Summary: The Council has acknowledged it was at fault in the way it failed to meet Mrs X’s needs fully over a period of 5 years, relying on Mr X to provide support himself or pay for it privately. The Council has already offered reimbursement in a number of key areas and has now agreed to further recognise the considerable anxiety and frustration suffered by Mr X while he awaited a resolution.

The complaint

1. Mr X (as I shall call him) complains that the Council failed over a long period to put in place sufficient care for his wife who is disabled and has dementia. He says as a result they spent considerable amounts on private care and his own health suffered.

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The Ombudsman’s role and powers

2. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I considered the information provided by Mr X and the Council. Both Mr X and the Council had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

5. 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.
6. 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. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
7. The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)
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. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.

What happened

10. Mrs X has a progressive physical disease and dementia. Mr X is her main carer. Mr X also has spine and hip problems. Mrs X receives a budget from the Council in the form of a Direct Payment from which she has paid for carers and some help from a long-term personal assistant (PA). Mr X receives a carer’s budget to pay for care for Mrs X while he attends hospital appointments of his own.
11. Documentary evidence as early as 2015 from Mrs X’s physician reported Mrs X’s declining mobility, cognitive impairment and the difficulties faced by Mr X in the management of her care. Mr X has provided examples of letters to Adult Social Care from Mrs X’s physicians over the next five years which record that he was “at breaking point” because of the amount of care he was providing for Mrs X. Mrs X’s allocated social worker met or spoke to Mr X often during that time.

12. At an assessment in 2016 Mrs X was awarded a personal budget of £282.78 to pay for her care. That did not change until March 2021 after Mrs X’s allocated social worker had retired and a new social worker carried out a review. The revised budget for Mrs X was £1033.24.

The complaint

13. Mr X’s son complained to the Council in June 2022. Following an initial response and some further correspondence, the service manager wrote again in December 2022 to Mr X with a final response to his complaint.
14. The service manager noted Mr X’s concern that the Council had failed to provide the service Mrs X needed over a period of years: Mr X said her needs had not changed over the five years and yet her budget had been increased dramatically. Mr X said his son had found it very difficult to obtain responses from officers to his contact attempts about the complaint. He said although their complaint had been upheld there was no recognition of the toll on Mr X’s own health and the significant difficulties he had faced for some years because of the Council’s failure to resource the care package adequately.
15. The service manager reviewed the period from 2016 to 2020 and concluded that the social worker had not followed due process in terms of the appropriate reviews and assessments and had failed to show how the support package met Mrs X’s unmet needs and was properly funded.
16. The service manager also said it was unclear how Mr X’s needs as a carer had been assessed to quantify the level of support he was able to continue to give. She said the social worker had not provided copies of the assessments so had not given Mr and Mrs X the opportunity to comment or object.
17. In terms of the period from May 2020 to March 2021, the service manager said there was a period of six months when it was unclear which organisation had responsibility for Mrs X’s care. From May 2020 until March 2021 Mrs X did not have an allocated social worker.
18. The service manager said the fresh assessment in 2021 identified there was unmet need as Mr X was no longer able to provide care and support on a 24-hour basis; she said the previous assessments had not met the required standards and did not clearly identify the unmet need. She acknowledged there had been fault on the part of the Council for a number of years.
19. The service manager responded to Mr X’s indication that he wanted to claim for financial recompense to recognise the impact of caring over several years, and the effect on his own health and welfare. The service manager said she was unable to make a financial offer for personal injury claims but provided details of the Council’s insurers.
20. The service manager said the Council would reimburse the costs associated with Mrs X’s residential care in March and April 2021. She agreed to reimburse the cost of any care paid for by Mr and Mrs X between January 2016 and December 2022 which should have been arranged and funded by the Council. She also agreed to reimburse Mrs X’s PA for the 24-hour care she had provided which could not have been wholly funded out of Mrs X’s Direct Payment.
21. The service manager apologised for the poor level of service Mr and Mrs X had received. In recognition of the time and trouble spent in pursuing the complaint she also offered a payment of £500.
22. Mr X was dissatisfied with the Council’s response and complained to the Ombudsman. He said the Council had ignored his and his doctor’s letters about the amount of care Mrs X needed for years. He said nothing changed until his son intervened.
23. The Council acknowledges that the offer of £500 does not make up for years of uncertainty. It says it was offered primarily in recognition of the time and trouble Mr X and his son had spent in pursuing the complaint which it says it took far too long to respond to.

Analysis

24. There is no dispute over the fault on the part of the Council and the additional amount of care that its failings required from Mr X, nor the extra expenditure it caused.
25. The Council has recognised the injustice caused and offered reimbursement of the expenditure one Mr X has provided the requested evidence of expenditure. It has apologised for the shortcomings in its service over a long period of time. It has already provided contact details so that Mr X can pursue a personal injury claim through its insurers.
26. The Council also offered a payment of £500 in recognition of the time and trouble Mr X and his family went to in seeking to have the matter resolved. In my view that did not go far enough and I recommended a more substantial sum. Mr X was left with the impression that it was only when his son intervened that the Council took action in respect of his situation. In addition it took far too long to contact Mr X’s son and then Mr X with a full and adequate response to the complaint.

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Agreed action

27. Within one month of my final decision the Council should provide details of how it has carried out its proposed remedies in paragraph 20 above (presuming that by then it has received the information it needs from Mr X);
28. Within one month of my final decision the Council agrees to make an offer of £1000 to Mr X in recognition of the significant time and trouble spent in pursuing the complaint;
29. The Council should provide us with evidence it has complied with the above actions.

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Final decision

30. I have completed this investigation. I find there was fault on the part of the Council which caused injustice to Mr and Mrs X, which will be remedied by the completion of the recommendation at paragraph 20 above.

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Investigator's decision on behalf of the Ombudsman