Summary: The Council was at fault for the delay in completing Mr Y’s needs assessment and Ms X’s carers assessment. It was also at fault for poor communication. The Council has agreed to apologise to Ms X for the frustration and uncertainty this caused and offer to complete new assessments. There was no evidence of faut in the support it offered Ms X with Mr Y’s benefits.

The complaint

1. Mrs X complained the Council has failed to:
1. Produce a support plan for her adult son Mr Y setting out his care and support needs and who will meet them in line in line with his Education, Health and Care (EHC) Plan,
2. provide advice and support with claiming benefits
3. properly assess Mrs X’s needs as a carer and
4. communicate effectively with her across all these issues.
2. This has caused them distress and uncertainty and has had a potential financial impact on Mr Y.

Back to top

The Ombudsman’s role and powers

3. 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)
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 Mrs X and the Council as well as relevant law, policy and guidance.
6. I gave Mrs X and the Council an opportunity to comment on a draft of this decision. I considered any comments before making a final decision.

Back to top

What I found

Relevant Law and Guidance

Special educational needs

7. A child or young person with special educational needs may have an Education, Health and Care (EHC) Plan. This document sets out the child’s needs and what arrangements should be made to meet them. The EHC Plan is set out in sections. We cannot direct changes to the sections about their needs, education, or the name of the educational placement. Only the Tribunal or the council can do this.
8. Section D of the EHC Plan sets out the social care needs related to the child or young person’s SEN. Section H2 includes social care provision reasonably required by the learning difficulties or disabilities which result in eth child or young person having SEN. This will include any adult social care provision being provided to meet a young person’s eligible care needs under the Care Act 2014.
9. If a parent disagrees with the social care support set out in the EHC Plan they can make a complaint to the council. Alternatively, if they are going to appeal to the Tribunal about other parts of the EHC Plan, they can ask the Tribunal to consider any is agreement. If the Tribunal makes a finding on the social care elements, it is non-binding. (It is not a statutory right of appeal).

Needs assessments

10. 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.
11. Sections 21 to 23 of the Care Act 2014 set out the limitations on the circumstances in which councils may meet care and support needs. In particular, they make clear that councils must not meet needs by providing or arranging any health service or facility which is required to be provided by the NHS. In other words, the Council is not legally allowed to provide care and support where their needs are fully met by CHC funding.

Continuing healthcare

12. Continuing healthcare (CHC) is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. The Department of Health and Social Care’s National Framework for NHS Continuing Healthcare and NHS funded Nursing Care (July 2022 (Revised)) (the National Framework) is the key guidance about Continuing Healthcare. It states that where an individual is eligible for Continuing Healthcare funding, the Integrated Care Board (ICB) is responsible for care planning, commissioning services and case management.

Carers assessments

13. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
14. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Benefits and appointeeship

15. If someone is unable to manage their affairs due to a disability, an appointee can act on their behalf. The appointee is responsible for making and maintaining any benefit claims with the Department for Work and Pensions.

What happened

16. The following is not intended to be a full account of everything that happened in this period, nor does it refer to all the records I have considered. It is a summary of the key events and facts relevant to this complaint.
17. Mr Y is a young adult. Mr Y’s care and support is fully funded by NHS CHC. He has an EHC Plan. Ms X appealed to the Tribunal seeking a 52 week specialist provision for Mr Y and changes to the content of the EHC Plan. The following is a summary of the main events relevant to the complaint. I have considered what happened from February 2024 until October 2025.
18. In February 2024 Ms X corresponded with Mr Y’s social worker. She requested a needs assessment for Mr Y. The notes record the social worker explained that Mr Y’s care and support was the responsibility of the health service as he was funded by CHC. They offered Ms X a carer’s assessment which she did not agree to at that time.
19. During the summer, the Council agreed to Mr Y attending the specialist provision.
20. In July 2024 Ms X requested a carers’ assessment. The social worker met with Ms X in August 2024. However, the notes record this was not completed as Ms X wanted to discuss the current situation, so the social worker emailed Ms X some questions and then chased up the response in September 2024. In September 2024 Mr Y started attending the specialist provision.
21. The social worker completed an assessment based on information Ms X provided as part of her appeal to the Tribunal which she asked that they consider. Her concerns at that time focused on the impact the Tribunal process was having on her mental and physical health.
22. In November 2024 the Tribunal heard Ms X’s appeal about the content of Mr Y’s EHC Plan. The Tribunal recommended changes to section D and H of the Plan.
23. Section D of the Plan following the Tribunal included:
• Mr Y needed help and assistance from a social care professional to ensure and oversee that he was receiving his full benefit entitlement and the management of them.
• Mr Y needed a social care professional to ensure multi agencies were working together collaboratively and to act as one point of contact
• Mr Y should have a support plan to list his eligible care and support needs and to determine who is going to meet them.
• The Council to provide a named allocated social care professional to attend Mr Y’s EHC Plan reviews.
24. Section H2 of the EHC Plan, following Ms X’s appeal to the Tribunal stated that Mr Y will have a support plan to list his eligible care and support needs and to determine who is going to meet them.
25. In November 2024 the social worker referred Ms X to the Council’s income maximisation team (IMT) for support with benefits. The IMT closed the referral in mid-December as the social worker was on leave and had not responded to its contact. It had established that Ms X was Mr Y’s appointee for benefits.
26. The social worker re-referred Ms X and an officer from the IMT spoke with her in early January 2025. They noted Ms X said she found the benefits system too complicated and wanted to step down from managing things. The officer explained if the Council became responsible it would receive Mr Y’s benefits instead of her and asked if she wanted support with claiming benefits which Ms X agreed to.
27. Ms X wrote to the Council in early January 2025. She summarised Mr Y’s expenditure since he moved to his new provision. She requested ASC reimburse her for the costs which she said were covered in his previous placement.
28. In mid-January 2025 a manager wrote to Ms X. They explained that:
• In relation to finances, as part of a needs assessment they could look at Mr Y’s capacity to manage finances and where there was a risk could look to put plans in place to support Mr Y. As appointee Ms X was responsible for managing his benefits. The Council could suggest a third-party advocacy company at a cost to offer support and management if required.
• They would ask the social worker to complete a needs assessment to ensure the Council had a full understanding of Mr Y’s needs. A needs assessment would identify Mr Y’s needs under the Care Act and the support plan sets out how the needs would be met. In this instance that would be through health services and the CHC framework. They explained CHC is non chargeable whereas ASC is means tested.
• They said they agreed a social work professional needed to attend EHC Plan reviews and they would ask a social worker to do so.
29. Ms X remained unhappy that subsistence costs she had to pay to support Mr Y at his provision were not met by the Council. The social worker explained they had referred Ms X to the IMT for benefits advice who agreed to support her as Mr Y’s appointee. If Ms X did not want to be appointee they could look to appoint an external appointee.
30. In late January 2025 the social worker visited Mr Y to undertake a needs assessment. The conversation record following the visit noted the support Mr Y received and that his care and support needs were monitored and supported by staff round the clock. It noted Mr Y’s needs were being well met at the provision and his care and support was fully funded and managed by the NHS CHC. Mr Y’s CHC was reviewed in February 2025 and remained unchanged.
31. In February 2025 the IMT noted Mr Y was now receiving universal credit backdated to January 2025 and closed the referral.
32. In mid-February 2025 Ms X asked for a copy of her carers’ assessment which the social worker sent the same day. Ms X responded that she did not agree with it. She said it made no reference to negligent financial oversight and being unable to work due to the necessity of going to Tribunal. She said there was no outcome summary or established needs. She refused to sign it. The social worker noted they had closed the case. They noted the assessment was completed based on wording from the Tribunal statement as requested by Ms X.
33. In late March 2025 Ms X complained to the Council that it had not complied with the Tribunal Order and the allocated social worker was not responding. Ms X also contacted the Council as she said Mr Y’s social care assessment was still outstanding.
34. A manager responded to Ms X’s complaint in early April 2025.They said:
• The conversation record completed related to Mr Y and outlined his care act eligibility and needs. This document formed part of identifying his need for care and support.
• Ms X was Mr Y’s appointee for benefits and it was not the Council’s responsibility to manage such benefits.
• The Tribunal Order set out a list of expectations for the Council at section D. It had responded in January outlining how it would meet these.
• Mr Y’s support was provided through CHC although it was prudent for the Council to have plans in place should this change which is why the social worker completed a conversation record.
• They would speak with the social worker regarding advocacy and a carers’ assessment.
• They had maintained contact where possible and reiterated what they had set out to Ms X in January 2025.
35. Following a conversation with Ms X in late April 2025, a Council manager wrote to Ms X. They apologised that the Council had failed to undertake an assessment of Mr Y’s care and support needs. They reiterated that whilst Mr Y was fully CHC funded the Council had a statutory responsibility to assess Mr Y’s needs. Although Ms X had raised concerns he had unmet needs, they said they could not comment on these until an assessment was completed. They agreed to:
• allocate a social worker to complete a care act assessment.
• collaborate with the NHS to clarify responsibilities and ensure coordinated support for Mr Y, to identify a key case worker to act as a single point of contact, streamlining communication. The Council would attend reviews and provide input at the request of the key case worker.
• discuss and support options for an advocate for Mr Y.
• confirm that the previous referral to income maximisation was progressing and explore additional avenues to support her in planning for Mr Y’s future particularly regarding financial matters.
36. Ms X remained unhappy and asked that the complaint remain open whilst the outstanding actions were resolved. She was also unhappy the issue of recompense of subsistence costs was not addressed. The Council manager wrote to Ms X in late April 2025 and confirmed they would not pay this. They said Adult Social Care had no obligation to pay anything towards the cost of Mr Y’s care. Ms X was Mr Y’s appointee and when it was identified she needed support with finances it actively supported her with this.
37. Ms X remained unhappy and complained to us.
38. In May 2025 the Council met with the NHS Integrated Care Board (ICB). They noted:
• Mr Y’s review in February 2025 identified no unmet needs. Mr Y was settled in his setting.
• Mr Y had access to money as required which was facilitate by Ms X transferring money from his benefits. They understood Mr Y was receiving the benefits he was entitled to.
• It would be helpful for all parties to provide Ms X with a single point of contact. The ICB agreed to provide the single point of contact and for them to be the lead organisation to support Mr Y.
• The social worker’s role was to address advocacy support and to complete a needs assessment. The social worker and case worker from the ICB would arrange to meet with Ms X to progress this.
39. A new social worker, social worker B contacted Ms X in late May 2025 and advised they had referred Mr Y to an advocacy service for a Care Act advocate and they were looking to arrange a date for a needs assessment. Ms X responded asking what the point was when it was clear what the outcome would be. Social worker B asked Ms X to confirm if she no longer wanted a needs assessment for Mr Y. Social worker B said they had met with all professionals involved in Mr Y’s care and support and all felt he had no unmet needs. It had agreed to assess Mr Y but did not understand what benefit this would provide at that time. They asked for Ms X’s view on Mr Y’s unmet needs.
40. Ms X responded that Mr Y’s day to day needs were met but there was a lack of information, support, communication and trust.
41. Ms X communicated with the Council manager between June and October 2025 with her concerns and to request access to Mr Y’s records. She said she had received an email that she could not have these as Mr Y lacked capacity to consent and she wanted to apply for legal guardianship.
42. The Council manager responded that the Council continued to progress work and the ICB CHC officer was Ms X’s key contact. They said the Council had offered to complete a care needs assessment but did not receive a confirmed response this was required so it was not completed. They told Ms X the case was closed to social worker B as all actions were completed or attempted to be completed.
43. The Council wrote to Ms X in mid-October 2025. It said it remained confident Mr Y was receiving the care he required which was commissioned through CHC. Ms X wanted access to Mr Y’s records and although Mr Y lacked the capacity to agree to this, Ms X was important to him and he wished for her to have sight of these. It was therefore willing to disclose them.
44. It confirmed a case officer from CHC was appointed as Ms X’s single point of contact and that when someone was funded by health this included any associated social care needs. Mr Y’s needs were being met through health and the Council could not arrange services which were the responsibility of health. It was therefore more appropriate for the single point of contact be an officer from health.
45. It reiterated it had offered a needs assessment and it remained open if Ms X wished to pursue this. It said advocacy would be made available to support specific decisions.
46. It acknowledged Ms X had requested a social worker attend the EHC Plan review. However, it said it was more appropriate that the CHC case officer attend as the care provider.

Findings

Mr Y’s care and support plan

47. Mr Y is fully funded by the NHS through CHC funding. This means the NHS is responsible for all Mr Y’s care and support. The Council cannot provide Mr Y with any care and support as the NHS is required to provide this (section 22 of the Care Act 2014).
48. However, where requested, the Council has a statutory duty to carry out an assessment of eligible needs under the Care Act and the Council agreed to do so. In Mr Y’s EHC Plan, following the Tribunal the Council agreed to carry out a needs assessment.
49. A social worker completed a conversation record in late January 2025 but did not produce a formal needs assessment or care and support plan, setting out that the NHS was meeting Mr Y’s needs. This is fault. The Council in late April 2025 again agreed to carry out a needs assessment. The social worker contacted Ms X, but she was unwilling to progress the assessment at that time.
50. The records show Mr Y’s care and support needs were being met at his provision, his CHC needs were reviewed and Mr Y was settled there. There is no evidence the delay in assessing Mr Y’s needs has caused him an injustice. Ms X has referred to unmet needs relating to information, support, communication and trust which appear to relate to her needs as a carer rather than Mr Y’s needs. The delay has however caused Ms X some frustration.

Benefits

51. Mr Y’s EHC Plan referred to Mr Y needing a social care professional to oversee and manage his benefits. However, Ms X is Mr Y’s appointee for benefits. This means she, not the Council, was responsible for making any benefit claims on his behalf. Benefits are awarded by the Department for Work and Pensions not the Council. It was open to her to contact the DWP or seek external advice regarding Mr Y’s benefit entitlement. Ms X could also have relinquished her role as appointee and the Council explained it could take over from her, She chose not to do so.
52. When Ms X raised concerns about Mr Y's benefits the Council acted appropriately and referred her to its Income Maximisation Team which supported her with a universal credit claim. There was no evidence of fault in the way the Council supported Ms X with Mr Y’s finances.

Ms X’s carers’ assessment

53. Ms X requested a carers’ assessment in July 2024. The Council sought to speak with Ms X to complete this but Ms X, at that time, was focused on Mr Y’s Tribunal appeal. When the social worker sent Ms X the assessment, Ms X did not agree with it. The social worker closed the case and there is no evidence they sought to discuss this further with Ms X at that time or to further explore the support she required in her role as Mr Y’s carer.
54. When Ms X was asked about Mr Y’s unmet needs she referred to communication and support, areas which appeared to highlight the support she required as a carer. The carers’ assessment the Council produced failed to properly assess Ms X’s needs as a carer, to identify any outcomes or need Ms X may have for support. This was fault and causes uncertainty over what, if any additional support Ms X may have benefitted from in her role as Mr Y’s carer.

Communication

55. The EHC Plan highlighted the need for a single point of contact for Ms X. Given Mr Y is fully CHC funded there was no fault in the decision this should be a member of the NHS ICB. However, this need was first highlighted in the EHC Plan following the Tribunal in November 2024. The Council delayed progressing this and I have seen no evidence it formally notified Ms X who this point of contact would be. This is fault which caused Ms X frustration and meant she continued to contact a variety of professionals to try and resolve her concerns.
56. If Ms X has concerns about communication from her single point of contact it is open to her to complain to the ICB about this.
57. The Council initially agreed that a social work professional would attend Mr Y’s EHC Plan reviews. It was not until October 2025 that the Council explained that it would be more appropriate for the case officer from the ICB to attend as the ICB was responsible for meeting Mr Y’s social care needs. The Council explained why it was more appropriate for the ICB case officer to attend the review and there was no fault in that decision. However, the inconsistent communication has added to Ms X’s frustration.

Back to top

Agreed Action

58. Within one month of the final decision, the Council has agreed to:
• apologise to Ms X for the frustration and uncertainty caused by the delays in assessing Mr Y’s needs and her needs as a carer and for the frustration caused by the Council’s poor communication. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology.
• offer to complete a needs assessment for Mr Y to help inform his EHC Plan and a carers assessment for Ms X. If Ms X agrees to this, these should be completed within three months of the date of the final decision.
59. The Council should provide us with evidence it has complied with the above actions.

Back to top

Decision

60. I find fault causing injustice which the Council has agreed to a remedy.

Back to top

Investigator's decision on behalf of the Ombudsman