Summary: Mr X complains the Council failed to arrange suitable support for him when he left hospital in April 2024, leaving him without the support he needed. The Council delayed in identifying the need to reassess Mr X’s needs, review his financial assessment with him, and review his risk management plan. These delays caused avoidable distress to Mr X, but he was left without the support he needed because he was not prepared to pay for it. The Council needs to apologise for the distress it caused and take action to improve its services.

The complaint

1. The complainant, Mr X, complains the Council failed to arrange suitable support for him when he left hospital in April 2024, leaving him without the support he needed.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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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How I considered this complaint

4. I have considered evidence provided by Mr X and the Council, as well as relevant law, policy and guidance.
5. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

What happened

6. Mr X is registered blind and has other health conditions. He is awaiting operations on an ankle and shoulder. He is also awaiting further operations on his eyes.
7. The Council’s sensory support team called Mr X on 5 April 2024 to arrange another session on kitchen skills. He said he was going into hospital for eye surgery on 11 April. As he would not have fresh food at home, he said it would be better to have the next session in the week beginning 15 April. They arranged a visit for 15 April.
8. Mr X left hospital in another part of the country on Friday 12 April 2024. He arrived home in the early hours of 13 April.
9. When the sensory support team contacted Mr X on 15 April, he said he only had cereal and eggs, so there was little point in having another session. He said he could not access the community to collect food or get money. They discussed ways of helping Mr X access such services, but he declined the offers, saying it was not the team’s responsibility to provide emergency assistance. Mr X said he would ask for an assessment under the Care Act 2014. The sensory support team said it would contact him on 22 April, but would have to review his case if cancellations continued, as it could not support him unless he was dedicated to rehabilitation training.
10. Mr X contacted the Council to complain about the lack of support. He said:
• it had known he would need support when he left hospital;
• when staff at the hospital contacted the Council, it told them he should assess himself when he got home.
11. The Council told Mr X someone from the crisis team would contact him within two hours. But this did not happen.
12. The next day, the Council’s social work team noted its sensory support team would need to refer Mr X for a Care Act assessment, after which they would visit to do a joint assessment.
13. After speaking to Mr X on 16 April, the Council referred him to a care provider for a package of care. This was for reablement care (which is free) to address the “crisis”. The referral said:
• Following recent eye surgery, Mr X could not cook or go near steam;
• Mr X needed care workers to visit for 30 minutes at teatime every day to help with food preparation and a drink;
• District nurses visited in pairs because of verbal abuse, so two care workers needed to visit Mr X;
• Care workers needed to be aware that Mr X had CCTV in and outside his property and was known to make recordings without consent.
14. The Council noted Mr X had said he wanted care workers to take him to a cash machine to withdraw money, but he had declined the offer of support with this from the sensory support team. It arranged for the care workers to tell Mr X they could not support him with withdrawing money when they first visited at teatime.
15. Mr X said he wanted help with:
• everyday living
• doing his shopping and withdrawing cash from the bank
16. The Council asked the sensory support team to help Mr X. It noted he was not eligible for a Care Act assessment, as the sensory support team was already supporting him.
17. On Saturday 20 April the care provider told the Council Mr X had said he no longer needed its help. It had concerns about how he would cope. It noted he only ate fresh fruit and vegetables (because of a digestive problem), and could not get them without support. The Council told the care provider it would contact Mr X on 22 April. The care provider did some shopping for Mr X and brought him fresh fruit and vegetables.
18. On 22 April the care provider confirmed Mr X had agreed it could continue visiting him. It said its care workers had gone out to get fresh fruit and vegetables for Mr X but after doing this discovered he already had enough.
19. On 23 April, after visiting Mr X to assess him and produce a care plan, the care provider suggested the reablement service was not right for him as he was not being “enabled”. The Council said Mr X had been offered solutions so he could have food delivered and use a cash machine, but he had turned them down. It said he had the mental capacity to make that decision. The care provider later told the Council Mr X had asked the care workers to buy food, as he did not have any.
20. On 24 April Mr X called the Council to complain about the care he was receiving. He said he had no food, as the care workers were not allowed to get it for him. He said he only had milk and eggs which were all out of date. He said he could not do online shopping and could not collect medication. He said a social worker had not contacted him since he left hospital.
21. The Council’s records say:
• it would ask the care provider to do a one-off shopping call;
• it would consider a food parcel if this was not possible;
• it would arrange a joint visit with the sensory support team to do a Care Act assessment for long-term care, for which Mr X knew there would be a charge as he had already had a financial assessment.
22. The care provider told the Council Mr X knew it could not shop for him. It also pointed out he had no cash to pay for shopping. Nevertheless, the care provider had bought food at the weekend and helped make a main meal on both days. The Council noted Mr X had declined help getting money from a cash machine. It also noted he knew a supermarket had agreed to deliver fresh food, if he could pay cash for it, but he turned this down as well. The care provider said Mr X would be out for most of 25 April, as he had a hospital appointment.
23. The Council arranged to visit Mr X with the sensory support team on 30 April. The latter said another supermarket had a service to help disabled people with shopping and payment in store. It noted Mr X could get a taxi to the supermarket.
24. The Council called Mr X on 24 April. They discussed options for obtaining cash and getting shopping:
• Accept support going to a cash machine (as care workers could not use his bank card without him being there)
• Have food delivered when he had cash to pay for it
• Get help ordering shopping online
• Get a taxi to a supermarket could help him with shopping
25. Mr X declined all these suggestions and said he would make a complaint. He also turned out the offer of help providing bank details to his pharmacy to pay the delivery charge. Mr X cancelled the care provider’s calls for the next two days, saying he felt unwell. He said the care workers had given him out-of-date food and the shopping provided at the weekend had been inadequate. The Council ended the call as Mr X was “angry and shouting”.
26. Mr X contacted the Council’s emergency duty team which agreed to deliver “a meal deal with fresh fruit and fresh milk”. It said it could not collect his medication as the pharmacy was now closed.
27. On 25 April, the Council contacted Mr X’s pharmacy, which agreed to deliver his medication in future. The Council said it would have his medication collected and delivered on 26 April. The care provider agreed to do this.
28. Mr X left further messages for the Council on 25 April, saying he wanted to add to his complaint. When the Council spoke to him on 26 April, he said he needed money from a cashpoint machine.
29. On 26 April the sensory support team said most cash machines could be used with earphones, so visually impaired people could receive guidance on which buttons to press. It said some machines had a contactless option, but it had already told Mr X about this. The Council noted another supermarket could take orders over the telephone and take payment on delivery by card. Mr X needed to provide his bank details on the first call, but the care workers could help him with this. The Council passed this information on to Mr X, who agreed to use the shopping service.
30. On 27 April Mr X told the care provider it was not convenient for him to accept support with an online shopping. The Council pointed out Mr X had agreed to accept help with shopping and suggested calling him back and pointing out it would not be providing another food parcel.
31. Mr X called the Council’s emergency duty team on 28 April. He said:
• no one had helped resolve the problem with medication until after he complained;
• care workers had refused to take him out shopping, so the Police had taken him out to get food;
• the care workers were rude and aggressive, ignored his instruction to cook fresh food and cooked frozen food;
• the care workers eventually left at his request, having partially cooked his food, which he had put in the freezer;
• video and voice recordings would evidence what he had said;
• the care workers must have dropped a carrot on the floor, which he slipped on after they left;
• the care provider said he had left its care workers waiting outside for 20 minutes, before letting them in, which he denied;
• 20 minutes was not enough time to meet his dietary needs, prepare fresh food and wash up.
32. On 29 April the care provider told the Council Mr X had wanted the care workers to make food which would have taken more than 20 minutes to prepare and cook. This resulted in a “heated conversation” which meant the care workers did not have enough time to help with food and left. The care provider said it was not sure how long reablement could continue as Mr X was not well enough after his operation to take part.
33. A hospital told the Council Mr X had visited after slipping on a vegetable. A scan revealed no injury to his eye, following recent surgery. But Mr X had refused to leave unless the hospital reported a safeguarding concern about the problems he had experienced with the care workers. The Council decided this did not meet the threshold for safeguarding enquiries under section 42 of the Care Act, and was more of a complaint.
34. A social worker and an officer from the sensory support team visited Mr X on 30 May. Mr X said he had been advised not to cut food in case particles got in his eye. He said upcoming surgery on his arm would hinder completing kitchen skills. He said he had also been advised not to access the community in bad weather, as it could damage his eye. The sensory support team decided not to close Mr X’s case, as he could not take part in training.
35. The two officers helped Mr X register for a supermarket doorstep delivery service. This meant Mr X could order a delivery over the telephone and pay for it from his bank account. Mr X said he did not want to pay for his pharmacy’s delivery service, as he was not sure if he had enough money. The social worker told Mr X reablement was only suitable if he could work with the care workers to develop kitchen skills. They said a chargeable package of care would be more suitable. But Mr X said he was entitled to six weeks of free care. They told him six weeks was the maximum but if reablement was not being used the service could end at any time. Mr X said he would wait two weeks, following surgery on his shoulder, before deciding whether to have a charged package of care. They told him the reablement service would probably end. Mr X asked about direct payments. The social worker agreed to look into this as longer-term plan following surgery on his shoulder.
36. On 1 May Mr X raised concerns about the need for two carers to visit and the need to give 24 hours’ notice if he wanted to cancel a call. On 2 May the Council noted Mr X had an intermediate care package, which meant there was no charge for the service.
37. On 3 May Mr X told the Council he needed to cancel some calls because of hospital appointments.
38. On 8 May Mr X told the Council he had cancelled most of the care workers’ visits that week, as he had medical appointments. The Council said he could not continue to receive a reablement service when no reablement was taking place. Mr X agreed to cancel the service from that day. He turned down the offer of a commissioned service. He said he was interested in receiving direct payments, to arrange his own support. The Council said this was not feasible, as his assessed charge would be nearly the same as the cost of the service. Mr X said he wanted a financial assessment, as he did not agree with the charge, as it did not take account of the taxis he uses to get to hospital appointments. Mr X said he still wanted to go ahead with an application and assessment for direct payments. The social worker agreed to call the following week, for an update on a further hospital admission, but did not do so.
39. Mr X called the Council on 21 May about a “booked appointment”.
40. The Council completed an assessment of Mr X’s needs on 22 May, based on its telephone calls with him. The assessment identified eligible care needs relating to:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Making use of the home safely
• Maintaining a habitable home environment
41. The assessment said Mr X did not want the Council to commission a service for him, as he did not agree with the need for two care workers and said he could not afford his assessed contribution. He said he wanted to explore direct payments, so he could employ one personal assistant.
42. On 23 May the social worker agreed to collect Mr X’s medication and deliver it to his home as a “one off”. They suggested finding a pharmacy which did not charge for deliveries. Mr X said he was living on cereal as he could not cook and asked about direct payments. The social worker said he would need a financial assessment to see if this was feasible, as his previous assessed contribution was more than arranging care privately.
43. In the evening of 31 May Mr X complained the Council had failed him. He said he now needed an emergency operation in London as his eyes were worse than previously assessed. He said he could not see to prepare meals or order food. He said he needed help over the weekend. The Council told Mr X if he received support over the weekend, he would have to pay the full cost until there had been a financial assessment. Mr X ended the call as someone was at his door and said he would call back, but did not do so.
44. The Council tried calling Mr X on 1 June, but he did not answer.
45. On 3 June the Council noted Mr X would need a financial assessment before it could consider direct payments.
46. An officer contacted Mr X in response to a complaint he had made. Mr X said the social worker had arranged to visit but did not. The officer suggested there had been a misunderstanding. Mr X accepted the social worker had apologised for not calling him when arranged. Mr X said he was paying a lot of money for transport and accommodation linked to his medical appointments in different parts of the country. The officer said they would ask colleagues to prioritise a financial assessment. After that, they could consider direct payments if his assessed contribution was less than the cost of care. Mr X said he would have little or no movement in his right (dominant) arm after planned surgery on his shoulder. Mr X said he was having problems with his medication because of his poor eyesight. The officer said his social worker would contact him to discuss this. Mr X said it was not appropriate for a sight impaired person from the sensory support team to offer to take him to a cashpoint, as Mr X had been told not to go outside after his surgery, in case he got something in his eye. The officer suggested it had been a viable option until he explained he could not go out, but Mr X disagreed, saying the team had already been aware he could not go out. Mr X questioned the need for two care workers to visit him. He said the fact he had CCTV in his property was not a good enough reason. The officer said the Council would review his risk management plan. Mr X confirmed he wanted to make a formal complaint.
47. On 4 June the Council reviewed Mr X’s financial assessment. It noted his assessed contribution had increased from £117.24 a week in 2023 to £125.21 a week. It also noted it had invited him to provide evidence of his medical appointments and the travel/accommodation costs associated with them over a two or three month period, but he had not done so. It also noted Mr X received the higher rate mobility allowance of £75.75 a week.
48. Mr X told his social worker his toilet seat had broken and his landlord said it was his responsibility to replace it, but he could not do so. He accepted a referral to a handyman services, which arranged to visit on 11 June. He declined the offer of a care package, because of the charge. He also declined changing his pharmacy. The social worker agreed to collect and deliver his medication again.
49. When the Council replied to Mr X’s complaint on 7 June, it said:
• There was no record of the hospital contacting the Council in April
• Adult social care did not know about his surgery until 15 April, after which it set up an intermediate care package
• On 15 April he spoke to several officers and was offered support
50. Mr X made a further complaint to the Council on the same day.
51. On 13 June the Council sent Mr X a “pre-service direct payment letter”.
52. On 14 June Mr X told the Council he had an emergency hospital appointment on Monday 17 June. He said he needed to book accommodation but needed help with this. His social worker tried to call him back, but there was no response.
53. In the early hours of 19 June Mr X contacted NHS 111, saying he needed urgent carer support. NHS 111 passed the message on to the Council. Later in the morning he told his social worker he had spent two days in London, but they had not been able to operate because of low pressure in both eyes. He said the eye which retained some vision had been sewn shut. The social worker prepared a package of care for Mr X.
54. When the Council replied to Mr X’s further complaint on 27 June, it said:
• It did not accept the claim Mr X had not been able to contact his social worker, and listed the contact they had from its records;
• There was no evidence of the social worker making an appointment to visit Mr X on 28 May;
• The County Durham Handyperson Service (a service jointly funded by the Council and the NHS) was responsible for the decision to ask Mr X to provide evidence of his eligibility to access the service.
• A risk management plan in 2023 identified Mr X as someone with a history of being verbally abusive to staff; who used CCTV to record care workers and who had made unsubstantiated claims against staff in the past;
• It reviewed the risk management plan on 14 June and decided CCTV was no longer a risk. This was because he had the right to have CCTV in his home, provided he made visitors, including care workers, aware of it.

Is there evidence of fault by the Council which caused injustice?

55. There is no evidence the Council was told Mr X would need more support before he left hospital in April 2024. However, when Mr X had contact with the Council and its sensory support team , it should have been clear to everyone that his circumstances had changed and he needed an assessment of his needs to identify the appropriate support for him. The failure to do so was fault by the Council. Mr X couldn’t take advantage of the sensory support team’s help, as that was aimed at developing independence skills and he needed to recover from the operation before doing that.
56. It should have been possible for Mr X to refer himself for an assessment, rather than wait for the sensory support team to refer him for one. Had the Council assessed Mr X, as he requested, it would have been apparent that reablement support was not appropriate for him. However, while this resulted in a delay in identifying the right support for Mr X, it was his unwillingness to pay which prevented him from receiving it. Mr X turned down other offers of support, such as arranging a pharmacist which would deliver his medication without charging for the service.
57. Mr X’s unwillingness to pay was based on two issues, being charged for two care workers and concerns about the accuracy of his assessed charge.
58. Although there is nothing in Mr X’s case notes, it appears the Council reviewed his risk management plan in June and decided his CCTV was no longer a risk. The Council told him about this when responding to his complaint but did not say whether the other risks remained in place and, if so, on what basis. That was fault by the Council. It is a basic principle that councils need to explain their decisions and the reasons for them. The Council needs to review Mr X’s risk management plan and explain the outcome and the reasons for it.
59. In June 2024 the Council noted that in 2023 it had invited Mr X to provide evidence of the travel/accommodation costs associated with his hospital appointments, but he failed to respond. It is not clear from the Council’s records whether it repeated this invitation. If not, it needs to do so.
60. The Council distanced itself from the Handyman Service’s decision to ask Mr X to provide proof of his eligibility to access the service. But it is a service commissioned by the Council (and the NHS) to support people with care needs. It is unclear why a referral from the Council would not be enough to evidence eligibility to access the service, as opposed to someone who had self-referred themselves. The Council needs to work with the Handyman Service with a view to providing a more seamless service.

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Action

61. I recommended the Council:
• Within four weeks:
1. writes to Mr X apologising for the failure to engage more constructively with him after he returned from hospital in April 2024, including the delays in acting on the need to reassess his needs, review his financial assessment and review his risk management plan;
2. reviews Mr X’s risk management plan and write to him explaining what risk, if any, remains in place and the reasons for its decision;
3. if it had not already done so, ensures Mr X is given another opportunity to provide evidence of the travel/accommodation costs associated with his medical appointments.
• Within eight weeks:
1. takes action to ensure people in Mr X’s circumstances can self-refer for an assessment of their needs;
2. works with the Handyman Service with a view to it accepting referrals from the Council without the need for the person to then prove their eligibility to use the service.
62. The Council has agreed to do this. It should provide us with evidence it has complied with the above actions.

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Decision

63. I find fault causing injustice. The Council has agreed to take action to remedy the injustice it has caused.

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Investigator's decision on behalf of the Ombudsman