card was never withdrawn and is still in place. It says there was a disruption in the finance system in July 2025 which affected all card holders.

Analysis

20. The Council is correct to say it cannot fund services for a health need. That is not evidence of fault.
21. Mr X has been offered a hydrotherapy service by the NHS which it says would meet his needs, but this is not acceptable to Mr X or Mrs C who wish for his current specialist physiotherapy services to continue.
22. The issue which the pre-paid cards was a temporary problem which affected many other users and has been resolved.

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Decision

23. I have completed this investigation as there is no fault on the part of the Council in its decision not to fund a health service.

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Investigator's decision on behalf of the Ombudsman