London Borough of Hillingdon (18 017 769)

Category : Adult care services > Disabled facilities grants

Decision : Upheld

Decision date : 22 Jul 2019

The Ombudsman's final decision:

Summary: Mr X complains the Council delayed completing major adaptations necessary for his wife’s safety, causing them both distress and resulting in her untimely death. The Ombudsman does not find fault in the Council’s handling of adaptations but finds the Council failed to communicate properly with Mr X. The Ombudsman recommends the Council provides an apology and payment to Mr X.

The complaint

  1. Mr X complains the Council delayed completing major adaptations as necessary for his wife’s safety. He believes his wife fell and subsequently died as a result. While awaiting adaptations he had to carry his wife up and downstairs. He also reduced his working hours to help her move around the home.

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The Ombudsman’s role and powers

  1. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
  2. 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

  1. I spoke to Mr X and I reviewed documents provided by Mr X and the Council. I gave Mr X and the Council the opportunity to comment on a draft of this decision and I considered the comments provided.

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What I found

  1. Disabled Facilities Grants (“DFG”) are for people with a qualifying disability who need adaptations in their home to help them remain in their home. They are mandatory and must be awarded if the applicant meets the qualifying conditions.
  2. The maximum amount of a grant is £30,000. A council can award other discretionary help if it thinks it is necessary. The amount a council will pay for a mandatory grant is subject to a means test.
  3. A council will only approve a grant it if accepts the work is necessary and appropriate to meet the needs of the disabled person. An occupational therapist (“OT”) usually completes the assessment of need. The council will also take into account the age and condition of the property.
  4. The statutory time limit for assessing a formal application is six months.
  5. The work must usually be completed within twelve months of the council approving the application. If the council has told the applicant it will defer the payment then the work must be finished within 12 months of the date specified on the notice. The council can extend the time limit.

What happened

  1. In March 2016 Mr X applied for a DFG for adaptations to his home for his wife.
  2. In April the Council told Mr X how much he would have to contribute towards any works based on its financial assessment. It explained it next had to arrange an assessment.
  3. In July an Occupational Therapist (“OT”) visited Mr and Mrs X to assess Mrs X’s needs.
  4. The OT report says Mr and Mrs X own a 3 bedroom home with all bedroom and wash facilities upstairs. There is a toilet downstairs. Mrs X has difficulty using the stairs to access the bedroom and bathroom. She needs two people to support her on the stairs. Her needs are currently met by her husband and a carer. The OT will make a referral to look at the feasibility of downstairs washing and sleeping facilities. A stairlift is not appropriate. The report notes Mrs X’s medical conditions, including asthma. It does not record any allergies or any environmental factors which may provoke an allergic reaction or asthma attack.
  5. On 4 July the OT completed a recommendation for major adaptations for downstairs washing and sleeping facilities.
  6. The Council’s records show it did not progress the case until 2 September due to an internal miscommunication.
  7. On 2 September the Council told Mr X its contractor would arrange to visit to carry out a survey and draw up plans within the next two weeks.
  8. In early October a contractor visited Mr and Mrs X. Mr X then emailed the Council to say Mrs X was happy with the proposal except for the location of the lift. She had concerns about the lift being in the bedroom and asked for it to be moved elsewhere.
  9. The Council told Mr X to liaise with its contractor who later reassured Mr X about the lift.
  10. In late October a lift company visited Mr X and provided further information. Mr X then emailed the Council with concerns. He explained Mrs X could not operate her wheelchair to access the lift alone and was unable to see the buttons. However, there was not enough room in the lift for him to accompany her or operate the lift. There was also little space to safely move her wheelchair across the landing to the bathroom. Mr X asked for an alternative solution.
  11. I have not seen any response by the Council.
  12. In early December Mr X queried why the Council was installing a lift when the OT had recommended downstairs living. He noted:
    • The Council first suggested using the front living room but he uses that for work and prayer. And, it would not allow his wife privacy and dignity as the front door entered into the room.
    • Considering his wife’s health continued to deteriorate he felt a downstairs bedroom and level access shower was needed. He suggested the Council use the rear reception room for this.
    • He repeated why the lift was unsuitable.
  13. The contractor told the Council it initially recommended downstairs living in the central reception room but Mr X declined as he did not want to compromise his living space. The lift was therefore the only option. And, only one location was suitable. It remained open to use the central reception room. However, it could not recommend the use of the rear conservatory as it would have to remove this and build an extension. It could meet Mrs X’s needs within the existing footprint of the property so this work was not necessary.
  14. The Council asked Mr X if he would agree to adapt the central reception room. It chased a response after a month, in January.
  15. In February Mr X told the Council he would be happy for it to adapt the central reception room and include the rear room to allow him space for a bedroom next to his wife. He suggested he could remove and rebuild the rear room to the Council’s specification. I note the Council took this as agreement to adapt the central living space.
  16. In March the contractor confirmed it would progress with its original suggestion to adapt the central reception room.
  17. Mr X and the contractor exchanged further correspondence and the contractor confirmed it would not look to extend the property.
  18. Mr X then told the Council he had concerns about using the central room. He said there was no direct fire exit, no windows for his wife to look from and no space for him to share the room as necessary to provide care. He again suggested the Council adapt the rear reception room.
  19. The contractor told the Council the proposed layout met Mrs X’s needs and it would not look to alter the rear room. Internally the Council considered offering Mr X a trade off.
  20. In April the Council told Mr X the proposed scheme met Mrs X’s needs and it would send him some information about a trade-off.
  21. Mr X again said the proposal did not meet his wife’s needs and said the Council had not directly addressed the concerns he raised. He felt the Council’s main concern was cost.
  22. The Council responded to Mr X repeating it could adapt the central room. Mr X could use the funds for his own scheme if he wished, by way of a trade -off, provided the OT agreed this met his wife’s needs.
  23. At the end of April the Council sent Mr X information about carrying out works himself under a trade-off. It reiterated that if Mr X wanted the Council to carry out works the only feasible option was for it to convert the central reception room as proposed.
  24. Mr X then made a complaint.
  25. In response the Council explained it first suggested using the central reception room but Mr X refused. It then considered installing a lift. It explained the central room still had access through the conservatory to the garden and access to the hallway. It could meet Mrs X’s needs within the existing footprint of the property and so it would not adapt the rear room, though he could agree to a trade-off. It remained satisfied it had offered two suitable schemes.
  26. Mr X maintained the only suitable option was for the Council to convert the rear room and therefore it should provide him with the cost of that proposal under a trade-off. I note Mr X made these comments in July and later chased the Council for a response.
  27. The Council’s records show it wanted to check with the OT whether Mrs X’s needs could be met by adapting the central room, given Mr X needed to provide care at night. The OT confirmed there was sufficient space in the central room for two singles or a double bed.
  28. In October 2017 the Council wrote to Mr X again advising of the two options for works or he could have the funds towards carrying out the works himself under a trade off.
  29. Mr X gave the Council further reasons in support of adapting the rear room. He said due to his wife’s asthma and allergies she needed to be away from the kitchen. In the rear room she could keep the windows open for fresh air. This also met her need for dignity and privacy. He suggested if the Council could guarantee she would be safe from an asthmatic attack he would consider the proposal for the central reception room.
  30. The Council’s records show it checked with the OT if she was aware of these issues. The OT said she was unaware of such issues previously but felt no scheme could keep Mrs X away from cleaning and cooking smells.
  31. The Council told Mr X to provide any medical evidence of his wife’s conditions for it to consider.
  32. Mr X suggested the Council obtain the evidence.
  33. The Council’s records show at the end of November it decided to arrange another OT assessment to review Mr X’s concerns.
  34. In January 2018 an OT reassessed Mrs X. The OT assessment reports Mrs X has extreme difficulty on the stairs. The OT recommended a hospital bed downstairs but the client declined. The OT explained they needed medical evidence of the respiratory problems complained of.
  35. In February the Council wrote to Mr X to say it would seek evidence from Mrs X’s GP and asked if she still consented to this.
  36. Mr X said he had given consent in 2016.
  37. The Council reviewed a GP report provided in March 2018. It found no record Mrs X suffered from allergies and no mention that environmental factors triggered her asthma or allergies.
  38. In July Mrs X went into hospital.
  39. In August Mr X told the Council he had already provided medical evidence (dated 31 May 2018) that showed his wife was severely asthmatic with allergies. He said the OT from the hospital had now suggested the rear room was the only suitable option for Mrs X as it offered a direct exit from the property in an emergency.
  40. In September the Council provided a response to Mr X’s MP. It maintained it had offered two suitable schemes in agreement with its OT. However, it had not seen the evidence of 31 May Mr X mentioned and he should provide a copy. It had also spoken to the hospital OT who confirmed she did not recommend a rear extension.
  41. I note that throughout Mr X’s correspondence with the Council he explained how his wife was struggling to move around their home. He said she had fallen many times and he was concerned about her safety if adaptations were not made quickly.
  42. When I spoke to Mr X he explained he had to carry his wife up and down the stairs and she had to drag herself round the house like an animal. She often fell and injured herself. He felt the Council was responsible for his wife’s death as she had a bad fall which resulted in her death. Mr X felt if the Council had adapted their property this would not have happened.
  43. In response to my enquiries the hospital OT provided records of her visit to Mr and Mrs X in August 2018. This says she explained to Mr and Mrs X she had no influence over major adaptations, but she would recommend a microenvironment in the third reception room.
  44. Mr X provided copies of Mrs X’s health records including the evidence of 31 May. I have reviewed all the documents. They confirm Mrs X had asthma. The documents do not report any allergies or suggest Mrs X’s asthma is triggered by cooking or cleaning odours.

Findings

  1. I cannot say the Council’s decision on adaptations was wrong, simply because Mr X disagrees. I also cannot say the judgement of the Council’s OT is wrong, simply because another OT has a different opinion. I must consider whether there was fault in the way the Council reached its decision.
  2. An OT assessed Mrs X’s needs with input from Mr X. I note the assessment reports Mrs X has asthma. A contractor considered the OT assessment, spoke to Mr X and surveyed the property before drawing up plans for a lift. I am therefore satisfied the Council took relevant information into account when it first proposed installing a lift. I find no fault in this regard.
  3. When Mr X raised concerns about his wife’s ability to operate the lift, there is no evidence the Council considered or addressed these specific concerns. This amounts to fault. However, I note there was only a short period from the date Mr X raised concerns to the date the Council proposed an alternative solution.
  4. The Council then proposed to adapt the central reception room. I note this was in line with the OT assessment, the contractor was satisfied this was viable and the Council’s OT felt this met Mrs X’s needs. I am therefore satisfied the Council took relevant information into account when it proposed adapting the central room. I find no fault in its decision making process.
  5. In October 2017 Mr X told the Council his wife would be at risk in the central room as she had severe allergies to cooking and cleaning odours that would trigger her asthma. I consider the Council reasonably asked for evidence of this however Mr X declined to provide this. I do not find the Council at fault in that respect. Once the Council considered the medical evidence available, it found no evidence Mrs X would react badly to cooking or cleaning nearby. I note Mr X disagrees with the Council’s view, however, I cannot say the Council is wrong when it has followed a proper decision making process.
  6. The Council had offered two schemes to Mr X, one of which was fully considered as necessary and appropriate to meet the needs of Mrs X. Although Mr X did not like this option and did not accept the adaptations, I find this was through no fault of the Council.
  7. Having reviewed the Council’s records I find there was a poor level of communication with Mr X and some avoidable delay because the Council:
    • initially failed to progress the OT recommendation of July 2016;
    • did not respond when Mr X first raised concerns about the lift;
    • did not recognise Mr X only agreed to adapt the central room in conjunction with the rear room, resulting in unnecessary protracted discussion until this was clarified;
    • did not directly address all of Mr X’s concerns about the central room;
    • delayed in responding to Mr X’s comments of July 2017 until October 2017.
  8. The faults identified above caused Mr X further uncertainty, distress and frustration in already difficult circumstances. He was also put to time and trouble in chasing the Council for responses.
  9. Mr X sadly lost his wife in very distressing circumstances. I appreciate he feels this could have been avoided if the Council made the adaptations he wanted. However, the Council did not have to agree to the adaptations Mr X wanted. And, as Mr X did not agree to the Council’s proposal, there was no opportunity for the Council to complete adaptations. While I understand Mrs X was struggling to mobilise around her home and this impacted on Mr X as her carer, I cannot say any failing by the Council caused or prolonged these difficult circumstances or Mrs X’s death.

Agreed action

  1. To remedy the injustice identified above I recommend the Council complete the following actions within one month of the date of my decision:
    • Provide Mr X with a written apology for its poor level of communication and avoidable delay;
    • Pay Mr X £300 for time and trouble;
    • Pay Mr X £300 in recognition of the uncertainty and distress he suffered.
  2. The Council has accepted my recommendations.

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Final decision

  1. I find the Council failed to communicate properly with Mr X, causing injustice. The Council has accepted my recommendations and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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