Summary: Mr X complains about delay in completing an occupational therapy assessment which was essential for an adaptation for Mr Y. He says this caused the process to take much longer than it should, and Mr Y’s needs were not properly met for longer than necessary. The Ombudsman finds the Council at fault and recommends it pay Mr Y £350 and ensure assessments are not delayed in future.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains that the Council delayed completing an occupational therapy (OT) assessment on his father, Mr Y.
2. Mr X says this meant the adaptation Mr Y needed was considerably delayed and this impacted on his health and wellbeing. Mr X has found dealing with the process stressful and difficult.
3. Mr X says this contributed to the process taking much longer than it should. It has caused much frustration and pain. Mr Y was without the adaptations he needed and his needs were not met in the most suitable way for longer than necessary.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended) In this case, Mr Y has consented to Mr X complaining on his behalf.

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How I considered this complaint

7. I considered information from the Complainant and from the Council.
8. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

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What I found

9. Disabled Facilities Grants 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. Examples of the work a DFG can fund include:
• installing ramps
• installing a stair lift
• adapting the kitchen or bathroom
10. The maximum amount of a grant payable by a council is £30,000. A council can award other discretionary help if it thinks it is necessary. The amount a council of grant will pay is subject to a means test.
11. An application consists of:
• A written request for the adaptation detailing the premises to be adapted.
• Estimates of the costs from at least two contractors unless the housing authority decides differently.
• Details of any claim for the grant to cover preliminary or ancillary services.
12. Before approving a grant a council must be satisfied the work is necessary and suitable to meet the disabled person’s needs and also reasonable and practicable. Councils should consult social services authorities to decide whether proposed works are “necessary and appropriate”. It is not mandatory for the OT assessment to be provided by the social care service; private contractors are also acceptable. Councils will usually expect an OT assessment as part of the application. They may also require other information to determine whether works are appropriate.
13. A council should give the applicant a decision on a grant application as soon as reasonably practicable. This must be within six months of the grant application. If a council refuses a grant it must explain why. Once the work is complete the council must pay the grant in full before 12 months from the date of the grant application.
14. The Ombudsman’s focus report “Making a house a home: Local authorities and disabled adaptations” describes three stages:
• Stage 1 – from the initial enquiry to the OT referral. This part of the process should take five working days for urgent cases and 20 working days for non urgent cases.
• Stage 2 – from the OT recommendation of a scheme to approval.
• Stage 3 – from approval to completion of the works.
15. For urgent cases the target to complete the process is 55 days from start to finish and for non-urgent 150 days.
16. In February 2015 the government withdrew its guidance, “Delivering Housing Adaptations for Disabled People: A Good Practice Guide”. It replaced it with “Home adaptations for disabled people: a detailed guide to related legislation, guidance and good practice” published by the Homes Adaptations Consortium in 2013.
17. This non statutory guidance stresses the importance of close links between housing and social care authorities to ensure local people receive the most suitable help.

What happened

18. In January 2009, an OT assessed Mr Y and recommended rails and equipment. The OT also recommended a stairlift and level access shower conversion to the bathroom for the late Mrs Y. The Council provided Mr Y with further equipment, but Mr X did not agree to the stair lift and bathroom conversion. He felt the stair lift was unsafe with small children in the house and did not want the bath removed. He wanted a ground floor extension instead.
19. In 2010, Mr X advised the Council that his parents were to move overseas.
20. In September 2015, in response to a DFG request, the Council assessed Mrs Y again and recommended a stair lift and level access shower conversion to the bathroom. Mr X declined and asked for a downstairs extension. Sadly, Mrs Y died before any works began. Mr X asked if the work could still be done for the benefit of Mr Y. The Council said Mr Y would need an assessment as his needs may be different.
21. On 28 January 2016, the Council referred Mr Y for an OT assessment.
22. On 1 March 2016, an OT assessed Mr Y. Mr X wanted a ground floor extension for him. Mr Y was unsure whether he would have surgery which would potentially improve his mobility and change his needs. The OT recommended equipment to help him use the stairs and bath. The OT contacted Mr X to ask about the outcome of Mr Y’s hospital appointment with a consultant. He was to have surgery but had no date. The OT visited to trial the equipment which was successful and noted Mr Y managed well; the OT closed the case.
23. In May 2017, the Council received a request for help but despite several attempts, the Council could not contact Mr X or his family.
24. On 28 January 2018, a community nurse referred Mr Y to the Council for assessment around meals, personal care and mobility. She noted a request for a ground floor extension.
25. The Council assessed Mr Y on 12 February. Mr Y was having difficulty with accessing the upstairs of the house, including the bathroom. The assessor proposed a stair lift and equipment to help him use the bath which he declined. Mr X was not happy to have the lift and wanted a downstairs extension. He asked for an OT to assess. On 20 February, Mr Y was added to the list for an OT assessment with normal priority.
26. On 25 September, an OT tried to contact Mr X or Mr Y but got no response. She wrote asking them to contact and arrange an appointment. The letter said the Council would close the case if the OT did not hear within ten days. Mr X complained about this because they had waited for seven months to hear.
27. In October, the Council visited to assess Mr Y as arranged with Mr X, but Mr Y had gone overseas for a holiday. Mr X says this was partly because he could not cope with being at home unable to use the stairs and get to the bathroom. Mr X said he would return in the new year and agreed to let the OT know when he returned.
28. On 20 February 2019, Mr X advised the Council that Mr Y had returned.
29. On 1 March, the OT assessed Mr Y with a surveyor from the district council responsible for housing and DFGs. The OT identified that Mr Y needed safe and suitable access to a bedroom bathroom and WC. Equipment to help him access the bath was no longer suitable. The surveyor identified some planning constraints to an extension. Council records note they discussed options with Mr and Mrs X and the surveyor agreed to look at options for meeting Mr Y’s needs within the existing footprint of the house. Mr X says the surveyor said usually the Council would look to use the existing footprint of the house, but he would try to make the case for an extension. Mr X says the surveyor did not produce any attempt at plans for an extension.
30. On 12 March, the OT team manager spoke to Mr X and discussed the possible outcomes and the self funding grant which Mr X had decided to take up.
31. On 9 April, the OT team manager compiled supporting information for Mr Y’s application for the adaptation. She noted the limited space in the home and that the lack of space meant Mr Y would now find it difficult to use equipment to aid bathing. She said Mr Y would currently be able to use a stair lift and level access shower upstairs. But, should his health and mobility decline, a bed could be placed in the lounge which is the only living room in the house. She noted the OT recommendation was not for an extension but for a stair lift and a conversion of the downstairs WC to a level access shower room. She said the Council wanted to support the family in maintaining their caring role. It needed to consider the impact on Mr and Mrs X as Mr Y’s carers and in caring for their young children. She noted that Mr X was unhappy with the grant funding offered by the district council because the ground floor conversion would be more expensive than the upstairs conversion it agreed.
32. On 7 May, Mr X agreed to the Council’s offer to contribute £5,000 funding as the district council would not agree to the stairlift and downstairs conversion. He also asked the Council and the district council to help him find approved builders to give quotes so they could submit the full application.
33. On 10 May, the Council responded. It said it had checked with the district council. The district council could refer Mr X to a consultant who could support with project management and the fees would be included in the grant if approved. It asked for Mr X’s consent for the district council to refer him to the consultant. Mr X agreed the same day.
34. On 29 July, the district council approved the grant.
35. The Council says it had “multiple priority referrals” and more urgent assessments which caused the delay in offering Mr Y an assessment. It said Mr Y’s assessment could not be treated as priority because the outcome was likely to be the same.

Was there fault which caused injustice?

36. The OT assessment was significantly delayed; it was seven months before the Council tried to contact Mr Y. While I recognise the Council’s difficulty with a high level of priority cases, the Council still has a responsibility to assess each individual within an acceptable timescale. Seven months is too long.
37. The Council says it believed it had offered Mr Y adequate support. The OT assessment, offered only because Mr X challenged the assessment outcome, was therefore not a high priority. If the Council had been confident in the support it offered, it did not need to refer for an OT assessment. However, the February 2018 assessment did not fully consider Mr X’s concerns about the impact of the proposed equipment on the wider family and home. I am satisfied the Council was right to refer for an OT assessment but this should have been completed promptly.
38. It is not clear how long Mr Y had been overseas when the Council wrote to him, but if it had offered an assessment within four weeks, it was likely he would have been available. Even if Mr Y was overseas, the Council would have done what it could. I found the Council was at fault here.
39. The process took five months from the March 2019 assessment to approval. If the Council had assessed in March 2018, on the balance of probability, it should have been approved one year earlier. We cannot say whether the outcome would have been the same but it was unlikely to have been significantly different. While Mr Y’s travel overseas added to the delay, this would potentially have been avoided if the Council had assessed when it should. Mr Y was overseas for around six months, and this was only partly due to his difficulties in the home. I have therefore concluded this caused him avoidable and significant discomfort and distress for around six months. However, the Council had offered Mr Y equipment to assist with bathing and this could potentially have helped in the short term. Accepting this would not have meant they could not challenge the outcome and would not have meant accepting the stair lift to which they strongly objected. This would have minimised the discomfort and distress to Mr Y.
40. I cannot say this caused Mr X injustice as he does not appear to have chased the Council for the assessment. He only contacted the Council when he saw the letter for Mr X which did cause him some stress. The letter was somewhat insensitive; expecting a response within ten days despite waiting for seven months is likely to cause offence. However, the Council has apologised for this and I consider this enough to deal with any injustice to Mr X. Although it should not have lengthy delays in future, it should consider whether the wording of this letter might be improved in such circumstances.
41. The OT manager’s supporting information provided a helpful and clear analysis of the needs and circumstances. I would have expected to see similar consideration in the March 2019 assessment. Had the Council done this, it would have been clear in March 2019 whether it had offered enough support to meet Mr Y’s need.
42. I was pleased to note the Council’s positive actions in respect of supporting Mr X with the process, and the offer of funding which avoided further delays. This ensured Mr X’s needs would be met as well as Mr and Mrs X’s needs as carers. The Council has a responsibility to do this but it is pleasing to see the proactive and positive approach it took to the situation.

Agreed action

43. To remedy the injustice identified above, I recommended the Council:
• Pay Mr Y £350 for the discomfort and distress it caused by delaying the OT assessment.
• Take action to ensure OT assessments are completed within acceptable timescales in future.
• Consider the wording of correspondence during periods of delay.
• Complete these recommendations within two months of the final decision and submit evidence to the Ombudsman. Suitable evidence would include:
1. Confirmation of the payment.
2. An action plan to cover the two other recommendations.

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Final decision

44. I have completed my investigation and have upheld Mr X’s complaint that the Council delayed completing an occupational therapy (OT) assessment on his father, Mr Y.

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Investigator's decision on behalf of the Ombudsman