Summary: Mr A complained that a care coordinator, working for an integrated mental health and social care service, failed to support his son to apply for Universal Credit. We have not found fault by either the responsible Council or NHS Trust. However, we have found fault in how both organisations responded to Mr A’s complaint. Neither would accept responsibility for it at first. Both organisations have agreed to apologise, take corrective action and make a financial payment to address the injustice this caused Mr A.

The complaint

1. Mr A said that in 2021 his son, Mr X, was “totally incapacitated”. Mr X complains that, during this time, Mr X’s care coordinator failed to apply for Universal Credit (UC) for Mr X. Mr A said the care coordinator had a duty of care to do so. Mr A said the care coordinator applied for Personal Independence Payments (PIP) for Mr X. He said, because of this, he thought everything was in hand and did not know that no one had applied for UC.
2. Mr A said this fault caused a financial loss and untold stress in waiting for it to be resolved.
3. We are investigating the actions of both Bolton Metropolitan Borough Council (the Council) and Greater Manchester Mental Health NHS Foundation Trust (the Trust). The Council employed Mr X’s care coordinator but had seconded her to the Trust, to work for a specific service. Both the Council and the Trust told Mr A the other organisation was responsible for Mr X’s care coordinator’s actions in Mr X’s case.
4. In approaching the Ombudsmen Mr A said he would like:

• the responsible organisation to pay Mr X the equivalent amount of what he would have been awarded through UC, had the application been made at the correct time, and
• Mr X to receive an apology.

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The Ombudsmen’s role and powers

5. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
6. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
7. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
8. When investigating complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
9. We cannot question whether an organisation’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. 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, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
10. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

11. I considered evidence provided by Mr A and spoke to him on the telephone. I asked questions of the Council and the Trust and asked them to provide supporting evidence. I considered everything they provided in response. I also considered relevant law, policy and guidance.
12. I shared a confidential draft decision with Mr A, the Council and the Trust and provided them with an opportunity to comment on it. I considered all the comments I received before making a final decision.

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What I found

Legislation and guidance

Personal Independence Payments

13. PIP is a benefit that can help with extra living costs for people who have both:

• a long-term physical or mental health condition or disability; and
• difficulty doing certain everyday tasks or getting around because of their condition.

Universal Credit

14. UC is a payment to help with living costs. People may be entitled to it if they are on a low income, out of work, or cannot work. UC is paid monthly and consists of a standard allowance and extra amounts people may qualify for. This can include an extra monthly amount for people who have a disability or health condition and have limited capability for work and work-related activity. The law says that for any period a person has to stay in hospital for more than 24 hours, they are to be treated as having limited capability for work.
15. In some circumstances, UC can be backdated for up to one month. The Government’s Department for Work and Pensions (DWP) sets the rules around these benefits and assesses them.

Section 75 of the NHS Act 2006

16. Section 75 of the NHS Act 2006 allows NHS organisations and councils to arrange to delegate their functions to one another. Subsection 5 of the NHS Act 2006 says the NHS and councils remain liable for the exercise of their own functions.
17. In Mr A’s area, at the time of the events complained about, the Council and the Trust had such an agreement. Under this agreement the Council delegated some of its adult social care responsibilities to the Trust. The intent was to have a combined, integrated service to provide mental health and social care to people in the area. Under the agreement the Council seconded staff to the integrated service, including social workers. The agreement said that, while the Trust was responsible for delivering services, the Council would remain responsible for its own functions.

Mental health guidance about benefits

18. During the period I have investigated, the Department of Health guidance “Refocusing the Care Programme Approach” and “National Service Framework for Mental Health” (the Framework) applied to managing Mr X’s mental health care needs.
19. Both “Refocusing the Care Programme Approach” and the Framework say that assessment under the Care Programme Approach (CPA) should cover personal circumstances including family and financial status. The Framework also says care plans for people on an enhanced CPA should include “arrangements needed for an adequate income” (page 53).
20. The Mental Health Act 1983 “Code of Practice” (the MHA Code) says:

• “Included with the CPA care plan [is] … support provided in relation to social needs such as … finances” (paragraph 34.3); and
• “Care planning requires a thorough assessment of the patient’s needs and wishes. It is likely to involve consideration of … assistance in welfare rights and managing finances” (paragraph 34.19).

Adult social care guidance about benefits

21. The Department of Health & Social Care’s “Care and support statutory guidance” (the CSSG) provides statutory guidance to staff who support people under the Care Act 2014. This says:

• Local authorities must establish and maintain an information and advice service. This “should include information and advice on eligibility and applying for disability benefits and other types of benefits and, on the availability of employment support for disabled adults” (paragraph 15.70);
• “Different people will need different levels of support from the local authority and other providers of financial information and advice depending on their capability, their care needs and their financial circumstances. People may just need some basic information and support to help them rebalance their finances in light of their changing circumstances. Topics may include welfare benefits, advice on good money management, help with basic budgeting and possibly on debt management. The local authority may be able to provide some of this information itself, for example of welfare benefits, but where it cannot, it should work with partner organisations to help people access it” (paragraph 15.71).

The Mental Capacity Act 2005

22. The Mental Capacity Act 2005 (the MCA) is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The MCA (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
23. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity. A person should not be treated as unable to make a decision:

• because they make an unwise decision;
• based simply on: their age; their appearance; assumptions about their condition, or any aspect of their behaviour; or
• before all practicable steps to help the person to do so have been taken without success.

24. The council must assess someone’s ability to make a decision when that person’s capacity is in doubt. How it assesses capacity may vary depending on the complexity of the decision. An assessment of someone’s capacity is specific to the decision to be made at a particular time.

Complaint handling

25. Under The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the Complaints Regulations) there is a duty to investigate complaints properly and in a way that will resolve them efficiently. There is also a duty to cooperate when a complaint is made to one organisation and contains material relevant to the other.
26. The Complaints Regulations say that the organisations must “co-operate for the purpose of (a) coordinating the handling of the complaint; and (b) ensuring that the complainant receives a coordinated response to the complaint.” This involves a duty on each of them to agree who should take the lead in coordinating the handling of the complaint and communicating with the complainant. They must both provide each other with relevant information.

Relevant events

27. Before the summer of 2020 Mr X had attended university. In the summer of 2020 there was a significant change in his behaviour.
28. Mr X was detained in hospital under the Mental Health Act 1983 (the MHA) in early October 2020. Clinicians diagnosed Mr X as having paranoid schizophrenia.
29. Mr X’s detention ended, and the hospital discharged him home, just under a month after he entered hospital. This happened against Mr A’s wishes as Mr A did not consider Mr X was well enough.
30. For the first six weeks after Mr X returned home he shut himself in his room. A review in mid-November 2020 noted that Mr X had been isolating in his room with minimal communication and not effectively engaging with the team. They said it seemed likely he remained psychotic. Several days later, at Mr A’s request, a different care coordinator was allocated to work with Mr X.
31. Mr X said that, during this period, Mr X did not communicate with him for several months because mental health issues had caused him to be deluded and paranoid. Mr A said Mr X had “barricaded himself in his room”.
32. The Council told us that, during her work with Mr X, the care coordinator gave Mr X a copy of a CPA care plan which had been completed before she became involved. Part 3 of the care plan said:

• “I will also have a full assessment of my living skills, this will include my finances” and “Together with my care coordinator we will look at what help I may need”.
• “I will be given support with applying for benefits whilst I am unwell. I can request a benefits review from various community services and agencies such as CAB…Mhist [Mental Health Independent Support Team]…BAND [Building A New Direction]…Welfare Rights…and there is also a Benefit Advice drop in shop…If I have any debt issues the team could support my to access appropriate services such as CAB, Step Change, Money Skills or Christians Against Poverty…”

33. In notes of her visits to Mr X the care coordinator recorded that Mr X demonstrated he had the mental capacity to engage with her. The notes of the care coordinator’s visits show she focused on trying to help Mr X recover and keep well, with the aim of staying out of hospital.
34. In early December 2020 professionals considered assessing Mr X under the MHA again, due to concerns that he continued to experience psychotic symptoms and was not compliant with his treatment regime. However, they cancelled these plans due to reports that Mr X was improving.
35. The records state that, during a visit in mid-January 2021, the care coordinator “discussed goal setting with [Mr X] & explored [Mr X’s] future with him. [Mr X] explained that he is unsure about his future & what he wants…”
36. In its complaint response to Mr A, the Council said that, during this period:

• The care coordinator told Mr X about PIP, because he was getting into debt;
• Mr X contacted “PIP new claims” and asked for a PIP application form;
• The care coordinator went through the PIP application form with Mr X, to support him to complete it, and then took the form away because it required a professional’s opinion.

37. There are no notes about these actions in the contemporaneous records which were shared with me.
38. In early February 2021 the care coordinator recorded “Complete PIP form for [Mr X] and posted back to [Mr X’s] property for [Mr X] to post”. Several days later another member of the team noted “PIP documents posted through letterbox as per request care-coordinator”.
39. In the middle of the month the care coordinator made notes of a telephone conversation she had with Mr A. The care coordinator told Mr A she had asked for the PIP form to be returned to Mr X. She reported that Mr A asked Mr X about this while they were on the phone and Mr X confirmed that he had it. The care coordinator noted that she “explained that the deadline is in 2 days and [Mr X] is required to sign the document and post if he wants to successfully have PIP”.
40. Mr X was detained in hospital under the MHA again around three months later. He remained in hospital for around two months. When Mr X returned home he began receiving PIP payments.
41. In the early autumn of 2022 Mr X was detained in hospital under the MHA again. Mr A said that, during this admission, staff helped Mr X to apply for UC. An inpatient note of a review with Mr X recorded that Mr X said he had been budgeting over the last four months and said he would “move out and sort universal credit”.
42. Mr X returned home in the second half of October 2022. In the following month Mr X told him about the application for UC. Mr A said this was the first time he knew that no one had previously helped Mr X to apply for UC. Mr X began receiving UC payments in late 2022.

Request for backdated UC

43. Mr A initially sought a back payment of UC, on behalf of Mr X, from the DWP. It took over a year for the DWP to confirm it would not make the requested payment. During this time Mr A told the Trust and Council he was asking the DWP to make a back payment. He said he anticipated that it would not be possible and, if so, he would make a complaint to request they provide the relevant reimbursement.

Complaints process

44. After getting the DWP’s decision Mr A then began a complaint in September 2024, initially with the Trust. The Trust advised Mr A to complain to the Council. It did so on the basis that the Council had been responsible for the actions of Mr X’s care coordinator. The Council told Mr A the Trust was responsible.
45. The Council responded to a complaint from Mr A in April 2025. The Council said it was sorry there had been some confusion about whether the Council or the Trust should investigate Mr A’s complaint. The Council noted this had caused the REP “uncertainty and additional time and trouble”.
46. The Council said it remained of the view that the Trust was responsible for Mr X’s care coordinator’s actions in 2021. However, the Council said the dispute between it and the Trust had meant that Mr A had not received a response to his complaint. The Council said, because of this, it had considered Mr A’s complaint under the appeals stage of its own complaints procedure.
47. The Council said Mr X’s care coordinator did not apply for PIP for Mr X. It said the care coordinator explained to Mr X what PIP was, because he was getting into debt. The Council said Mr X later made his own decision to apply for PIP and requested the relevant application form himself. The Council said the care coordinator then went through the PIP application pack with Mr A and supported him to complete the form. It said Mr A then sent off the application himself.
48. The Council said this support had not set a precedent. It also said it did not mean the care coordinator had a responsibility to apply for further benefits for Mr X. The Council maintained that it was not the care coordinator’s responsibility to make benefit applications for Mr X.

Analysis

Support to claim benefits

49. Throughout the complaints process neither the Council nor the Trust has accepted responsibility for the social worker’s actions. The Council argued that the social worker was working for the Trust at the time. The Trust, in contrast, argued that the Council continued to hold overarching responsibility of the social worker.
50. Mr X was under the care of an integrated service. The aim of the partnership agreement was to put the provision of both Council and NHS responsibilities under the responsibility of one integrated team. In other words, an intent to provide a more seamless, efficient and customer focused service. There were staff with contracts directly with the Trust, and staff employed by the Council and seconded to work in the integrated service. However, regardless of who paid their wages, the personnel in those integrated services were there to provide a joined up, health and social care service to the service users. Their role was to offer whatever care and support was available for, and would help, the service user regardless of which organisation was ultimately responsible for the type of support to be offered.
51. In view of this, the issues of which organisation employed the social worker, or which organisation hosted the service, are irrelevant. The key issue is whether the Council and/or the Trust had any underlying responsibilities to provide Mr X with advice about and support with benefits.
52. Based on the law and guidance summarised in paragraphs 18 to 21 above, both the Trust and the Council had relevant responsibilities. Under these, the integrated service should have discussed benefits with Mr X and signposted him to services that could provide advice if staff did not have the expertise to provide advice themselves. Professionals are not expected to apply for benefits on behalf of people they support. This should only happen when there is a formal arrangement in place, for example when someone has been made an appointee.
53. The contemporaneous records do not contain many references to interactions about benefits. They focused, primarily, on Mr X’s mental health and wellbeing and on efforts to persuade him to engage with his treatment plan. Given what both the records and Mr A have reported about Mr X’s mental health during this time, this seems understandable. A focus on finances, education or employment may have been premature if Mr X’s mental health was not stable.
54. As detailed above, a care plan created for Mr X around the time of his initial detention included information about who he could approach for advice on benefits. There is evidence of the team supporting Mr X with an application for PIP.
55. The Council told us that the care coordinator said she could remember advising Mr X about available benefits, including UC, and encouraging him to consider applying. The care coordinator said Mr X declined to pursue UC due to concerns he had about an associated stigma, and because, at that time, he intended to re‑start his university studies later that year. As detailed above, there are records to show that the care coordinator was actively considering Mr X’s capacity to make necessary decisions at this time. The records show the care coordinator thought about relevant tests of capacity. I understand that Mr A is clear in his mind that, throughout this period, Mr X did not have the mental capacity to understand information about benefits, or to make informed decisions about it.
56. Overall, there are conflicting accounts of events which, from our independent and distant perspective, I cannot resolve. There is some evidence to show that staff did speak to Mr X about his finances and benefits, and that they satisfied themselves that Mr X understood these conversations, and I cannot ignore that. Because of this, on the balance of probabilities, I have not found evidence of fault in the support staff offered Mr X during this time.

Complaint handling

57. As noted in paragraph 50, both organisations had responsibilities to Mr X and should have focused on them, rather than the day-to-day practicalities of funding streams and employment contracts. The failure to take responsibility for the complaint, or to work together to resolve it, was fault by both the Council and the Trust. The Council did, ultimately, provide a response but Mr A had to wait for an unnecessary amount of time for this.
58. Because of the fault Mr A was caused avoidable time, trouble and frustration. This is an injustice to him which the organisations should address.

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Agreed actions

59. Within one month of the final decision the Trust and the Council should both, individually, write to Mr A to acknowledge their part in the fault in the way they handled his complaint, and to apologise for the injustice it caused Mr A.

We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisations should consider this guidance in making their apologies.

60. Within two months of the final decision the Council and the Trust should both each pay Mr A £50 as a tangible, symbolic recognition of the impact of its fault, in terms of the avoidable time, trouble and frustration he was caused by the failure to address his complaint in a timely way.
61. Within three months of the final decision the Trust and the Council should both review this case – either independently or collaboratively – as a learning tool, with a view to making specific, measurable and realistic service improvements to the way they consider and address complaints about integrated services.

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Decision

62. I do not find fault causing injustice in the way professionals supported Mr X with benefits. However, I find fault in the way both the Council and the Trust initially responded to Mr A’s complaint, by not accepting responsibility for it. The Council and the Trust agreed to take actions to remedy the injustice this caused Mr A.

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Investigator's decision on behalf of the Ombudsman