Summary: Mr B applied for grant funding for a downstairs toilet. There is no evidence of fault in the way the Council assessed Mr B’s eligibility for funding and in the way it made further enquiries from medical professionals.

The complaint

1. Mr B says the Council has failed to approve his application for a disabled facilities grant (DFG) to provide him with a downstairs toilet. He says he needs the toilet because of his disability, but the Council says he does not need it as his condition is temporary.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
3. If we are satisfied with a council’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

4. I have discussed the complaint with Mr B. I have considered the documents that he and the Council have sent and both sides’ comments on the draft decision.

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What I found

5. Disabled Facilities Grants (DFG) are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to provide grant aid to disabled people for certain adaptations.
6. The Council will need to check that the proposed works are:
• necessary and appropriate to meet the disabled person’s needs. They will usually consult an occupational therapist (OT) from the social services department to make the assessment and
• reasonable and practicable depending on the age and condition of the property.
7. The maximum grant that can be paid in England is £30,000 and the grant is means tested.

What happened

8. Mr B is an adult who has mobility problems caused by osteoarthritis and degenerative disease in his spine and knees. The Council’s occupational therapist (OT) assessed Mr B in October 2017 and recommended a stairlift and works to the bathroom (conversion into a wetroom) which were to be paid by a DFG.
9. The Council fitted the stairlift in October 2017. The DFG application for the bathroom adaptions was approved in March 2018.
10. Mr B contacted the Council on 5 June 2018 and said that the proposed adaptation works to his house should include a downstairs toilet. The OT said this was not something Mr B mentioned in his original assessment, but she would contact his GP.
11. Mr B cancelled the proposed adaptations works a few days later as he said he was too worried about being without a toilet while the works to the bathroom were being done.
12. The GP wrote to the OT on 21 June 2018, but the information did not suggest that there was a need for a downstairs toilet and the OT closed the case.
13. Mr B complained to the council on 22 August 2018. He said:
• His needs had changed, and he was waiting for surgery to his bladder.
• He needed to urinate more urgently and the stairlift was too slow to take him to the toilet in time which then resulted in accidents.
• The stairlift was too expensive to run with the frequency that he needed it. It cost an extra £20 in electricity per month.
• He had won his PIP appeal and his son had moved in to become his carer.
• He cancelled the adaptation works as he could not be without a toilet for a long time.
14. The Council spoke to Mr B after his complaint and suggested that the OT should come out for a re-assessment of his needs to decide whether he could be eligible for any other works. Mr B agreed to this plan.
15. The OT carried out her assessment on 11 September 2018 and said:
• Mr B said he had a urology appointment as he had continence problems.
• Mr B said he had to use the toilet around 30 times a day and had accidents when he could not reach the toilet in time, as the stairlift was too slow.
• Mr B had to drink a lot throughout the day as this alleviated his muscle cramps.
• Mr B’s son had moved in and supported Mr B in daily living tasks.
16. The OT said she would get up to date information from Mr B’s GP relating to his continence to consider the downstairs toilet request. The OT discussed the use of a commode. Mr B had previously rejected this as he said he would have difficulty emptying the commode. The OT thought that it could be a possibility now that Mr B’s son had moved in. Mr B agreed that urine bottles may be temporary solution while the Council decided whether he was eligible for a downstairs toilet.
17. The OT asked the GP for information after her assessment of Mr B and the GP wrote back on 2 October 2018. The GP said Mr B had been referred to urology for a different medical condition than the urinary frequency but said that this condition was likely to have an impact on his urinary function. She said there was nothing in Mr B’s medication which would have caused increased urinary frequency.
18. The OT wrote to the GP again on 25 October 2018. She asked her:
• Had Mr B discussed urinary incontinence with the GP in the past?
• If so, what action would the GP have taken and what referrals would she have made?
• What impact did the related condition have on the urgency and frequency to urinate?
19. The GP contacted the OT on 6 November 2018 and said Mr B had never raised the issue of urinary frequency or urgency with her so she was not aware that he had difficulties in this area.
20. The OT visited Mr B on 8 November 2018 to explain the outcome of the assessment and provided a response to his complaint. She also wrote a letter following the visit. She said:
• Mr B had visited a urologist but this visit related to a different medical condition.
• Mr B had not sought GP help for the urinary urgency/frequency problem.
• The GP said Mr B started taking medication, on 30 October 2018, which could increase his urinary output.
• At the meeting on 8 November 2018, Mr B said the urologist was now looking into the urgency/frequency issue.
• There was not enough medical evidence at the moment to justify a downstairs toilet.
• Mr B should therefore seek further advice from the GP or the urologist on the issues of his frequency and urgency of urination and should update the OT.
• The OT needed more information about whether Mr B’s continence problem was temporary or permanent and untreatable. She would not recommend a permanent adaptation such as a downstairs toilet for a temporary problem.
• Mr B could use a commode or urine bottles as a temporary solution.
• The cost of running a stairlift was negligible and was less than £10 a year. The increase of his electricity bill was therefore not related to the use of the stairlift.
• The installation of the wetroom would mean that he would not have access to a toilet for six hours on two days so this should not stop him from having the wetroom installed.
21. The OT received more information from the urologist on 26 November 2018. The urologist said:
• Mr B was due to have surgery in January 2019.
• His urinary symptoms were not the main reason for the surgery, but a secondary issue. However, the urinary symptoms may improve following the surgery.
• If they did not improve, then Mr B would be assessed further. Depending on the outcome of the assessments, he may be offered medication or further surgical intervention.
• Therefore, if the urinary symptoms did not improve in the short term as a result of the surgery, they would improve within the medium term.
22. The Council therefore did not change its decision relating to the downstairs toilet as it remained of the view that Mr B’s urgency/frequency problem was temporary.

Analysis

23. It is not for the Ombudsman to say whether Mr B should have a downstairs toilet or not. Only the Council can decide this, based on assessments in line with statutory guidance.
24. I accept that Mr B is frustrated at the Council’s position, but I do not find evidence of fault in the Council’s actions.
25. The Council has followed the guidance and the correct process to make its decision. The Council has appointed occupational therapists to carry out the assessments. They have carried out two assessments of Mr B’s needs in October 2017 and in September 2018.
26. They have also made further enquiries by asking for medical opinions from the medical professionals involved with Mr B. The medical professional said the condition was treatable and would improve in the medium term and the Council therefore decided against providing a downstairs toilet at this stage. The Council provided a temporary solution by offering a commode and urine bottles. The Council has said it will review the decision if Mr B provides medical evidence that the issues are permanent and untreatable.
27. Although I understand Mr B disagrees with the Council’s current decision, the Ombudsman cannot question the merit of a decision if there is no fault in the way the Council has made the decision.

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Final decision

28. I have completed my investigation and have not found fault by the Council.

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Investigator's decision on behalf of the Ombudsman