Summary: There was fault in how the Council handled significant changes to Mrs C’s care package. It had not reviewed this regularly, and did not seek to agree the changes with Mr and Mrs C, nor give Mr C proper notice when he was employed to deliver care to his wife. The Council also took too long to review its assessment of their son’s care needs. The Council’s shortcomings caused Mr and Mrs C distress and uncertainty and it has agreed to remedy this.

The complaint

1. Mr and Mrs C complain about how the Council assessed the care needs of Mrs C and their son, K. In particular they say:
• The Council reduced Mrs C’s care needs from 35 hours to 12.5 hours per week. It failed to take into account her eligible care needs, including parenting her son, and instead said that these would mainly be met by Mr C. It did not explain why it had changed the arrangements or whether Mr C could continue to be paid via direct payments.
• It was not clear about the process for this and told Mr C that this would not go to a panel or any other decision-maker. It also wrongly told Mr C the reduction in hours would be with immediate effect and then changed the timing several times.
• The Council failed to complete K’s care assessment or care plan.
• It told a councillor it would review the care assessments for Mrs C and their son but failed to do so.
• The social workers have not acted professionally, they misled them as to the process and failed to attend appointments as arranged.
2. Mr C says this has caused the family significant distress and left them uncertain as to how the care needs will be met and whether the family’s financial situation will change.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. 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)
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(i), as amended)

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How I considered this complaint

5. I considered the information provided by Mr C and discussed the issues with him. I considered the information provided by the Council including its file documents. I also considered the law and guidance set out below. Both parties had the opportunity to comment on a draft of this statement. I have considered all the comments made before issuing this final decision.

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What I found

The law and guidance

6. 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. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
7. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
8. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, 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. When preparing a care and support plan the council must involve any carer the adult has. The support 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 for that person.
9. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must take all reasonable steps to agree the revision with the person and their carer.
10. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.
11. A direct payment cannot be made to certain relatives including a spouse unless the council consider it necessary to do so. (The Care and Support (Direct Payments) Regulations, regulation 3)

What happened

12. Mr and Mrs C live with their son, K. K has complex care needs including his personal care, communication, mobility and health. In 2015, Mrs C suddenly became ill. She was left with very restricted mobility, such that she uses a wheelchair or mobility scooter outside and a walking frame inside. Mrs C also needs help with all her personal care and cognitive tasks.
13. When Mrs C suddenly became disabled, the Council assessed her care needs. It said she needed 21 hours of care per week and initially this was provided by a personal assistant. However, the Council found that a lot of the personal assistant’s time was taken in supporting Mrs C in parenting K, and it questioned whether Mrs C was having her own needs met. The Council decided to increase the hours of care to 35, to be funded via direct payments. As Mr C had to care for Mrs C and K, and support Mrs C in her parenting of K, the Council allowed the family to use the direct payments to pay Mr C to provide this care. The care needs assessment is clear that this arrangement would continue for around a year and the Council intended to review it.
14. The Council reviewed the care arrangements and reassessed Mrs C’s care needs in 2020. The Council decided to continue with the current arrangement of paying Mr C to deliver 35 hours of care weekly.
15. In April 2023, the Council visited Mr and Mrs C at home to review Mrs C’s care needs. By this time, Mrs C was recovering from surgery intended to improve her mobility and reduce pain. It proposed to see whether occupational and physiotherapy could help Mrs C become more independent. By this time, K was approaching adulthood. He still had significant care needs, but the Council and the family would need to plan how these would be provided by adult care services. The parenting support that Mrs C now needed had changed.
16. It decided that Mr C could no longer be paid via direct payments to provide Mrs C’s care. It also decided to reduce the care hours from 35 per week to 12.5 hours per week. Mrs C’s care assessment says that she needs help with her personal care and that she cannot shop or prepare meals herself. It says that it would offer Mrs C enablement rehabilitation so that she will be more independent with her personal care, and Mr C will support his wife to maintain her relationships, manage her meals, manage her home, access the local community, carry out her caring responsibilities, support her with decision making and cognitive tasks, and manage her health and medication needs, but this would not be funded via the care package.
17. Mr C says he was shocked to receive this assessment as nothing had changed since he had first started the care arrangements in 2015. He telephoned the Council. He says the social worker told him that the reduction would happen immediately, that they were the only decision-maker and there was no panel or review process. The Council then notified Mr C the direct payments would be reduced in four weeks’ time. The Council stopped paying the direct payments and Mr C had to chase it to get these reinstated and backdated.
18. Mr C asked the Council to consider keeping the current rate of direct payments for the summer holidays to give them time to prepare for the change and to make sure they could meet K’s care needs when he was not at school. Mr C says the Council agreed, but then notified him the higher rate would only be paid for a further two weeks.
19. Mr C’s local councillor contacted the Council on the family’s behalf. The Council agreed with the Councillor that it would review Mrs C’s and K’s care needs. Mr C also pointed out that he was employed by his wife via her direct payments. He would need proper notice to terminate his employment. He could not understand how he could care for his wife and son for the time not covered by carers, and also find work to fit around that.
20. Mr C complained to the Council. He said the Council had wrongly told him that the social worker was the sole decision maker; had given him conflicting and misleading information about when the direct payments would be reduced; had given misleading reasons as to why the Council had originally allowed Mr C to be the paid carer; had failed to take into account K’s care needs; had not explained how Mr C was supposed to work and care for two disabled people; had agreed to review the care assessments but had failed to do so; and had not explained why the care arrangements needed to change.
21. The Council responded. In summary it said:
• The Council will extend the support and the reduction will take place on 30 June (an extension of 2 weeks).
• It had wrongly actioned the reduced hours too early and apologised for this. This meant that the direct payment was made late.
• The original assessment was not a joint assessment but was a single assessment for Mrs C. This included support in her parenting of K of 19.5 hours. This support was provided by Mr C as an exceptional arrangement allowing Mrs C to employ her husband as a paid carer. It would not now agree to allow paid parenting support to be provided by the other parent.
• It apologised if there had been inaccuracies in its correspondence.
• It offered reablement to Mrs C following her hip replacement with the aim of her being more independent in the home.
22. The Council arranged for Mrs C to be assessed by a physiotherapist and occupational therapist to see whether therapy or adaptations might help increase her independence. These assessments found that although Mrs C was in less pain, she still had difficulties with pain and mobility. She has multiple aids in the house and said she had established a good routine with her husband to work to her strengths.
23. In the meantime, the Council said it now needed to re-assess K’s care needs. Mr C met with the social worker to do the assessment. The social worker said the assessment and care plan would be finished, but then the Council allocated the case to a different social worker who wanted to start the process again. The Council increased K’s package of care in September 2023, but it did not complete the reassessment until December 2023.
24. The case notes show very little contact between the Council’s children’s services and Mr and Mrs C. In October the case notes say “it is a worry and a concern, there has been no communication between professionals to reach a conclusion for support needed”. The case note also says that Mr and Mrs C have ceased communications with the Council as they are under so much stress. Mr C says this is not the case and it has been liaising with the Council about his payments.

Analysis

25. The Council has acknowledged that it should have reassessed the arrangement for Mr C to provide 35 hours care sooner. This is particularly the case when Mrs C had surgery with the aim of improving her mobility. The Council did not review Mrs C’s care needs or how these would be met regularly and this was fault by the Council. Had the Council reviewed the care arrangements more regularly, then these may have changed sooner. However, the Council may also have been able to manage any changes better with more support and agreement to transition to fewer hours of paid care.
26. The Council has acknowledged that it did not properly communicate with Mr C about the changes to the care package. It was fault for the Council not to seek to agree the changes with Mr and Mrs C, nor explain properly to them how the changes would be made and give proper notice of these. The Council has now confirmed that Mr C can be paid to deliver 12.5 hours of care to his wife. The Council also paid Mr C his statutory redundancy pay.
27. However, I have no basis to criticise the Council’s assessment of Mrs C’s care needs made in 2023. It made the decision to change the care arrangements because her surgery, and that her son was approaching adulthood and would have his needs met differently, meant that Mrs C’s needs had changed. The Council assessed the needs properly, and also made sure that a physiotherapist and occupational therapist assessed the scope for reablement to increase Mrs C’s independence.
28. The Council has acknowledged that it took too long to assess K’s needs. This compounded the distress and uncertainty caused to K and Mr and Mrs C. However, the Council increased K’s care package ahead of the current assessment, and I note that the assessment, when eventually completed, did not alter the care package.
29. The Council says that Mr and Mrs C limited their communication with the Council. However, this would not stop it from assessing K’s needs. I also note that there is very little contact on the Council’s files attempting to re-engage Mr and Mrs C.
30. There is no indication that K was receiving less care than he needed, but the delay in completing the re-assessment of his needs added to the uncertainty already brought about by the changes to Mrs C’s care arrangements. Overall, the Council caused distress and uncertainty Mr and Mrs C when it delayed K’s re-assessment, failed to give sufficient notice of significant changes to Mrs C’s care arrangements, or communicate properly with the family to transition to reduced hours.

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Agreed action

31. The Council will within one month of the date of this decision:
• Apologise to Mr and Mrs C. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended in my findings.
• Make a symbolic payment to Mr and Mrs C of £500 in recognition of the distress and uncertainty it caused them.
• Share this decision with relevant staff.
32. The Council should provide us with evidence it has complied with the above actions.

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Final decision

33. I have completed my investigation. There was fault by the Council causing injustice to Mr and Mrs C, and their child, K.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman