Summary: There was fault in the way the Council decided to reduce Mr B’s support package without a clear explanation. The Council has agreed to apologise to Mr B.

The complaint

1. Mr B complains that the Council reduced his support package in September 2018. He says the reduction was not in line with the statutory guidance as the Council had not properly explained what the reasons for the reduction were.

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The Ombudsman’s role and powers

2. 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)
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

4. I have discussed the complaint with Mr B’s representative. I have considered the documents that he and the Council have sent, the relevant law, guidance and the Council’s policies and both sides’ comments on the draft decision.

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What I found

Assessing needs

5. The Care Act 2014 says the Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which sets out the cost of meeting the needs.
6. The needs assessment decides how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Councils must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
7. The outcomes are:
• Managing and maintaining nutrition.
• Maintaining personal hygiene.
• Managing toilet needs.
• Being appropriately clothed.
• Being able to make use of the home safely.
• Maintaining a habitable home environment.
• Developing and maintaining family or other personal relationships.
• Accessing and engaging in work, training, education.
• Making use of necessary facilities or services in the local community.
• Carrying out caring responsibilities for children.

Needs met by a carer

8. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. This ensures that the entirety of the adult’s needs are identified and the local authority can respond appropriately if the carer feels unable or unwilling to carry out some or all of the caring they were previously providing.

Carer’s assessment

9. If it appears that the carer may have any level of needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments will establish not only the carer’s needs for support, but also the sustainability of the caring role itself, which includes both the practical and emotional support the carer provides to the adult.

Reviews of the care plan

10. Councils are expected to review the care plan at least every 12 months.
11. The review should be proportionate to the needs to be met, and the process should not contain any surprises for the person concerned. Reviews must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstance.

What happened

12. Mr B is registered severely sight impaired and has needs for care and support. His wife, Mrs B is his main carer.

May 2016 – assessment

13. The social worker assessed Mr B’s needs.
14. Mr B needed support to achieve the following outcomes. Mrs B was the main carer in these areas:
• Managing and maintaining nutrition.
• Maintaining personal hygiene.
• Being able to make use of the home safely.
• Maintaining a habitable home environment.
• Developing and maintaining family or other personal relationships.
15. Mr B received Council support for the following:
• Maintaining a habitable home environment. Mrs B did the cleaning tasks and paid the bills, but Mr B’s personal assistant supported him in accessing emails.
• Accessing the local community. Mrs B did some of the shopping and Mr B also did this task with support from his personal assistant. He also received support from his personal assistant to go to social outings and medical appointments.
16. Mr B told the social worker he would benefit from more time to access the community because of his rural location and the time that was spent travelling to places.
17. The Council agreed a care plan of six hours support by a personal assistant.

June 2017 – review of care plan

18. The Council reviewed Mr B’s care plan.
19. Mr B asked for more support to access the local community. The social worker agreed an increase and explained the reasons:
• Mr B’s needs has not changed, but sadly Mrs B’s health and wellbeing had deteriorated. Therefore, Mrs B was unable to provide the level of support that she had been providing.
• Mr B lived in a rural area and this meant any community amenity was a long drive away. So a lot of the time allocated to access the community was actually spent travelling. Mrs B had provided some support to Mr B in this area in the past, but was unable to do so because of the decline in her health
20. The Council increased the support to 8 hours.

July 2017 – review of carer’s needs

21. The Council reviewed Mrs B’s needs as a carer. Mrs B said her caring role was all consuming and she often felt stressed and exhausted trying to juggle the responsibilities of her caring role. She had medical conditions affecting her hips which meant it was difficult to mobilise and she rarely accessed the community unless necessary. Mrs B said she was also the primary carer for her sister who had mental health problems.
22. The Council allocated a £150 personal budget and NHS short breaks funding to fund essential breaks throughout the year.

April 2018 – review of carer’s needs

23. The review said there had been no changes and the support package for Mrs B remained the same.

May 2018 – agency closure

24. The agency which the Council employed to provide care and support to Mr B closed down. The Council offered other agencies, but Mr B said they were not suitable. Mr B agreed to consider direct payments so that he could pay for his personal assistant.
25. Mrs B had an NHS ‘carers planned short breaks’ review in September 2018 which said she continued to be eligible.

September 2018 – assessment

26. The social worker re-assessed Mr B’s needs and noted that Mr B did not have a personal assistant.
27. This meant he had been unable to access the community, keep in touch with friends or help in the shopping. He had relied on Mrs B’s support a lot more and said that taxis were not willing to pick him up because of his remote location.
28. He did have a befriender/volunteer from a charity who visited him for one and a half hours every other week and they would go for a walk locally.
29. The social worker said Mr B needed support with shopping, reading his correspondence and connecting with friends. Mr B agreed to consider a period of rehabilitation from a rehabilitation officer for help with assistive technology so that he could access the internet and emails independently.
30. The Council reduced the support to 4 hours support for social inclusion.

November 2018 - complaint

31. Mr B complained to the Council for cutting his support in half. He said:
• His needs had not decreased, if anything, his health had deteriorated.
• Mrs B’s own health had deteriorated and she suffered from a number of medical conditions which affected her ability to provide care. Mrs B now also had caring responsibilities for her sister. Therefore, she was no longer able or willing to provide the support she had provided in the past. The social worker had not considered this when he reduced the support.
• When Mr B raised the issue of Mrs B’s ability to provide the support, the social worker ended the review assessment.
32. The Council responded and said:
• Mrs B supported Mr B in the majority of the tasks and she had said she could continue to do so, although she was finding it increasingly difficult.
• Mr B had been offered support from a rehabilitation officer in regards to assistive technology so he could access emails and the internet independently.
• Mr B was also receiving support from a charity to help with social inclusion so the Council reduced his support in this area.

January 2019 - complaint

33. Mr B complained again. He said:
• The charity volunteer already supported him at the time when he received 8 hours support so this could not explain the reduction in support.
• The charity volunteer only visited him 1.5 hours every two weeks, not 4 hours every week.
• His main need for support was in ‘accessing the community’ and the charity volunteer did not assist in this.
• The Council had not properly considered whether Mrs B could continue to provide care at the level that she was providing.
34. The Council said:
• Mr B had now received a period of rehabilitation from the rehabilitation officer.
• It offered Mr B a review of his needs.

February 2019 - assessment

35. The social worker said that:
• Mr B had still not found a personal assistant.
• Maintaining personal hygiene. Because of the extent of Mrs B’s caring responsibilities and her own ill-health, Mrs B was using the NHS Carers Break funding to help in laundry tasks.
• Maintaining a habitable environment. Mr B had encountered problems in using assistive technology and his current state of mind precluded him from engaging in reablement. Mrs B had withdrawn her support with reading emails and correspondence so Mr B was not receiving support in this area and needed a personal assistant to help him with this.
• Maintaining personal relationships. Mr B needed a personal assistant to go into the community, but had been unable to find one. This had a knock-on effect on his ability to meet people and make friends and he was entirely reliant on Mrs B in this area. The volunteer continued to meet him for 1.5 hours every two weeks, but this may be coming to an end as volunteers were only meant to work with an individual for 6 months.
• Accessing the community. As Mr B did not have a personal assistant, he had been unable to access the community. This also affected his ability to attend medical appointments. He had been unable to do any shopping so this role had fallen on Mrs B. However, because of Mrs B’s own ill-health and the extent of her caring role, she was unable to continue to do the shopping.
• Mr B also needed to monitor his blood pressure 3 times a day and required assistance with this.
• The lack of support in the previous months had had a significant impact on Mr and Mrs B’s health and wellbeing and had contributed to Mrs B’s carer’s stress.
• The social worker said it was hoped that Mrs B’s health would improve so she could increase her carer’s role again in the future. The social worker proposed a review in two months.
36. The Council agreed 9 hours support via direct payments and assisted in finding an agency which could deliver the care.
37. The social worker provided a more detailed breakdown on how she arrived at the 9 hours provision. I have put in brackets the ‘outcomes’ this corresponded to for clarity.
• 4 hours – social inclusion and attendance at appointments (‘accessing the community’)
• 2 hours – shopping (‘accessing the community’)
• 2 hours – access to written and digital information (‘maintaining a habitable environment’)
• 1 hour – laundry (‘maintaining personal hygiene’).
38. Therefore, in essence the Council had reinstated the provision of the June 2017 care plan with an extra hour for laundry.

February 2019 – complaint

39. Mr B complained again and said that, although he had agreed to the offer of a re-assessment, the Council had still not provided a good reason for cutting his support in half.
40. The Council said:
• The provision of 8 hours for social inclusion had been excessive and he had previously been ‘over-provisioned’ in this area.
• Mrs B’s health had deteriorated and she was no longer able to provide the care she provided in the past in relation to shopping. The Council had reviewed Mr B’s needs and was in the process of finding a care provider.

Analysis

41. The Ombudsman cannot say what the care plan should be or how many hours support Mr B needed. Only the Council can do this, based on the assessments.
42. I have investigated whether the Council has assessed Mr B in line with the law, guidance and policies.
43. The first and main purpose of Mr B’s package of 8 hours support was to meet Mr B’s need to ‘access the community’. Mr B was unable to drive because of his impaired sight. The support was high because he lived in a remote area and a lot of the time was taken up driving to the destination.
44. The second aim of Mr B’s support package was to help him in accessing emails and the internet. The Council said this met the outcome of ‘maintaining a habitable home environment.’
45. In the complaint correspondence, the Council said it reduced Mr B’s support by 50% in September 2018 for two reasons, so I will consider those reasons in more detail.
46. The first reason for reducing the support was the Council’s offer of rehabilitation through a rehabilitation officer. The aim was to make Mr B more independent through the use of assistive technology and therefore to reduce his need for support. However, the Council reduced the support before Mr B started the rehabilitation process and before the Council knew what the effect would be on his ability to live independently and his need for support. This was fault.
47. This failure became clear when the Council then re-assessed Mr B in February 2019, after he had completed the rehabilitation. The assessment noted that Mr B encountered problems in using assistive technology and had been unable to engage in reablement. So essentially the rehabilitation had failed and this need continued to be unmet. The Council then decided to reinstate the provision.
48. The Council’s second reason for reducing the support in September 2018 was the fact that a volunteer visited Mr B for 1.5 hours every two weeks. I agree with Mr B that this did not properly explain the reduction in support.
49. The volunteer did not really help Mr B in ‘accessing the community’. The volunteer did not drive Mr B anywhere or take him to appointments or help him shopping which were Mr B’s main needs in this area. In any event, the volunteer provided the equivalent support of 45 minutes a week so this would not explain a reduction of 4 hours.
50. The Council then said in its later complaint correspondence that it reduced the support from 8 to 4 hours because 8 hours was too high. If this was the case, the Council should have explained why 8 hours was too high and why 4 hours was sufficient. It failed to do so.
51. I also agree with Mr B that the September 2018 assessment did not properly consider whether Mrs B was ‘able and willing’ to provide the support that the Council was no longer providing. The only mention of Mrs B in Mr B’s needs assessment was that she was willing to continue her caring role in certain areas (meal preparation, personal hygiene, clothing, laundry and cleaning), although she was finding this increasingly difficult.
52. However, I cannot find evidence that the social worker asked Mrs B whether she was willing or able to provide an extra 4 hours of support to access the community. There is also no evidence that the social worker properly considered what the impact of the reduction would be on Mrs B’s ability to provide care and this was fault.
53. Therefore, to conclude, I have found fault in the way the Council reduced Mr B’s support package as it was not done in line with the statutory guidance. The assessment did not clearly explain what the changes in need or circumstances were that led the Council to conclude that Mr B’s support package should be reduced.
54. I have considered the injustice Mr B suffered as a result of the fault. This is difficult to say as during the time that the Council made the reduction, Mr B did not have a personal assistant (May 2018 until April 2019). Therefore, regardless of the hours of support in the care plan, Mr B would have not received the support.

Agreed action

55. Mr B says that the main outcome he wanted from his complaint was for the Council to reinstate the provision that he received before the reduction. This has happened.
56. The Council has agreed to apologise in writing for the fault within one month of the final decision.

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Final decision

57. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman