Summary: Mrs X complained about the Council’s decision to remove transport funding from Mr X’s care package and about its complaints handling. We found fault in the Council’s decision making and complaint handling which caused Mrs X and her family distress and frustration. To put matters right, the Council agreed to apologise to Mrs X and make a symbolic payment of £500. And, after Mrs X has taken welfare benefits advice, the Council agreed to carry out a financial assessment to further consider what contribution Mr X should make towards the cost of his care package.

The complaint

1. Mrs X said the Council was wrong to withdraw transport funding for Mr X’s care package following a policy change and without reassessing his financial contribution. Mrs X said the Council also wanted Mr X to change to an unsuitable service provider. Mrs X also complained about the Council’s delay in dealing with her concerns, including setting up a direct payment, and its poor communication and complaint handling.
2. Mrs X said it took much time and trouble to deal with the Council. And the Council’s actions caused uncertainty and significant stress and anxiety for all the family, including Mr X, which negatively affected their mental health and wellbeing.
3. Mrs X wanted the Council to reinstate and backdate Mr X’s transport funding. And, if it refused, Mrs X wanted the Council to review Mr X’s personal contribution to his care package. Mrs X sought a genuine apology for the stress and anxiety caused and compensation for the family’s time and trouble in dealing with the Council. Mrs X wanted the Council to review both its transport policy and its approach to accessing care, which did not encourage choice for users. Mrs X also wanted the Council to improve its communication so it provided timely, clear and helpful information.

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The Ombudsman’s role and powers

4. 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)
5. We may investigate complaints from the person affected by the complaint issues or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. Here, we decided Mrs X was a suitable representative for Mr X. (Local Government Act 1974, sections 26A and 34C, as amended)
6. 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

7. I have:

• considered Mrs X’s written complaint and supporting papers;
• asked for and received further information from Mrs X;
• asked for and considered the Council’s comments and supporting papers about the complaint;
• shared Council information with Mrs X; and
• shared a draft of this statement with Mrs X and the Council and considered any comments received before making a final decision.

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What I found

Background

8. 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. Councils are also responsible for providing care and support plans, which set out peoples’ needs, what they want to achieve, what they can do by themselves or with existing support, and what care and support may be available in the local area. The plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support.
9. Councils may charge people for non-residential care following their needs assessment. Before charging, they must carry out a financial assessment to decide what someone can afford to pay towards their personal budget. Charging must not reduce someone’s income below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. Councils must give people a written record of their completed financial assessment.
10. Disability related expenditure (DRE) is money people spend on things because of their disability, which they would not otherwise spend. Councils should consider DRE when carrying out financial assessments and deciding what contribution people can reasonably make towards their personal budget.
11. People may ask for their personal budget as a direct payment. Direct payments enable people to arrange their own care and support to meet their needs. Councils must consider requests for direct payments made at any time and have clear and quick procedures in place to respond to them.
12. Government Care and Support Statutory Guidance says councils should review care and support plans at least every 12 months. Councils should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met.
13. A Personal Independence Payment (PIP) is a benefit for people who are under State Pension age that need help with daily activities or moving around because of a long-term illness or disability. As relevant to this complaint, Mr X is entitled to and in receipt of a PIP that includes the higher mobility allowance of (currently) £75.75 a week.

The Council’s Transport Policy

14. The Council has a 2022 adult services Transport Policy (‘the Policy’). The Policy says transport is not in itself an eligible social care need but a means of accessing other services and support. The Policy expects people to meet their own transport needs to access services and support. This means the Council will only fund transport where no suitable or appropriate alternative exists. Before deciding to fund transport, the Council must consider other ways people can reasonably be expected to access services and support making their own travel arrangements. The test is whether, if the Council does not provide transport, an eligible need for services would be unmet. Care and support plans must include transport outcomes and give reasons for any Council funded transport.
15. The Policy expects people to apply for and use their benefit entitlements, including the PIP mobility allowance. If people assessed as able to arrange their own transport refuse to do so and then do not access a service, the Council views them as declining the service. The Policy also says where people incur added transport expenses because of their disability, it is considered in their financial assessment and appropriate allowances made.
16. The Policy also says transport should only be provided to the nearest available service that meets an assessed need. People choosing to access services further away than the nearest appropriate service are expected to pay all their travel costs.

What happened

17. For many years, Mr X had had a care and support plan, which was subject to regular financial review. The plan provided for Mr X’s travel to and from, and attendance at, a named day centre from Mondays to Fridays (‘the Centre’). Mr X contributed towards the cost of his personal budget, which budget was managed by the Council.
18. In early summer 2023, Mrs X received a copy of a reviewed care and support plan for Mr X. (The Council later said it started the review in summer 2022 and completed the revised plan about nine months later and about a month before sending it to Mrs X.) Mrs X quickly contacted the Council asking why it had sent her the plan. Mrs X said the plan was briefer than the longstanding previous plan, contained errors and did not refer to Mr X’s travel to and from the Centre.
19. In the correspondence that followed, the removal of funding for Mr X’s travel to and from the Centre was a key issue for Mrs X. The Council told Mrs X it was too late for her to challenge the Plan as the review was completed more than a year earlier. The Council suggested Mrs X complain about its withdrawal of Mr X’s transport funding. The Council also said the procedure for funding transport would be through a review and assessment of Mr X’s social care needs, so she might wish to ask for this in her complaint. The Council said it only funded transport after considering all options and finding no other transport available. So, the Council suggested Mrs X explain in her complaint why she believed Mr X had no other way of attending the Centre.
20. Mrs X complained to the Council. The complaint raised the Council’s failure to send Mrs X a copy of the Plan until it was too late to challenge it. The complaint also set out Mrs X’s position on the removal of Mr X’s transport funding for the Centre, which it had agreed was the place most suited to meet his needs. The complaint pointed to Mr X’s inability to use public transport without support. And Mrs X explained why no members of Mr X’s immediate family could drive him to the Centre on weekdays. Mrs X also became aware the Council was ending its contract with the Centre. She therefore raised the need for a direct payment in her complaint correspondence to ensure Mr X could continue to attend the Centre.
21. In response to the complaint, the Council apologised for the delay in providing a copy of the Plan. It also referred to the Policy. It now made decisions to help with transport when assessing or reviewing needs. And it had to find all non-funded transport options inappropriate. It then made funding decisions to meet assessed needs. The Council said all transport help was subject to its charging policy and a full financial assessment. It also reviewed funding decisions yearly and would prioritise Mr X’s review, which was now due. The review would deal with his transport needs and evaluate all suitable transport help.
22. It took about four months to complete the complaints procedure. The Council’s final response said it had completed Mr X’s reassessment and its Combined Placement and Sourcing Team would decide the best option to meet his needs. And Mr X’s new care and support plan would confirm how his reassessed needs would be met. The Council also said it did not include benefits paid to meet mobility needs in financial assessments. Such benefits should therefore remain available to people to meet their mobility related needs.
23. The Council approved a direct payment, without transport costs, which it said was enough for Mr X’s continued attendance at the Centre. Mrs X appealed the decision. In response, the Council referred to the Policy and that Mr X received a PIP mobility allowance. The Council said it was appropriate for Mr X to use his PIP for travel costs to the Centre. The Council suggested Mrs X might consider shared transport (family or taxi) with others attending the Centre to reduce travel costs. The Council did not uphold the appeal.

The Council’s comments to the Ombudsman

Care services and transport funding

24. The Council said it had to meet peoples’ assessed eligible needs for care and support applying best value for public money. It could not provide a place for Mr X five days a week at its own day centres, one of which (Centre C) was significantly closer than the Centre to Mr X’s home. It had therefore approved a direct payment so Mr X could arrange to continue attending the Centre. However, it considered Centre C would have been a suitable placement for Mr X if it had capacity to accommodate him five days a week.
25. It had calculated the costs for attending a day centre five days a week. However, in approving Mr X’s personal budget, that amount exceeded its calculations by about £140. The amount approved was enough to cover the cost of Mr X attending the Centre five days a week.
26. The Council confirmed Mr X could not travel independently and needed close supervision to use public transport. The Council also recognised Mr X’s close family could not drive him to any day centre on Mondays to Fridays.
27. Under the Policy, Mr X was expected to use his PIP mobility allowance to pay for travel to a day centre, whether it was the Centre or Centre C. Existing transport arrangements meant, despite the significant extra travel distance to the Centre, it cost 30 pence a day more to travel there compared to Centre C. The Council said it had not considered whether shared transport was available to Mr X. It would have done so if Mr X intended to attend a different day centre to the Centre. But Mr X was to continue attending the Centre using existing transport arrangements.
28. Under the Policy, as transport arrangements existed for Mr X’s travel to the Centre, his PIP mobility allowance should cover his travel costs. It had sent Mrs X a copy of the Policy and explained many times that it expected Mr X to use his PIP mobility allowance to fund his travel costs. (On asking the Council if it currently funded transport costs for any person attending the Centre, the Council did not provide a ‘yes or no’ response.)
29. The Council did not consider Mr X would need to use his PIP mobility allowance for most medical and dental appointments. And, Mr X might reclaim his hospital travel costs from the National Health Service.
30. It completed a financial assessment for Mr X in spring 2022. However, it revised assessments every year to show changes in benefit payments and told people about any changes. It sent Mrs X a letter in February 2024 about its proposed 2024/25 review, which it expected to complete in April 2024. The letter said Mrs X should check the figures in due course and make contact if any were wrong. The Council also provided a copy of the revised 2024 assessment, which showed Mr X’s financial contribution to his care services. The assessment included a note about contacting the Council if anything was wrong or needed updating. The Council said Mr X’s family had not asked it to carry out a new financial assessment or consider any changes to his DRE or other transport costs. (Mrs X disputes this.) However, it had now asked its social care team to refer Mr X for a new financial assessment.
31. The Council said it sought to support people in claiming correct benefits. It also now recognised it would have been good to gather information about travel costs to the Centre and Centre C when reviewing Mr X’s plan and its funding. It now accepted the Centre was the best value option for meeting Mr X’s assessed needs (see paragraph 27). It also considered it reasonable to now assign a caseworker to refer Mrs X to a Welfare Benefits Advisor. This should ensure it had up to date information about Mr X’s income and any new DRE when carrying out the new financial assessment.

Direct payments

32. The Council said Mrs X first raised the matter in summer 2023 and a direct payment was in place when its contract with the Centre ended. The Council said it gave Mrs X’s request medium priority as it related to a change in arrangements to pay for existing care services. However, it recognised Mr X’s family’s dissatisfaction with “the pace of progress”. The direct payment and Mr X’s continuing attendance at the Centre were linked. Once it agreed a personal budget for Mr X’s attendance at the Centre, it had contacted Mrs X to confirm the approval of the necessary direct payment. It also told Mrs X that, in line with the Policy, it would remove travel costs from the care package as Mr X received the PIP mobility allowance.

Communication and complaints handling

33. The Council said it aimed to provide timely, clear and helpful information and to keep Mr X at the centre of its thinking. It sometimes needed time to gather information and reply to Mrs X’s concerns. It also had to balance competing priorities. It had signposted Mrs X to its complaints procedure and the Ombudsman. The Council accepted it avoidably delayed issuing its final complaint response and offered to make a further apology to Mrs X.

Consideration

Care services and transport funding

34. The Council told Mrs X too much time had passed for her to challenge the care and support plan she received in 2023. This was not correct. The Council now says it completed the plan review about two months before sending it to Mrs X and the evidence showed she immediately questioned its contents. I therefore found the Council at fault here. Being told it was too late to challenge the plan would likely have been distressing for Mrs X. So, I also found the Council’s fault caused injustice.
35. After receiving the 2023 plan, Mrs X pursued her concerns about its contents without delay. In response, the Council put her concerns through its complaints procedure. It also reassessed Mr X’s care and support needs and further considered transport funding. If Mrs X had been able to challenge the plan she received in 2023, I find the outcome would not have been substantively different. So, I did not find Mrs X was caused any greater injustice in relation to receipt of the summer 2023 plan.
36. Mrs X questions the lawfulness of the Policy. However, disputes about the legality of council policies are matters for the courts not the Ombudsman to decide. Here, the Policy says the Council reasonably expects people to use their benefit entitlements related to mobility needs to fund their travel to access services and support. The evidence showed the Council applied the Policy to Mr X’s care and support package and its funding.
37. However, the evidence showed the Council did not gather all key information when reviewing Mr X’s care and support plan and its funding in late 2023 (see paragraph 31). I found this was fault. The evidence showed Mrs X continued to question the Council’s funding decision and express dissatisfaction with its actions. So, she brought her complaint to the Ombudsman. I therefore found the fault caused Mrs X further distress, which was injustice.
38. The Council has now confirmed that Mr X’s attendance at the Centre represents ‘best value’. It was not for me to say whether the Council should fund Mr X’s travel costs to the Centre. But it should make its transport funding decisions using all relevant information when applying the Policy. The Council has offered to further consider financial matters (see paragraphs 30 and 31). This would provide redress for Mrs X’s concerns about the impact funding travel to the Centre has on Mr X’s finances. It would also give Mrs X the opportunity to ensure all figures used by the Council in the financial assessment were correct.

Direct payments

39. The evidence showed it took the Council about six months to deal with Mrs X’s direct payment request. This was a significant time. However, approval of the direct payment linked to the Council’s review of Mr X’s care and support plan in late 2023. The approved direct payment was in place, to cover the cost of Mr X’s attendance at the Centre (but without travel costs), when the Council’s contract with the Centre ended (see paragraphs 23 and 32). I therefore did not find the time taken by the Council affected Mr X’s continued attendance at the Centre.
40. However, I saw no evidence the Council kept in touch with Mrs X during the six months and or explained how it linked consideration of the direct payment with the review of Mr X’s care and support plan in late 2023. In response to the draft of this statement, the Council said there was dialogue with Mrs X and it told her a case worker would be allocated to deal with her request. However, I saw no independent and objective evidence to substantiate the comments. And, it took the Council several months to allocate a case worker. Mrs X, in response to the draft of this statement, repeated that it was very stressful when the Centre’s contract with the Council neared the end without an agreement for a direct payment. I therefore found fault causing injustice here.

Communication and complaints handling

41. I addressed communication about Mrs X’s direct payment request in paragraph 40.
42. I recognised Mrs X found the Council’s complaint responses unsatisfactory. However, the Council’s letters addressed key issues proportionately. But there were communication failures as identified at paragraphs 34, 37 and 40.
43. The Council has also recognised there was avoidable delay before it sent its final complaint response to Mrs X (see paragraph 33). I agreed and this was fault. This would have added to Mrs X’s frustration and distress, which was injustice. However, I did not find a timelier reply would have affected what the Council said. Mrs X would therefore still have brought her complaint to the Ombudsman.

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Agreed action

44. I have found fault causing injustice. And the Council has offered some redress (see paragraphs 30, 31 and 33). To address the injustice I have found caused to Mrs X and Mr X, the Council agreed:

• (Within 10 working days of this statement) to send Mrs X a written apology for the distress and frustration caused by its inaccurate (see paragraph 34), incomplete (see paragraph 37), poor (see paragraph 40), and delayed (see paragraph 43) communications.
• (Within 20 working days of this statement) to pay Mrs X a symbolic payment of £500 in recognition of the distress and frustration caused by its inadequate communications (see paragraphs 42 and 43).
• (Within 20 working days of this statement) to assign a caseworker and secure Mrs X’s referral to a Welfare Benefits Advisor.
• (Within 10 working days of this statement) to start a financial assessment for Mr X and process it without avoidable delay.
• (At Mrs X’s request once she has accessed advice), to carry out a further financial assessment should Mr X’s financial position change following the referral to a Welfare Benefits Advisor.

45. We publish guidance on remedies that includes information about making effective apologies. The Council should consider this guidance in making the apology referred to at paragraph 44.
46. The Council should provide us with evidence it has complied with the agreed actions at paragraph 44.

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Final decision

47. I completed my investigation, finding fault causing injustice, on the Council agreeing the actions at paragraph 44.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman