Summary: We will not investigate Mr P’s complaint. We are unlikely to find fault with the way North East Lincolnshire Council and NHS Humber and North Yorkshire Integrated Care Board decided how much to pay towards his direct payment.

The complaint

1. Mr P complains that North East Lincolnshire Council (the Council) and NHS Humber and North Yorkshire Integrated Care Board (the ICB) unfairly decided not to pay his personal assistant £17 per hour, or pay her travel expenses, as part of a direct payment for his section 117 aftercare. He says they did not support him to find a personal assistant. He says he should not be expected to pay toward the personal assistant. The thought of changing personal assistants causes him great anxiety. He would like the Council to either pay the personal assistant £17 per hour, or their travel expenses.
2. Mr P also complains about the complaints process between the Council and ICB. He said it is complicated and not accessible for people with autism. Also, the ICB significantly delayed responding to his complaint. That caused him great anxiety.

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The Ombudsmen’s role and powers

3. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault or unlikely we could add to any previous investigation by the bodies. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)
4. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. 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, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))

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How I considered this complaint

5. I considered information provided by Mr P and the organisations.
6. Mr P had an opportunity to comment on my draft decision. I have considered his comments before making a final decision.

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What I found

Relevant legislation and guidance

7. Anyone who may have a need for community care services is entitled to a social care assessment when they are discharged from hospital to establish what services they might need. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act (e.g. Section 3). Aftercare services provided in relation to the person’s mental disorder under S117 cannot be charged for. This is known as section 117 aftercare.
8. Direct payments give service users choice and control over their care and support. They are cash payments given to service users or their representative by councils so they can buy community care services. The payments must be enough to enable the service user to buy services to meet their eligible needs, and must be spent on services that meet eligible needs.

Background

9. In North East Lincolnshire:
• A company called Focus provide the Council’s adult social care service.
• A company called Navigo provide the Council and ICB’s mental health service.
• Focus and the ICB hold an Individual Commissioning, Approval and Advice Panel (the Panel). The Panel make and review decisions about care packages.
• The ICB handles adult social care complaints for the Council.
10. In March 2023, the Panel decided to fund Mr P one hour of support, seven days a week. That support met his section 117 aftercare needs.
11. In May 2023, the Council provided direct payments to Mr P, so he could employ a personal assistant. It agreed to pay him £14 per hour because they had to travel from outside the area, which is above the Council’s standard rate.
12. In early June 2023, Mr P complained to the Council, ICB and Navigo. He said £14 per hour did not cover his personal assistants costs, and was paying an extra £3 himself to her. He also wanted the Council to cover their travel expenses. Mr P was unhappy the organisations did not support him to find someone more locally.
13. In mid-June 2023, Mr P asked the Council about other care agencies. It then shared a list of over 20 care agencies he could enquire about supporting him.
14. In August 2023, Mr P raised his complaint with the Ombudsmen.
15. In October 2023, the Ombudsmen asked the Council and ICB to respond to Mr P’s complaint.
16. In February 2024, the Panel reviewed Mr P’s complaint. It refused to pay £17 per hour or the personal assistants travel expenses.
17. In April 2024, the ICB wrote to Mr P. It was sorry for the delay and for causing him upset and frustration. It said the Panel had reviewed his request. Mr P had decided to employ the personal assistant from outside the area, so was responsible for negotiating travel expenses. It would not pay travel expenses from direct payment funds, as the personal assistant was an employee of Mr P. It said the Council already pay Mr P above the hourly rate, and he would need to fund any extra costs privately.

My assessment

The Panel’s decision

18. I have seen evidence Navigo shared a list of local care providers who could potentially support Mr P. So I do not agree with Mr P’s view the organisations did not support him after February 2023. I understand Mr P had already found a personal assistant before June. But I am unlikely to find Navigo, on behalf of the Council, acted with fault. Once Mr P received the list of care agencies, he could have worked with it to discuss an alternative care provider.
19. I am also unlikely to find fault with the Panel’s decision making. On two occasions, it has considered Mr P’s circumstances and already used its discretion to pay above the hourly rate for his personal assistant. Also, I agree Mr P should not use the direct payment to pay for travel expenses.

The complaint handling

20. We have previously investigated a complaint by Mr P and found fault with North East Lincolnshire’s complaint handling. I will not reconsider this issue.
21. When we referred Mr P’s new complaint to the ICB in October 2023, I agree the ICB delayed responding to him. But it has apologised for the delay. I would not likely make any further recommendations to remedy Mr P’s frustration. Therefore, I will not consider this complaint further.

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Final decision

22. We will not investigate Mr P’s complaint about the Council and ICB. We are unlikely to find fault with the way they decided how much to pay towards his direct payment. Also, we are not likely able to achieve anything more for his complaint about how the Council and ICB handled his complaint.

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Investigator's decision on behalf of the Ombudsman