Summary: There were significant delays in the Council’s assessments of Mr B’s needs and reviews of his care plan. The Council also sometimes failed to properly explain how it had considered Mr B’s needs and how it had reached the decisions. The Council has agreed to apologise, to pay a financial remedy, to review the care plan and provide training to relevant staff.

The complaint

1. Mr B complains about delays in the assessment of his needs and care plans and he says the Council has not fully understood his needs.

Back to top

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)

Back to top

How I considered this complaint

4. I have discussed the complaint with Mr B. I have considered the evidence that he and the Council have provided, the relevant law, guidance and policies and both sides’ comments on the draft decision.

Back to top

What I found

Law, guidance and policies

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 set out the Council’s duties towards adults who require care and support.
6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
7. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
8. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.

What happened

9. Mr B is an adult man who is deaf, has a mental health diagnosis and physical health conditions. He lives with his partner, Ms C (who is also deaf) and his two stepchildren.
10. Mr B’s care plan dated 16 May 2019 said he received a package of support from the Council of two hours per day (14 hours per week), from 9:00 until 11:00. The support related mostly to the provision of personal care, supporting Mr B in his wheelchair to go into the community with his dog and attendance of appointments. He started receiving the support after a long hospital admittance.

Review assessment – July 2020

11. The social worker carried out a review assessment on Mr B’s needs in July 2020.
12. The social worker noted that Mr B’s physical condition had improved greatly and Mr B no longer needed support for his personal care. Sadly, Mr B’s dog had also died so he no longer needed support to walk his dog. Mr B agreed that he no longer needed the morning support (9:00 to 11:00) in terms of personal care and walking the dog, but said he still needed support in reading his correspondence and making telephone calls. He wanted a different agency to provide the support as he was not satisfied with his current agency.
13. The assessment concluded: ‘support plan to be collated, budget to be requested for direct payment, personal assistant to support 2 hours per week to assist with telephone calls and correspondence.’
14. It appears from the documents that, during this time, the Council continued to pay out the direct payments relating to the old care plan as the Council failed to cancel the plan and the payments. The Council stopped the payments in November 2021 and reclaimed this money.

July 2020 to April 2021

15. Mr B was unable to find a personal assistant but in September 2020 he found an agency which delivered specialist services to people who are deaf and hard of hearing (agency K).
16. Agency K contacted the Council on 2 September 2020 asking them what the position was. The social worker replied and said it was her understanding that Mr B wanted to use a personal assistant but agency K could support him in identifying an assistant who communicates in BSL.
17. Agency K informed the social worker on 20 October 2020 that Mr B wanted agency K to provide the support rather than employ a personal assistant. There was no reply so agency K chased the social worker on 2 November 2020 as agency K said the lack of support was ‘taking its toll’ on Mr B and his family.
18. The social worker sent an email on 19 November 2020 and said the plan was for agency K to assess Mr B to see how they could support him. The social worker explained to the agency’s manager that Mr B was entitled to 2 hours support.
19. The agency’s manager carried out an assessment of Mr B’s needs and emailed the social worker on 30 November 2020. She said 2 hours support would not be sufficient to meet Mr B’s needs. Mr B did not just need translating support but also needed support in managing his medical condition, his mental health and general wellbeing. He also needed support to attend medical appointments and social activities and many other areas of support.
20. The social worker replied and said the Council could not fund support relating to managing Mr B’s underlying health condition. Mr B’s dog had passed away so he no longer needed support for the dog and he was able to manage his personal care needs independently. The main need that had been identified related to managing his correspondence and telephone calls.
21. Agency K started to provide Mr B with 3 hours support a week from its Prevention service in November 2020. It is my understanding that agency K has 2 sources of funding:
• Prevention service – which is free to the person but is funded by the Council.
• Personal budget – support funded from the person’s personal budget set out in the care plan, funded by the Council.
22. Agency K chased the social worker on 26 January 2021 as there had been no further progress. On 28 January 2021 the social worker sent an email to agency K and proposed to set up a meeting to clarify what support was needed as ‘the support [Mr B] is requesting does not come under the social care remit.’
23. Mr B asked the social worker on 24 February 2021 whether the Council would pay for online BSL interpreters. Agency K chased the social worker on 16 March 2021 as it said Mr B’s circumstances had changed.

April 2021 to November 2021

24. On 15 April 2021, Mr B emailed the Council asking for a re-assessment of his needs. He said:
• He needed support in maintaining family relationships. Because of the lack of support, his children had to support him with adult matters, written correspondence, telephone calls and accessing services. They were too young to understand the adult world and he had no privacy or confidentiality.
• He had limited understanding of written English and needed correspondence to be translated. He was unable to access most services.
• He needed support in accessing facilities and services in the community, including recreational facilities.
• He needed support to make decisions about his health care.
• The support worker helped him to maintain a safe home and fulfil his responsibilities as a tenant. They helped him claiming the correct benefits.
• He needed support to prevent social isolation and a deterioration in his mental health.
• He needed support in caring responsibilities for his children.
• The lack of support had affected his self-worth, wellbeing and family relationships.
25. The social worker spoke to the manager at agency K on 12 May 2021. Mr B wanted support to attend health appointments, but the social worker explained the Council would not fund this as the NHS had a patient transport service and Ms C should be able to assist in taking Mr B to the appointment. Agency K said there was a lot of confusion about what adult social support the Council would provide. The social worker agreed to arrange a re-assessment of Mr B’s needs.
26. Agency K contacted the Council on 23 and September 2021 to chase progress. The agency had been supporting Mr B under their Prevention Service but this could not continue (Prevention Service was limited to one year) and needed a long-term solution.
27. A noted dated 30 September said the social worker’s supervisor discussed the case with the social worker. The supervisor said Mr B may need some support, ‘an hour or so for admin tasks.’ The social worker should arrange a meeting to discuss and agree ‘a small care package.’
28. In October 2021, the social worker agreed to organise the reassessment meeting.

Review assessment – 29 November 2021

29. The social worker re-assessed Mr B’s needs on 29 November 2021. The social worker noted that Ms C provided most of the support that Mr B needed. Agency K supported Mr B with correspondence, making telephone calls and attending appointments. The support from agency K was coming to an end so the social worker recommended that this support should be provided and funded by the Council.
30. The assessment concluded: ‘support plan to be collated, budget to be requested for direct payment, for the support from [agency K] to continue, to assist with telephone calls and correspondence…’ The assessment did not say how many hours of support Mr B needed.

November 2021 – February 2022

31. Agency K continued to chase the Council over the following months as there was no progress.

Complaint – 14 February 2022

32. Mr B complained to the Council on 14 February. He said:
• He had a meeting with the social worker in July 2021, but since then no progress had been made. He and agency K continuously had to chase the social worker for progress.
• The social worker agreed that he needed 6 hours of support in November 2021, and the social worker told them on 15 December 2021 that she had sent the request to the budget holder. However, on 9 February 2022 they found out from a colleague of the social worker that the plan had not been sent yet.
• Mr B also complained that the social worker did not understand his needs. He felt that, as his needs were non-generic, this had been a barrier to understanding his needs. As a result his needs had not been met and the lack of support and understanding had been detrimental to his mental health and wellbeing.
33. On the same day, the social worker emailed agency K and said she needed further information to make the request for funding. She asked agency K to provide a further breakdown of the 6 hours support.

Agency’s K breakdown of support – 21 February 2022

34. Agency 5 sent an email to the social worker with a breakdown on 21 February 2022. The agency said:
• Mr B had limited communication in spoken or written English. A lot of services such as the bank, leisure centres, utilities, the GP and online services were therefore inaccessible to Mr B without support.
• The support worker would translate correspondence from written English into BSL to enable him to respond.
• This included support with utilities, budgeting and paying bills.
• Mr B needed support to report repairs and emergency breakdowns to maintain a safe home and to book the workmen.
• Mr B needed support to translate NHS letters and book interpreters at NHS appointments.
• The support worker supported Mr B at NHS appointments to ensure he retained the information, shared relevant information with the health professionals and translate written information.
• The support worker supported Mr B to access leisure facilities to reduce his isolation and give him more independence.
• Mr B would also be supported in family life and communicating with the school.
• Support was flexible. Some days Mr B ‘may need more than 6 hours per week… the following week he may not need the full hours.’

Care plan – 28 February 2022

35. The social worker copied agency K’s request into Mr B’s care plan and sent the request to authorise the care plan to the budget holder on 28 February 2022.
36. The budget holder decided on 3 March 2022 that 6 hours was ‘not proportionate’ in assisting Mr B with written and verbal correspondence. The reasons were: ‘Support with managing finance is not required, this is clearly identified in the outcome that [Mr B] manages all his own finances. Translation with NHS appointment is not required because the service is accessible on request.’ The budget holder agreed to fund 2 hours support per week.
37. The social worker sent an email to Mr B and agency K on 10 March 2022 to explain why the care plan had been reduced to 2 hours. She said support to attend hospital appointments could not be included as the NHS would provide transport and interpreters. She said that the management of finances could not be included as Mr B had previously said he managed his own finances and payment of bills.
38. Agency K’s manager responded on 13 April 2022. She said:
• Mr B had been receiving 3 hours support under its Prevention Service for 12 months.
• Mr B’s mental health had started to decline in December 2021 and he started to self-harm.
• As a professional who worked with Mr B, she was concerned that the reduction to 2 hours would have a negative impact on Mr B’s mental health.
• She acknowledged that the NHS provided interpreters, but explained the difference between the role of an interpreter and a support worker at medical appointments.
• The interpreter just translated English into BSL. The support worker prompted service users to enable them to share information they may have forgotten; support workers took notes as service users were unable to do so and were often unable to retain all the information they had been given. Support workers created visuals and prompts to help service users understand and access information.
• In essence, the support worker ensured that service users had the same access to information as the hearing community did.
• In terms of banking, the manager said Mr B paid the bills, but the support worker had to set up online banking and direct debts as Mr B was not able to do this. When there were any problems with the online banking, the support worker had to resolve them.
39. The social worker responded and said she would discuss the response with her manager. The social worker discussed the matter with her manager on 3 May 2022 but the notes do not say what the response was.

Mental health request – 27 May 2022

40. The community mental health nurses emailed the Council on 26 May 2022 as they were concerned about Mr B’s mental health.
41. The email said: ‘mental health services believe [Mr B] would benefit from more support hours to help him rebuild his confidence and support him to access activities that are for his needs and enjoyment outside of the family unit.’ They asked whether the Council could re-assess Mr B’s needs.

Council’s complaint response – 21 June 2022

42. The Council responded to Mr B’s complaint from February 2022 and said:
• Mr B asked for an assessment of his needs on 15 April 2021 and the social worker spoke to Agency 2 on 12 May 2021. Nothing further was then done from 12 May 2021 until 28 September 2021 and the Council apologised for this.
• The social worker communicated with Agency 2 in October 2021 and carried out the assessment on 29 November 2021.
• The Council explained that social workers carried out the assessments, but they were checked by a Social Care Lead Officer (SCLO) who has to authorise them before they can then be sent for budget approval. The SCLO asked the social worker to make amendments on 7 December 2021 and was reviewed again on 5 January 2022 when SCLO told the social worker that a breakdown of the 6 hours was required. The social worker was then unavailable from 9 January to 15 February 2022 and submitted the assessment for approval on 28 February 2022.
• The budget holder did not approve the 6 hours on 3 March 2022, but approved 2 hours on 18 March 2022. The Council then had to obtain the actual figures from Agency 2 to start payments on 10 May 2022.
• The Council said there was ‘evidence of delays in completing and authorising a care and support plan for you.’ The request was made on 15 April 2022 and the plan was not put in place until 10 May 2022. There was delay at the beginning (May to September 2021) and then a further 9 weeks delay.
• It also said, ‘there were clearly occasions when communication from your allocated social care officer could have been improved’ and apologised that the communication ‘fell below the standard expected by Adult Social Care’.
• The Council had fed this back to the social worker’s manager who would monitor future performance.
• The Council upheld the complaint that Mr B’s support plan and care package had been ‘unreasonably delayed.’

Review of the care plan – 31 August 2022

43. A note dated 14 June 2022 showed that the social worker had not sent out the care plan yet and the plan was to send out the care plan and to carry out a review.
44. The social worker reviewed the care plan on 31 August 2022. The review includes copies of the email from the support worker dated 13 April 2022 and from the mental health team dated 27 May 2022.
45. The social worker noted that, since the completion of the care plan, there had been changes in Mr B’s mental health which were having a negative impact on him. Mr B wanted to access the community but was unable to do so without support. The mental health team had said that Mr B would benefit from additional support. The review concluded that that care hours had to be increased but did not specify the number of hours.

Agency K’s request – 15 September 2022

46. Agency K contacted the Council on 15 September 2022. The agency’s manager said 2 hours per week was not enough to meet Mr B’s needs and showed the hours the agency had provided per month:
• April, June and July: 8 hours
• March: 25.5 hours
• May: 10 hours
• August: 20 hours
• September: 15 hours (for half a month)
47. The manager explained that Mr B had numerous medical appointments to attend and explained the role of the support worker (as opposed to an interpreter) again. She said the lack of support and the lack of access to information was having a detrimental effect on Mr B’s mental health.
48. Agency K chased the Council for a response in the following months.

Mr B’s complaint – November 2022

49. Mr B took his complaint to the Ombudsman in November 2022. He said he had tried since June 2020 to have his needs met and this had still not happened. He complained about the delay, but also about the Council’s failure to understand his needs which meant it had failed to meet the needs.

Council’s care plan – 11 November 2022

50. The Council provided Mr B with a new care plan on 11 November 2022. The care plan says that the 2 hours support will end on 10 November 2022 and 6 hours support will start from that date. However, the Council has informed me that the support was increased to 4 hours.

The Council’s response to the Ombudsman

51. Mr B told me that one of the areas of disagreement was his need for a support worker to attend medical appointments. He said it was the Council’s position that an interpreter was sufficient and this was one of the main reasons why his care plan only included 2 hours support.
52. I asked the Council the question and the Council said it acknowledged that Mr B needed a support worker and a BSL interpreter at certain appointments such as medical appointments, to meet his needs.
53. I asked the Council why it had decided that Mr B needed 4 hours support whereas before it said he needed 2 hours support.
54. The Council said:
• It assessed Mr B on 7 December 2021 and the outcome was that Mr B’s needs could be met by 2 hours of support.
• In September 2022, Mr B’s support worker said there had been a decline in Mr B’s mental health and that the allocated hours were insufficient to meet his needs. Mr B was attending numerous medical appointments which required additional support.
• The Council reassessed Mr B on 9 November 2022 and concluded he now needed 4 hours of support.

Analysis

55. I have considered Mr B’s complaint about delay but also his complaint about the Council’s failure to properly understand, assess and therefore meet his needs. I note that the Council did not address this second complaint in its complaint response to him, but it should have done.
56. It is not the role of the Ombudsman to carry out an assessment of Mr B’s needs or to say what his care plan should be. I can only investigate whether the Council has properly assessed Mr B’s needs and has fully explained how it has reached the decisions in the care plan.
57. The Council has already upheld the complaint about delay to a large extent. In my view there was fault both in the delays to carry out the assessments and in a failure to properly explain how the decisions were reached in the needs assessments and care plan reviews.
58. The social worker assessed Mr B in July 2020 and said he needed 2 hours of support to help in communicating. However, the social worker failed to progress this assessment and to provide Mr B with the care plan. She failed to obtain the budget holder’s approval and failed to put the care plan in place. This was fault.
59. Agency K became involved in September 2020 and started to chase the Council for progress, but the plan was not further progressed which was further fault.
60. The social worker then said in January 2021 that the support Mr B requested ‘does not come under the social care remit.’ It appears that, at this stage the Council’s position had changed and it was not clear whether it still agreed that Mr B was entitled to 2 hours support. There was no explanation why the Council’s position had changed and why the July 2020 needs assessment had been superseded. There had been no further assessment of Mr B’s needs to explain this change of position. This was fault therefore, both in the further delay caused and a failure to properly assess Mr B’s needs.
61. Mr B sent an email on 15 April 2021 where he set out his needs for support and asked for a re-assessment of his needs. The social worker agreed to re-assess Mr B needs in May 2021 but failed to do so which led to further delay until October 2021 when the social worker started to organise the re-assessment.
62. There was also a linked concern that, at this stage, the Council did not fully understand Mr B’s needs as it was still the position that support to medical appointments could not be provided as the NHS provided BSL interpreters.
63. The social worker re-assessed Mr B in November 2021. In the assessment the social worker agreed that Mr B needed 6 hours support a week, but she did not put forward the request until 28 February 2022.
64. The Council explained, in its complaint response, why there was a delay between November 2021 and February 2022. I appreciate that there was a process of approval but I am of the view that a lot of this delay could have been avoided. For example, it was not until January 2022 that the Council decided that agency K needed to provide a further breakdown of the 6 hours which were requested in the care plan and the request was not made until 15 February 2022. Surely this need for further information should have been raised much earlier.
65. The budget holder rejected the request for 6 hours on 3 March 2022 and reduced it to 2 hours.
66. Agency K responded to the rejection of 6 hours in its email on 13 April 2022. There was no response to this email. The mental health team also asked for a review in May 2022 and provided its reasons. Both these emails should have triggered a review of the care plan or at least a substantive response to explain why the decision to reduce the care plan to 2 hours would not be changed.
67. The review was agreed in June 2022 but did not take place until 31 August 2022 so that was a further delay. This review noted that the care hours should be increased, but did not say what the increase should be. There was then a further long delay until November 2022 when the Council increased the care plan to 4 hours.
68. I have further considered the Council’s reasons for the approval of 2 hours support in March 2022 and the increase to 4 hours in November 2022.
69. It was difficult, from the documents to understand the reasons for the Council’s decision making.
70. The documents set out what Mr B wanted and included copies of the emails from his support worker (February 2022) and the mental health team (May 2022) but it was difficult to say whether the Council agreed with these requests and how it decided the hours.
71. For example, one of the main reasons the Council rejected the request for 6 hours was that it was the Council’s position that Mr B did not need a support worker at the medical appointments as the NHS provided a BSL interpreter.
72. The Council later said, in its complaint response to the Ombudsman dated 14 April 2023, that it had changed its position and had accepted that Mr B needed a support worker and not just an interpreter at medical appointments. However, the Council did not say when this change happened and why the care plan was not reviewed at that stage. I read through the documents and could not find the date for the change or how this affected the plan.
73. In its complaint response to the Ombudsman, the Council said it increased the care plan to 4 hours because of the information regarding Mr B’s deteriorating mental health and need to go into the community. But this information was provided in April and May 2022 so this did not explain why the Council waited until November 2022 to agree to the increase.

Injustice

74. I have considered the injustice Mr B has suffered as a result of the fault.
75. Mr B did not have any support between July 2020 (when he was assessed as needing 2 hours) and November 2020.
76. In November 2020 agency K started to provide Mr B with 3 hours support under its Prevention Service. Therefore, at that stage, the injustice stopped as agency K was providing the support, albeit not funded by Mr B’s direct budget.
77. It is our understanding that agency K continued to provide the 3 hours Prevention support until the Council then took over the payment of 2 hours support a week from Mr B’s personal budget (April/May 2022).
78. After April 2022, there was further delay and a failure to re-assess Mr B’s needs until November 2022. I cannot say, for certain what the care plan would have been if the Council had reviewed the care plan earlier, but it is possible that Mr B would have started to receive the 4 hours support earlier. The injustice was therefore uncertainty of what the outcome would have been if the review had taken place earlier.
79. The aim of the Ombudsman’s remedy is to put the complainant into the position they would have been if the fault had not happened.
80. Mr B says he still does not understand how the Council decided his care plan. I agree that it is difficult to understand, from the documents I have read, how the Council reached its decision that 4 hours would meet Mr B’s needs. I therefore recommend the Council reviews the plan. The Council should clearly explain its reasons for its decisions in the care plan.
81. In cases such as this one, where the complainant has not suffered a direct financial loss, we can still make a symbolic payment to reflect the distress suffered. I have taken into consideration the fact that Mr B’s support worker and mental health worker were concerned that Mr B’s mental health was deteriorating because of the lack of support. I have also considered the fact that Mr B’s children had to provide the support before agency K started to provide support. I recommend the Council pays Mr B £500.

Back to top

Agreed action

82. The Council has agreed to take the following actions within one month of the final decision. The Council will:
• Apologise in writing to Mr B for the fault.
• Pay Mr B £500.
• Carry out a review of Mr B’s needs and his care plan. In the documents, the Council should set out how it has decided the number of hours that Mr B requires to meet his needs.
• Ensure that relevant staff have received training on meeting needs of people who are deaf or have hearing loss.

Back to top

Final decision

83. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Back to top

Investigator's decision on behalf of the Ombudsman