Summary: Ms X complained about the way the Council carried out an Occupational Therapy assessment for adaptations she wanted to her property. There was no fault in the Council’s actions.

The complaint

1. Ms X complained about how the Council carried out an Occupational Therapy (OT) assessment for adaptions to her property. Ms X complained the Council:
1. failed to act on her self-referral in 2021;
2. delayed in completing the OT assessment;
3. disagreed about which medical staff should be consulted;
4. disagreed about what adaptations were suitable; and
5. failed to communicate clearly with her or her advocate.
2. Ms X said she had not had sufficient adaptations in her home to meet her needs and this caused her physical and mental distress.

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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 how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. 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)

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What I have and have not investigated

6. I have not investigated point a) of Ms X’s complaint. This is because this complaint is late and there is no good reason Ms X did not bring it to us sooner.

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How I considered this complaint

7. I read the documents Ms X provided and discussed the complaint with her on the telephone.
8. I considered the documents the Council sent in response to my enquiries.
9. Ms 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

Relevant legislation and guidance

10. Disabled Facilities Grants (DFG) are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to give DFGs to disabled people for certain adaptations. Before approving a grant, a council must be satisfied the work is necessary, meets the disabled person’s current and future anticipated needs, and is reasonable and practicable. Councils will often consult an occupational therapist to determine what is necessary and appropriate.
11. The maximum grant payable by a council is £30,000. A council can award other discretionary help if it thinks it is necessary. The council grant amount is subject to a means test. The means test applies to the disabled person (the ‘relevant person’).
12. In March 2022 the government issued non-statutory guidance “Disabled facilities Grant (DFG) Delivery: Guidance for local authorities in England. The guidance identifies five key stages to delivering home adaptations:
• Stage 0: First contact with the service. Councils should ensure the public has access to information and advice about the DFG process.
• Stage 1: First contact to assessment and identification of the relevant works. An occupational therapist (OT) will assess the person’s needs and potential solutions through home adaptations.
• Stage 2: Identification of the relevant works to submission of the formal grant application. The person completes and submits the application form together with designs and costing for the works (where necessary).
• Stage 3: Grant application to grant decision. The council will check the application and issue a decision letter. If a council refuses a grant, it must explain why.
• Stage 4: Approval of grant to completion of works. The works are arranged and carried out and the necessary quality checks made.
13. Both the previous and current guidance set out best practice target timescales for moving through the stages which depend on the urgency and complexity of the works required. The guidance suggests 95% of urgent and complex works should be carried out within 130 working days and 95% of non-urgent and complex works should be carried out within 180 working days.

Council’s discretionary grant

14. This Council also provides a discretionary Independent Living Grant (ILG) for adaptations to a home that assist with independent living but do not add value to the property. It is not means tested and does not need to be repaid. The maximum grant available is £19,000 for essential improvement works. An OT assessment is required to establish if the adaptations are both ‘necessary and appropriate’ and ‘reasonable and practicable’.

What happened

15. Ms X lives alone and suffers from a number of health problems that affect her daily living activities. She moved into the Council’s area in late 2021.
16. Ms X contacted the Council in March 2022. She said she had difficulty using the stairs and getting to her bedroom and upstairs bathroom. She asked for an assessment of her needs.
17. An officer from the Council spoke to Ms X on the phone at the beginning of April. Ms X explained her health problems and said she needed support because she could not stand to make meals or get into the bath. She said she struggled to access the bathroom and move around her property. The Council offered some initial advice and arranged for an Occupational Therapist (OT) to consider Ms X’s access to the existing downstairs toilet and upstairs bathroom.
18. Ms X provided the Council with medical reports she had received in March 2021.
19. The OT visited Ms X at home seven working days later to complete an assessment. The records show the OT could not complete a full assessment as Ms X was fatigued. Ms X said she wanted a new downstairs toilet and asked for a referral to the home improvements scheme. The OT recommended minor aids such as grab rails that would meet Ms X’s needs. They also explained some of Ms X requests were not for the OT such as sound proofing, security and dentistry. They directed Ms X to appropriate services.
20. As Ms X stated she wanted adaptations to the bathroom of the property the OT discussed the case with their supervisor. They decided that to consider Ms X’s request for the downstairs toilet they would need further information from her GP, as the medical letter Ms X had provided was over a year old.
21. The Council states the aids the OT identified were delivered to Ms X at the end of April.
22. The Council and Ms X corresponded via email in May. Ms X provided some summaries from different medical teams. The Council asked Ms X for permission to gather current information from her GP and explained why. It said if Ms X would rather obtain the information herself and send it to the Council it would accept that. It said it needed to know:
• Ms X’s medical conditions;
• any planned treatments and what the expected outcome of any treatments were; and
• the long-term prognosis: how the conditions would affect Ms X long term, or if there was any improvement expected.
23. Ms X provided the Council with some further documents, one of which stated Ms X was undergoing further tests. The Council explained that the documents did not provide the information it required and again asked for permission to contact Ms X’s GP. Ms X stated she believed the information she had provided was sufficient for the Council to consider. She did not give the Council permission to contact her GP. On the basis that Ms X required further medical tests the Council transferred her case to its long-term team.
24. Ms X began working with an advocate at the end of May 2022.
25. Ms X’s advocate complained on her behalf to the Council in mid-June. They said Ms X felt unheard and was concerned about the delay in her assessment. The Council responded and stated it had done an initial assessment and provided equipment to reduce the risk to Ms X in April. It said as Ms X wanted adaptations it needed further, up-to-date information from her GP. It needed to know the outcome of the further tests and ongoing treatments to understand Ms X’s long term needs and functional ability. It said the case had transferred to the long-term team who would make appropriate recommendations when the outcome of the tests was known.
26. Ms X complained to the Council in July 2022. She said it had delayed completing an OT assessment it had agreed to do in April 2022. A Council Officer spoke to Ms X on the phone and assigned an OT to complete a further assessment.
27. The OT completed two home visits in July with Ms X. Ms X requested her advocate was present for the second visit. The OT observed how Ms X carried out daily activities and moved around her house. It noted Ms X’s concerns about the risks to her in her property.
28. The OT wrote to Ms X the following day explaining why they needed to contact Ms X’s GP and asked for her consent. The OT said that without further medical information from the GP they may be unable to complete the assessment. To reduce delay they would ask the Home Improvements Team (HIT) to send a preliminary enquiry form for a potential future Disabled Facilities Grant (DFG). The Council said it did not complete the referral immediately as it waited for Ms X to provide her consent. It said the OT contacted the HIT at the end of August and requested a preliminary assessment.
29. Ms X complained to the Council in August. She complained the Council:
• delayed the OT assessment;
• delayed the OT report;
• made inappropriate recommendations for adaptations to her property;
• delayed in referring her to the HIT team; and
• was not listening to what she was telling it about her needs.
30. The Council responded to Ms X’s complaint at stage one in September 2022. It did not uphold the complaints, it:
• explained the process of initial OT assessment and further assessment and the timescales;
• explained it needed information from the GP as they coordinate health concerns and are best placed to respond to questions the OT may have to avoid the OT making inappropriate recommendations. It said when matters were complex it was best to speak with the GP rather than all individual specialists;
• explained what it considered in making the recommendations and that it could not conclude the assessment as Ms X had not given consent to speak with her GP and their input was needed to risk assess the different options;
• said it had not previously referred her application to HIT as it was waiting consent to speak with the GP, but had now made the referral; and
• requested Ms X’s consent to speak to the GP.
31. Ms X raised further complaints with the Council. She considered the Council had sufficient information to progress her adaptations request without speaking to her GP.
32. Ms X said she provided the Council with a letter from her GP from August 2022 at the end of September 2022. The letter detailed Ms X’s diagnosis and impact on her daily living activities. The Council said the letter provided the information in needed to allow it to complete the OT assessment.
33. The OT completed the assessment at the end of November 2022 and proposed:
• a bathroom adaptation - level access shower with appropriate wall mounted seat and grab rails;
• a through floor lift to give access to all levels within existing property;
• improved steps and rails in the garden and to consider rehanging a door;
• explore appropriate heating & lighting for ground floor toilet; and
• provide grab rail to assist stepped access into lean to.
34. The assessment said it would refer Ms X to the Home Improvement Team (HIT) for completion of the initial test of resources, after which it would forward its recommendations for consideration with Ms X’s approval.
35. The Council responded to Ms X’s further complaints in November. It did not uphold her complaints. It explained its process and procedures around OT assessments and its recommendations. It said: ‘It is important for us to understand an individual’s medical history and the possible impact that both new and existing diagnosis have on a person. It is therefore based on this that requests have been made for access to your medical history from your General Practitioner.’ It asked Ms X to contact it if she wanted to proceed with the recommendations with the home improvement team.
36. The Council sent Ms X a DFG application form in December 2022. Ms X completed the application form. The Council said that the outcome of the financial assessment was that Ms X did not qualify for a DFG.
37. The Council sent Ms X an Independent Living Grant (ILG) application form which Ms X completed and returned at the end of January 2023.

My findings

Delay in completing the OT assessment

38. The Council completed an initial assessment within five weeks of Ms X’s request and provided appropriate equipment within a further three. As Ms X wanted more adaptations the Council completed further assessments which included gathering medical information and completing two additional home visits. There was a delay in completing this but it was not due to Council fault. The Council was unable to complete the assessments until it had sufficient medical information. Ms X provided this in September 2022. The Council completed its OT assessment and recommendations in November 2022, within two months of it having all the information it required. I am satisfied there was no significant delay in the Council’s actions.

Consultation with medical staff

39. The guidance states the Council needed to be satisfied any adaptations it recommended were necessary and appropriate. To do that it needed to understand Ms X’s medical conditions and how they affected her daily living activities at the time, and how they were likely to in the future. It asked for permission to speak to Ms X’s GP and explained why it needed to and what information it needed. Although Ms X provided some information from other medical professionals it was not the information the Council required. It is for the Council to decide what information it requires to complete the OT assessment. It clearly explained what information it required, from who and why. There was no fault in the Council’s actions.

Suitability of adaptations

40. We are not an appeal body. We cannot question the Council’s decision because Ms X disagrees with it. We can only decide if there was fault in the way the decision was reached. The Council visited Ms X at home to assess her needs, and her home. It gathered relevant medical information and considered Ms X’s preferred options in making its recommendations. There was no fault in how the Council made its decision as to what adaptations she required and so I cannot question the outcome. Ms X does not have to accept the adaptations recommended to her property.

Communication with Ms X and her advocate

41. I have reviewed the relevant documents and can see that the Council invited Ms X’s advocate to the home visit assessments and communicated with them via email when they raised complaints on Ms X’s behalf. Ms X did not always have an advocate in place and therefore the Council did not always include advocates in emails with Ms X. The records show the Council’s communication with Ms X was clear and direct. There is no evidence of fault in the Council's actions.

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Final decision

42. I have completed my investigation. There was no fault in the Council’s actions.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman