Suffolk at fault for a long review process and assessments that weren’t joined UP

Decision Date:  4 November 2022

What happened

Mrs C complained about how Suffolk had handled her brother, Mr E’s, review and their mother, Mrs D’s, carer assessment. She also raised issues with how the Council approached Disability Related Expenditure and charging, what was included in its transport policy, and how Mr D could use his Direct Payment.

Mrs D had a review of her needs as a carer in June 2020. This was followed by a review of Mr E’s needs in August and a follow up in September. Discussions about what Mrs D and Mr E needed were not joined up; Mrs D needed a break but the Council were talking about replacement care for Mr E rather than continuing with respite holidays.

A number of other unresolved issues came up during the review process and went on through further meetings (in September 2020 and February and March 2021) and through emails:

·       Mrs D asked Mrs C to manage Mr E’s direct payment and the Council said they needed to do a Mental Capacity Assessment on this decision

·       The Council later said they needed to do another MCA about whether Mr E could understand and consent to his care and support plan

·       The Council wanted the family to use Mr E’s motability car to transport him but the family said they were only allowed two drivers on the insurance

·       The family used direct payments to pay for the petrol but the Council said this was a universal cost that anyone would have to pay

·       The family asked for funding for Mr E’s dog but the Council said this should come under Disability Related Expenditure

·       The family used direct payments for Mr E’s oral hygiene, massage and chiropody appointments and the Council said these were health needs and could not be funded by adult social care.

The council asked for additional information including a breakdown of holiday costs, a diary of motability car journeys and expenses related to health needs.

During the year or so that the review went on, at the family’s request, the carer’s assessment for Mrs D was completed fully and some additional support agreed.

The care and support plan was finally sent in April 2021. After some to-ing and fro-ing, it did not include health needs; however, podiatry could be funded through DRE.

A new wash/dry toilet was requested by Mrs D in April 2021 as this was not working and causing stress. The Council did not agree to using the direct payment for this, and arranged an occupational therapy assessment. This took place in July and a new toilet was recommended and installed.

The financial assessment was delayed due to misplaced paperwork. When completed in July 2021, Mr E did not have to pay for care and support.

An updated plan was sent in August and a final plan in December. This followed a complaint process, an apology for delay and poor communication, and agreement in future to complete the carer’s assessment alongside the review.

There were further queries from the family, including about the dog, and the care plan was finally accepted on 17 January 2022. As an addendum, training for the dog was funded in May 2022.

What was found

The Ombudsman’s findings were mixed.

The Council’s review process was not timely. The carer’s assessment from June 2020 was not full enough and should have been done alongside Mr E’s in the first place. There was stress placed on Mrs D, due to the delay in replacing the toilet.

However, the Council was not found at fault in asking for additional information about motability use, completing two Mental Capacity Act assessments, saying the dog did not meet an eligible need, or not funding health services. The Council tried to facilitate referrals for health services.

The family’s concern that Mr E didn’t have enough money to cover his Disability Related Expenditure was not a fault of the Council as it was not asking for a contribution to care and support and can only provide for assessed eligible needs. If there is no charge, there is no offset able to be made.

The Council should have ensured the family had good information about what they could use the direct payments for, to avoid issues.

The Ombudsman asked the Council to apologise and pay a small sum to Mrs C and Mrs D for the frustration, upset and distress caused.

Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public.

For details as to how the treatment of various items of need or expenditure were regarded as properly treated or otherwise, please look at the full report via the link at the bottom.

A piecemeal approach by Suffolk ended up taking a year and a half, including complaints and LGSCO investigation, with input from multiple people. This shows that when a busy Council tries to do a bit here or there just to keep things pushing along, it not only misses opportunities to join up its own processes but can end up paying out as a result.

Unless it is something which the people themselves don’t want or is otherwise high risk for a council we think it makes most sense for them to do their needs assessments and carers’ assessments together. Otherwise, how can they make sensible decisions about meeting the person’s needs if they don’t know which, if any, of the eligible needs the carer will meet? And how does one know how to explore what the unpaid carer might be willing and able to do differently, and more beneficially, if one doesn’t know what the deficits and difficulties are?

We come across many situations where carers are not offered assessments or their needs and wishes are just not considered. Everyone needs to know to ask for a carer assessment and this must be meaningful and integrated to what else is happening, not just about a voucher for a spa day, some day soon, if and when the nationwide workforce crisis ends.

For as long as direct payments have been around, councils have agonised about what they can be used for. They are supposed to allow people to choose how their needs are met and they may be used in any way that meets needs in the care or the support plan. Timely discussions about the parameters of direct payments are essential or everyone gets confused. But it is worth pushing local authorities to allow creativity and flexibility, as this is exactly what direct payments were designed for.

Finally, the LGSCO says that the Council can only provide for assessed eligible needs. But of course it has a power to meet other needs if it wishes. It would be a bad thing if we all just accepted the idea that Councils would never consider meeting anything but the most vital needs covered by the domains in the eligibility criteria. Worse, if the idea took root that this is all they have the authority to do: section 19 should always be considered by a panel or decision-maker – and reasons asked for, as to why the power is not thought to be appropriately used, in the client’s situation. Otherwise the concept of ‘best value’ could lose all meaning.

If you want help, please consider seeking advice from CASCAIDr via our referral form on the top bar menu of the site.

The full Local Government Ombudsman report on the actions of Suffolk County Council can be found here: https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/21-016-450

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