Summary: The Council’s delay in conduction on Occupation Therapy assessment of Mrs X was fault. As a result, Mr X cannot know if his wife’s last weeks could have been less painful and more dignified. The Council has agreed to apologise and pay Mr X £250 in recognition of this injustice.

The complaint

1. Mr X complains on behalf of his late wife, Mrs X, that the Council took too long to deal with their request for help to manage Mrs X’s care and support needs, including aids and adaptations to help them manage at home.
2. As a result, Mr X says Mrs X’s last months at home were unnecessarily painful and undignified.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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

5. I spoke to Mr X about the complaint.
6. I made written enquiries of the Council and considered its response along with relevant law and guidance.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

What happened

8. Mrs X had a terminal illness and Mr X was caring for her at home. Mr X provided all of Mrs X’s personal care. Mrs X was sleeping in the living room because she could no longer safely manage the stairs.
9. Mr X says he did not know Mrs X might be able to get help to manage at home until a friend told him the Council might put a stairlift in.
10. In August 2020, Mr X contacted the Council. Mr X asked the Council to assess Mrs X for any aids and adaptations that might help her, including for a stairlift. The Council told Mr X that it would ask an Occupational Therapist (OT) to visit to assess Mrs X.
11. Mr X says the officer he spoke to told him that it would be at least 18 months before any works would be done. Mrs X was not likely to live that long.
12. In October 2020, the Council contacted Mr X to arrange a date for an assessment of Mrs X. By this time, Mrs X had died.
13. Mr X complained to the Council in August. The Council responded to the complaint in October. The Council apologised to Mr X. It explained that it did have a backlog of requests for an assessment by an OT but that it also prioritised cases by urgency. It explained the delay completing assessments was in part due to COVID-19 restrictions but also wider problems it had with staffing. It explained the action it was taking to address the backlog but accepted that this could not benefit Mrs X.

My findings

14. The Council first became aware that Mrs X might have care and support needs in August 2020 when Mr X contacted it by telephone. During this call, the Council’s records show that it suggested its Adult Care Service could support Mrs X while waiting for an assessment by an OT. Mr X declined this offer.
15. Mr X thought that it was going to take 18 months before an OT would assess his wife. The Officer did not explain that cases were prioritised based on urgency and that Mrs X’s circumstances would be treated as urgent. This was fault. The Council has apologised to Mr X for the confusion this caused. This is a suitable remedy for the avoidable confusion and distress this caused Mr X.
16. Mrs X died about six weeks after Mr X’s request to the Council. At that point, the Council had not assessed her. The Council’s records show it prioritised Mrs X’s assessment based on its urgency and did not only deal with requests in date order. Nevertheless, it could not assess her before she died. Although there is no set timescale for councils to complete such assessments, the Council accepts there was a delay and that this is fault. It apologised to Mr X for this.
17. In response to my enquiries, the Council explained that there are delays for OT assessments because of a drop in staffing levels and ongoing difficulty recruiting new OTs. This is a national problem, not unique to this council, and has led to the government listing Occupational Therapy as a ‘shortage occupation’.
18. The Council also demonstrated the impact of the COVID-19 pandemic on the delay. In January 2020, before the pandemic, the Council had 178 outstanding requests for an OT assessment, the oldest of which was nine months. By August, during the pandemic, there were 293 people waiting for an assessment and the oldest was 15 months. The average time between referral and assessment is 142.5 days.
19. However, the Council says it has taken the following action to address this:
• From September 2020, all OTs are managed by one person. This allows the Council to better manage workloads and address urgent cases.
• The Council recruits locum OTs to target the longest wait times.
• The Council has recruited three new OTs and is interviewing for a fourth.
20. The Council suggested it write a further apology to Mr X, including this information, to reassure him that the Council has taken his complaint seriously and “to emphasise our ongoing commitment to address the backlog and prevent a similar delay being experienced by others”. The Ombudsman welcomes this suggestion.
21. The most significant injustice caused by the Council’s delay was to Mrs X. As she is now deceased, this cannot be remedied. Even if the Council had assessed her sooner, it is very unlikely it would have been able to install a stairlift before she died. However, it might have been able to provide other aids to help Mr X care for his wife of 42 years with as much dignity as possible in her last days. Mr X must live with this uncertainty. This is an injustice to Mr X.

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Agreed action

22. As well as the further apology it suggested, the Council has agreed to pay Mr X £250 in recognition of the uncertainty caused by its delay.
23. The Council should take this action within four weeks of my final decision.

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Final decision

24. I have completed my investigation. The Council’s delay is fault. The action I have recommended is a suitable remedy for the injustice caused.

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Investigator's decision on behalf of the Ombudsman