Summary: there was no fault in the way the Council assessed Mrs Y’s need for home adaptations and decided on the relevant works for a Disabled Facilities Grant. Progress stalled because Mrs Y’s family could not reach agreement with the Council on the proposed scheme and therefore it did not proceed.

The complaint

1. Ms X complains on behalf of her mother, Mrs Y. She says the Council is taking too long to agree and deliver major home adaptations, funded by a Disabled Facilities Grant, to provide Mrs Y with accessible bathing facilities and access to the garden. She says the Council’s proposed scheme is unacceptable because it would lead to a loss of space in the kitchen/lean to and prevent her father, who is also disabled, from storing medical supplies on the ground floor which he needs for daily dialysis sessions.
2. Since she was discharged from hospital in August 2021, Mrs Y has slept in the living room where she uses a commode and is strip washed by care assistants. The lack of access to showering and toilet facilities has caused a loss of privacy and dignity. Ms X says it is difficult for Mrs Y to maintain good personal hygiene and this has led to recurring urinary tract infections. She says it has also affected her mother’s mental health.

Back to top

The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
    
4. 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(i), as amended)

Back to top

How I considered this complaint

5. I have spoken to Ms X and considered all the information she sent us. I have considered the Council’s response to my enquiries and relevant case records and correspondence. I have also considered the relevant law, government guidance and the Council’s Private Sector Housing Assistance policy.
6. I gave Ms X and the Council an opportunity to comment on my draft decision. I considered their comments before making a final decision.

Back to top

What I found

The background

7. Mrs Y was discharged from hospital in August 2021 following a stroke. She and her husband used to live with Ms X but her flat was not suitable for Mrs Y after the stroke. Mr & Mrs Y moved, with their adult son, to a three bedroom house owned by a relative.
8. All three bedrooms and the bathroom are on the first floor. Mrs Y has very limited mobility and she cannot manage the stairs. She has a care package with four daily calls from care workers to manage her personal care, laundry and other needs. Mr Y also has significant medical conditions which require him to have regular dialysis at home. He needs space to store several boxes of medical supplies which are delivered every month.
9. Mrs Y has lived on the ground floor since they moved to the house in August 2021. She has a profile bed and uses a commode in the living room. Care workers give her a strip wash in the living room. She has not been able to have a shower since she left hospital. Ms X says there is no privacy for Mrs Y because all her personal care and toileting takes place in the living room.
10. There are a few steps to the front door of the house. Mrs Y does not wish to move and declined the suggestion of applying for rehousing to a wheelchair accessible property.
11. Progress with Mrs Y’s request for a DFG has stalled because the Council and the family cannot agree on the design of the adaptations scheme and the works that are necessary and appropriate to meet Mrs Y’s needs.

Relevant law and policy

12. Disabled Facilities Grants (DFGs) are provided under the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to give grants to disabled people to make certain adaptations to their homes. The Act lists specific purposes for which a DFG can be awarded. This includes adaptations to enable the disabled person to have access into and around the home and garden, and an accessible toilet, shower and wash basin. DFGs can only be awarded to meet one or more of the purposes specified in the Act.
13. Before it approves a grant, the council must be satisfied the relevant works are necessary and appropriate to meet the needs of the disabled person. They must then go on to consider whether the proposed works are reasonable and practicable taking into account the age and condition of the building.
14. Following a request for a DFG, an occupational therapist (OT) or trusted assessor will assess the disabled person’s needs and identify potential solutions through home adaptations. The next stage is for a surveyor to visit the property to identify the relevant works and draw up the proposed scheme.
15. The maximum amount for a mandatory DFG is £30,000. Councils are not required to meet additional costs above this limit, but may top up grants as agreed locally and set out in their local Housing Assistance Policy. 
16. Newham Council’s Private Sector Housing Assistance policy includes a Customer Own Scheme (COS). This enables someone who meets the eligibility criteria for a DFG to ‘top-up’ the funding to include other works. The Occupational Therapist will recommend the most cost-effective solution for adaptations within the existing property. However the person may prefer a different option which still meets the needs of the disabled person but costs more. In these circumstances, the customer is responsible for paying the difference in costs between the DFG and the final cost of the works, including any unforeseen costs. They must provide written evidence that they can afford the more extensive works before the Council agrees to support their preferred scheme. And the Occupational Therapist must ensure the final scheme meets the disabled person’s needs.
17. The Council’s policy also says it may award a discretionary DFG as a top-up in exceptional cases where a home adaptation exceeds the mandatory £30,000 DFG limit. The maximum amount of a discretionary top-up is £15,000.
18. This discretionary support may be given when the Council considers it will enable the person to remain in employment, or if the adaptation will significantly reduce the costs, or delay the future costs, of care and support funded by the Council.
19. In March 2022 the government issued non-statutory guidance “Disabled facilities Grant (DFG) Delivery: Guidance for local authorities in England”. I refer to this as “the DFG Guidance” in this statement. It advises councils in England on how they can effectively and efficiently deliver DFG funded adaptations to best serve the needs of local older and disabled people. It brings together and sets out in one place existing policy frameworks, legislative duties and powers, together with recommended best practice, to help councils provide an adaptation service to disabled tenants and residents in their area.
20. The DFG guidance says that in most cases the client will agree the ‘relevant works’ that are necessary and appropriate to meet their needs. However, there will be occasions when a client would like the Council to consider different or more extensive works to their home. This may be because they need additional works outside the normal purposes of a DFG or they have a preference about how they intend to use their home. The guidance says councils should consider how to support client choice and not deny access to a Home Improvement Agency service for cases where a client seeks to exercise their choice.

The key events

21. This statement sets out the key events relevant to our investigation of Ms X’s complaint. I have not included everything that has happened since August 2021 or given details of every communication between Ms X and the Council.
22. An Occupational Therapist (OT1) visited Mrs Y in mid-August 2021 to review her care needs and care package a few weeks after she was discharged from hospital. She agreed the need for major adaptations if Mrs Y remained in the house to create suitable shower and toilet facilities on the ground floor and wheelchair access to the property.
23. On 27 September OT1 presented a report to the Council’s Major Adaptations Panel (“the Panel”). The Panel is made up of managers in the OT service and the manager of the Home Adaptations and Independent Living team. OT1 recommended the following options to meet Mrs Y’s assessed needs:

Option 1 Moving to a more suitable property with wheelchair access and all facilities on one level (she said this was the best option);

Option 2 A step lift at the front of the property to give Mrs Y access to the community and a ramped access to the rear garden. Divide the existing living room in two to create a ground floor bathroom and bedroom for Mrs Y.

Option 3 A through floor lift to enable Mrs Y to get access to one of the first floor bedrooms and adapt the existing bathroom. A step lift at the front of the property and a ramped access to the rear garden.

24. In her report OT1 said Mrs Y’s family did not agree with any of these options. They wanted the Council to award a DFG for a rear extension and ramped access to the front and rear of the house.
25. The Panel decided it needed more information from the community physiotherapist about Mrs Y’s potential for further rehabilitation. It also said more work was needed to establish the feasibility of options to improve access into and inside the property. They stressed the general principle that adaptations should be done within the existing footprint of the building wherever possible and the Council should adopt the most cost-effective solution.
26. Mrs Y’s case was assigned to a senior OT (OT2) who reviewed OT1’s recommendations because the family did not accept them. The case records show two appointments for OT2 to visit Mrs Y in September 2021 and November 2021 had to be rescheduled. The case notes say one appointment was cancelled due to COVID-19 restrictions in force at the time.
27. OT2 had to rearrange a planned appointment to visit Mrs Y in January 2022 because she was on sick leave.
28. OT2 visited Mrs Y with a manager from the Home Adaptations service on 10 February 2022. They are both members of the Panel which considered Mrs Y’s case in September 2021. Ms X could not attend but her brother was present. The officers prepared a rough sketch plan showing the dimensions of the new wet room (4 square metres) which would accommodate a shower, wash basin and toilet.
29. OT2 sent an email to Ms X the day after the visit. She asked for evidence of Mrs Y’s income and explained that the Council would need the owner’s written consent to any works. She outlined the proposed scheme and said she would have to present the case to the Major Adaptations Panel. She said it would be helpful to arrange a time to speak to Ms X.
30. OT2 spoke to Ms X in late February. Ms X said the family were not happy with the suggestion for a step lift at the front of the property. They would prefer a ramp. They also discussed the location of the access to the rear garden and a potential problem with removal of a chimney breast due to the location of pipework for the boiler. According to an email OT2 sent to the adaptations manager, Ms X agreed, in principle, to create a wet room at the rear of the house and a separate bedroom by partitioning the living room.
31. In mid-March 2022 Ms X sent OT2 evidence of Mrs Y’s income. She also confirmed that Mrs Y’s sister owned the property. OT2 then contacted a lift company to arrange for them to visit to measure the steps at the front entrance.
32. OT2 presented a report to the Major Adaptations Panel in late April 2022. She confirmed that Mrs Y did not wish to move. She said Mrs Y could not use a stairlift to access the first floor rooms. She had been referred to the Wheelchair Service and would need to use a wheelchair permanently. There was not enough room to install a through floor lift with enough turning space at the top of the landing to enable Mrs Y to get access to the existing bathroom. She said living on the ground floor was the best solution to Mrs Y’s long term needs.
33. The Panel agreed in principle to OT2’s recommendation to award a DFG to build a rear ground floor extension to create a wet room and a new access to the back garden. OT2’s report said Mrs Y agreed with this proposed scheme.
34. In early May 2022 Ms X asked the Council to consider an alternative scheme to meet Mrs Y’s needs. This involved building a larger rear extension to retain more kitchen space. The Council said they could proceed with these proposals if they included a 4 square metre wet room to meet Mrs Y’s assessed needs and used the Customers Own Scheme (COS) to fund the extra work they wanted.
35. In early July 2022 OT2 visited with a gas engineer to investigate the feasibility of leaving the boiler in its existing position when the rear of the living room was used as Mrs Y’s bedroom. The gas engineer confirmed the boiler would have to be relocated.
36. In late July 2022 OT2 wrote to Ms X to confirm the Council had approved the following works under a DFG scheme:

1. Remove the existing lean to structure and provide a 4 square metre extension to provide accessible bathing and toileting facilities;

2. Create a ground floor bedroom facility by partitioning the back of the lounge and removing a chimney breast to create enough space to give Mrs Y access to the essential facilities.

3. Remove the existing boiler and replace it with a new boiler on the external wall of the new structure – this would be funded under a separate part of the grant.

4. Place the washing machine in the existing kitchen by removing some existing cupboard space.

5. Replace the kitchen door to the garden with level access.

37. OT2 confirmed that the DFG would not cover the following works:
• Creating extra storage space; and
• Extending the Council’s scheme to include extra storage space at the rear of the property.
38. She explained that if the family wished to add an additional section at the rear of the property to create more space they could fund this work themselves by topping up the approved grant under the Customer Own Scheme. These works could be done at the same time.
39. OT2 also commented on the decision made by Ms X and her family to decline the Council’s proposed scheme for a step lift to enable Mrs Y to get in and out of the front entrance of the property. She encouraged Ms X to reconsider this so Mrs Y could have access to the community. She said this work could be carried out under a separate DFG if Ms X and her family changed their minds.
40. OT2 said she had also spoken to the Housing service about rehousing options for Mr & Mrs Y. Some two bedroom wheelchair adapted properties were available in the borough. She could support Mr & Mrs Y with this option which, in her opinion, would be a more suitable long term solution to their needs.
41. Ms X told OT2 in July 2022 they did not wish to use the Customer Own Scheme option to meet the cost of additional works to construct a larger extension.
42. In July 2022 OT2 contacted Ms X to discuss the option of trialling some temporary ramps to give access to the rear garden. This did not proceed any further.
43. In August 2022 the family declined the Council’s proposed scheme for a 2 metre by 2 metre rear extension on the grounds it would result in an unacceptable loss of kitchen space.
44. In late September 2022 OT spoke to Ms X. According to the case notes, Ms X said her mother was reluctant to proceed with major adaptations at the time. OT2 discussed arranging a visit with a surveyor to discuss options. Ms X agreed to speak to her parents about this.
45. On 11 October 2022 OT2 and a surveyor from the Home Adaptations team made a joint visit to consider other possible solutions. They took photographs of the existing lean-to structure and kitchen area. The surveyor informed OT2 they could achieve the desired outcome by demolishing the rear sub-standard conservatory and building a wheelchair accessible shower room extension. This would include a lobby area with a side external door to access the rear garden.
46. He added that the existing rear reception area could be used as a bedroom with natural light and ventilation from the front of the reception room. Bi-folding doors with vents could be fitted to provide privacy.
47. The Council considered this to be the most cost-effective way to meet Mrs Y’s need for accessible bathing facilities and access to the rear garden.
48. On 21 October 2022 OT2 presented the case again to the Major Adaptations Panel. The scheme had been amended following the joint visit to create a different means of access to the rear garden. Instead of access from the kitchen, which the family did not want and OT2 agreed was not the best solution, the revised plans showed a ramped access from a corridor to the garden. The Panel agreed to the scheme in principle.
49. On 25 October OT2 updated Ms X on the surveyor’s recommendations. She said the washing machine and dryer could be moved to new storage space next to the bathroom and stacked on top of each other. She asked Ms X for contact details for Mr Y’s dialysis delivery team so she could find out if they could deliver boxes of medical supplies to an upstairs bedroom where they could be stored.
50. In December 2022 a surveyor in the Home Adaptations team informed OT2 that the Council’s proposed scheme for a wet room extension with a lobby area to create access to the rear garden would cost approximately £35,000 to £40,000. The family’s preferred scheme for a full width rear extension, to include the shower room and retain the kitchen space with access to the rear garden would cost approximately £60,000 to £70,000. At this stage, the Council did not have builders’ estimates but the surveyor said this was the likely cost of the two schemes.
51. Ms X complained to the Council in November 2022. The Principal OT did not uphold Ms X’s complaint. She rejected Ms X’s request for a new assessment or second opinion on the grounds that it would not change the recommendations made following the October 2022 visit and would just cause further delay. She also suggested ways of storing Mr Y’s dialysis equipment and where to put the washing machine and chest freezer. Matters have not progressed further since then because the family and the Council still disagree on the proposed scheme.
52. The Council says its revised scheme would have met Mr Y’s needs as they were at that time. There would have been space to put a single bed in the partitioned ground floor bedroom for Mr Y’s use along with Mrs Y’s bed. Mr Y could also have used the ground floor wet room facilities.
53. Ms X complained to us in January 2023. We do not investigate what has happened since the complaint was made to us. However, Ms X informed me that Mr & Mrs Y’s circumstances have changed significantly. Both her parents were admitted to hospital earlier this year with serious health complications. Her mother’s health has deteriorated and her father’s needs have increased following an emergency admission in April 2023. Ms X recently enquired about the option of her parents applying for social housing in Newham or in the borough where she lives. This could enable them to move to suitable accommodation and, if they are accepted for rehousing in her borough, she would find it easier to provide extra care and support.

Ms X’s objections to the Council’s proposed scheme

54. Ms X says the revised scheme drawn up in October 2022 would have unacceptably reduced the size of the kitchen. The family use the adjoining lean to structure as an extension of the kitchen space and it would have been demolished under the Council’s scheme.
55. Ms X says the existing kitchen is small. A large chest freezer, washing machine and tumble dryer are kept in the adjoining lean-to. There would not be enough space for these white goods on the ground floor if the October 2022 scheme had been implemented. Ms X told me Mrs Y is incontinent and this creates extra laundry.
56. The Council says the washing machine and tumble dryer could be stacked on top of each other in the new ground floor corridor. They suggested the chest freezer could be moved upstairs to a spare bedroom. OT2 had offered to speak to the dialysis team to find out if Mr Y’s medical supplies could be delivered to the unoccupied first floor bedroom (they are currently stored in the living room). Mrs Y would have used the rear of the living room as her bedroom and it would have been partitioned with doors to provide privacy.
57. Ms X says the arrangements for delivery of dialysis supplies, and whether they could be delivered to a spare bedroom on the first floor, is irrelevant. Mr Y has four daily dialysis sessions which each take 40 minutes. 48 boxes of medical supplies are delivered every month which are stored in the living room so they are easily accessible. Mr Y has dialysis on the ground floor because he is not very mobile and has a visual impairment . Ms X says it is not practical to expect him to go upstairs four times a day and the medical supplies must be stored downstairs for this reason.
58. The Council made the point that a DFG can only be awarded for one of the specified purposes in the Act. It cannot be awarded to create additional storage space for medical supplies or equipment. Nevertheless the Council’s proposed scheme considered this need and there would have been some storage space in the new corridor. It also offered to contact the dialysis team to explore solutions but did not follow this up because Ms X did not provide details. It says Mr & Mrs Y’s adult son who lives with them, or the care workers, could access the chest freezer and Mr Y’s medical supplies if they were moved upstairs to a spare bedroom.

Analysis

59. Mrs Y has been living in a property without access to the essential facilities she needs, including a shower and toilet, since she left hospital in August 2021. That is extremely degrading and distressing for her and must have an adverse impact on her general wellbeing and health.
60. The Ombudsman’s role is to decide whether this situation has arisen due to fault in the way the Council assessed her needs and handled the DFG request. If we find fault, we go on to consider if it caused injustice to Mrs Y.
61. In this case the stumbling block is that Ms X and the wider family could not reach agreement with the Council on the relevant works necessary to meet Mrs Y’s assessed needs and what could be funded by a DFG. Without agreement on the proposed scheme, progress with the DFG came to a standstill.
62. I consider the Council’s proposed scheme for a small ground floor rear extension to create a wet room would have met Mrs Y’s assessed need for an accessible shower, toilet and washbasin. The proposed works would also have created a safe means of access to the back garden.
63. The Council consulted the family and revised the scheme as far as possible to take account of their views and wishes. It tried to move matters forward. But the Council also had to consider the most cost-effective way of meeting Mrs Y’s needs. Its surveyor estimated the total cost of Ms X’s preferred scheme would exceed the maximum £45,000 (the £30,000 limit for a DFG with a potential £15,000 top-up if the Council decided to award a discretionary payment under its Private Sector Housing Assistance policy). The Council cannot award a DFG for works it did not consider necessary to meet Mrs Y’s identified needs. And it could not award a DFG for works which fell outside one of the specified purposes in the Act.
64. Accordingly the Council could not accommodate the family’s preference for a larger rear extension to retain more kitchen space by using a DFG. The family could have incorporated these extra works into the scheme but only if they used the Customer Own Scheme and obtained approval from the Council.
65. Ms X raised concerns with the Council about the loss of kitchen space and the need for easily accessible storage of Mr Y’s medical supplies. The Council took this on board and suggested possible solutions. I understand Ms X did not accept the Council’s proposals but that does not mean the Council was at fault. I cannot find fault simply because Ms X and the family disagreed with the Council’s proposals.
66. Mrs Y is caught in the middle of this dispute and her needs are not being met. Undoubtedly this is causing her considerable distress and inconvenience. But the Council can only approve a DFG for works it deems necessary and appropriate to meet the disabled person’s needs. Although it must consult and work with the applicant and their family, it is not required to approve a DFG for the family’s preferred scheme if it costs more and includes works not deemed essential to meet the disabled person’s assessed needs (or works that are not eligible for DFG funding).
67. The Council has tried to address the family’s concerns by making changes to the proposed scheme. It also informed Ms X about the Customer Own Scheme which the family could use to “top up” the DFG to get the extra works done. Ms X said the family could not afford to proceed on that basis. It is very unfortunate that matters then reached an impasse. But it was not fault for the Council to decide only to fund works it considered necessary and appropriate to meet Mrs Y’s assessed needs.
68. I have concluded that the failure to reach agreement on the relevant works for a DFG is not due to fault on the Council’s part. Clearly it is in Mrs Y’s interests for the Council and Ms X to find a way to work together to meet her pressing need for suitable and accessible accommodation.

Back to top

Final decision

69. I have completed the investigation and found no evidence of fault by the Council.

Back to top

Investigator's decision on behalf of the Ombudsman