Summary: Ms B complains the Council did not take action about the concerns she raised about the NHS’s actions in relation to her son. It also delayed referring for advocacy. There was a delay in the Council making an advocacy referral. But this did not cause a significant injustice, as an advocate was in place by the time of a Care Act review.

The complaint

1. The complainant (Mr B) is represented by his mother (Ms B). Ms B complains:
• since July 2025 the Council has failed in its Care Act duties by deflecting her request for clinical support, which would have solved a medical problem and prevented indefinite social care costs;
• the Council delayed referring Mr B to an advocate;
• the Council has failed to enforce the least restrictive option for Mr B’s care and support.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully.
3. It is our decision whether to start, and when to end an investigation into something the law allows us to investigate. (Local Government Act 1974, sections 24A(6) and 34B(8), 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(1), as amended)

Back to top

How I considered this complaint

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

Back to top

What I found

Legal and administrative background

Care Act Assessments

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan for an adult with care and support needs. There may be some cases where a council considers it proper for the person’s care and support needs to be met by providing accommodation in another council area. Sections 39 to 41 of the Care Act and the associated regulations set out what should happen in these cases. The council which arranges the accommodation keeps responsibility for meeting the person’s needs.

Independent Care Act Advocate

8. The Care Act says a council should refer an adult to an Independent Care Act Advocate (ICAA) if the person would have “substantial difficulty” in being involved in their care and support planning and has no "appropriate individual" to support them.

Safeguarding

9. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. (section 42, Care Act 2014)
10. The Care Act says it is the council where a person is at, at the time of the concern, which has a duty to investigate safeguarding concerns. This applies regardless of who funds their care, or where they normally live. (section 42, Care Act 2014)

Mental Capacity Act

11. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. A key principle of the Mental Capacity Act is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome.

What happened

12. Mr B is Ms B’s adult son. He has multiple disabilities that lead to care needs. He does not have the mental capacity to make his own decisions. For several years he has lived in a care home, although he often spends weekends and holidays with Ms B. The care home is arranged and funded by the Council, but located outside the Borough.
13. For some time Ms B has had concerns about the medications NHS teams prescribe Mr B. Her view is alternative therapies are a better source of management of Mr B's conditions and behaviours. In 2024 the care home raised a safeguarding concern to the Council about Ms B not giving Mr B his prescribed medication when he was with her. The Council closed its investigation in early 2025.
14. Around the same time, the Council assigned Mr B a new social worker.
15. Ms B contacted the Council in July 2025 to ask it to intervene in Mr B’s case management and the provision, therapy and medication provided by the NHS. Her view is the Council had a duty to intervene, as the lack of appropriate intervention by the NHS was affecting Mr B’s care and support needs.
16. The Council treated Ms B’s contact as a safeguarding concern. So it forwarded it to the council that had jurisdiction for the place where Mr B was residing.
17. Later in the month, the NHS changed Mr B’s medication. Ms B made a formal complaint to the NHS, which she has since escalated to the Parliamentary and Health Services Ombudsman.
18. In early August, Ms B emailed the Council about its decision to “pass the buck” by referring her safeguarding concern to a different council. She advised her view was the Council should hold the NHS accountable. A Council manager replied to acknowledge her contact. He advised he had asked the Council’s team to carry out a review of Mr B’s care needs.
19. On the same day, Ms B asked the Council to refer Mr B for assistance from an ICAA. Mr B already had an advocate working with him for advocacy with health services.
20. At the end of August the Council’s social worker contacted the NHS regarding Ms B’s concerns about medication. She asked for a multi-disciplinary team meeting to discuss the issue.
21. In early September Ms B chased the referral for advocacy. The Council’s response advised its first referral was delayed due to an administrative error. The Council later apologised for this delay.
22. In October the Council’s social worker carried out a Care Act assessment review and completed a new care and support plan for Mr B. The Council’s record notes the review was prompted by Ms B’s ongoing concerns about Mr B’s medication and how that affected his quality of life. At the meeting Mr B was represented by an advocate (although Ms B has expressed her dissatisfaction about her lack of engagement). The Council’s records also note:
• Ms B was happy with the care and support Mr B received at the care home;
• Mr B was settled at the care home where he was well supported to meet all of his care and support needs;
• Ms B reported Mr B was unsettled when he was with her. The care home noted he was more settled when he was under their care;

• Mr B had an ongoing multi-disciplinary approach to his care comprising of his mother, his advocate, health team, staff at his placement, positive behaviour specialists, social care and occupational therapist;
• The care home had started 1-1 care with Mr B.

23. Ms B complained. The Council’s responses advised it did not have the remit to directly investigate other agencies. The agreed procedure was to forward such concerns to the relevant authority, who would then be responsible for assigning a reviewer with sufficient authority and independence to investigate the matter.
24. At the end of November, Ms B complained to the Ombudsman.

Analysis

25. Ms B’s view is the Council should have taken some action against the NHS bodies that were not promoting Mr B’s best interests, principally through their use of medication. Her view is that, at the latest, she made an explicit request for the Council to do this in July 2025. And it was fault that it took no action.
26. HeHHwThe part of the Care Act where a council might have a role in investigating the actions of a different public body, such as an NHS team, would be through its safeguarding duties. Looking at the history of the complaint, I can see the Council did carry out a safeguarding investigation, but that was about a concern raised to it about Ms B not administering Mr B’s medication when he was staying with her. As Ms B lives within the London Borough of Sutton, the Council’s safeguarding team was the appropriate body to investigate this concern.
27. When Ms B contacted the Council in July 2025 with her concerns about the NHS’s actions, the Council (correctly given my analysis set out in paragraph 26) treated it as a safeguarding concern. But, as Mr B lives outside the Borough, the NHS treatment and medication arrangements would have taken place in the area of a different council’s safeguarding team. I can see the Council did make a referral to that team. It had no role after that to decide what action that council took. So there was no fault in its actions.
28. I can see the Council also alerted the NHS to Ms B’s concerns about Mr B’s medication. It also reviewed Mr B’s care and support plan in the light of Ms B’s concerns. Those were appropriate actions.
29. The Council has accepted a delay in making a referral for an ICAA to assist Mr B. There was a delay. But it is unlikely to have caused a significant injustice, as an ICAA was in place by the time of the October review of his care and support plan and Mr B also had an advocate working with him for issues with health services.
30. Ms B makes reference to the Council not adhering to the least restrictive option for Mr B’s care and support. That is a term used in the Mental Capacity Act. I do not see how it is relevant to the duties set out in this investigation, so have not investigated this matter further.

Back to top

Decision

31. I find no fault causing an injustice and have completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman