Decision Date: 1 July 2024
Summary
The Ombudsman’s Investigator found fault in the manner in which Wiltshire Council provided care and support for Ms X, who had complained that the Council was failing to meet all her care and support needs.
What happened
Ms X is blind and has other physical disabilities which affect her mobility and ability to lift and carry things. She lives in her own home with support from the Council. She uses a walking frame inside her home and a wheelchair elsewhere.
Her June 2021 care and support plan stated that she was entitled to a direct payment to help her make use of community resources. The Council’s payment was intended to allow Ms X to:
- Go shopping (two hours per week).
- Go to the gym, an internet cafe, attend medical appointments or go on day trips (three hours per week)
- Attend religious services (five hours every four weeks).
Ms X requested an additional three hours per week to attend the gym, and so in October 2021 the Council reassessed Ms X’s needs. That assessment found that Ms X needed support in a number of areas of day-to-day life, as well, and so arranged a commissioned care package for a care provider to meet Ms X’s needs at home, including dressing, preparing and eating meals, cleaning and taking medication.
The Council also continued giving Ms X direct payments so she could arrange her own support to make use of activities in the community. The payment scope was altered a little and now specified to cover:
- Going shopping and attending medical appointments (three hours per week)
- Visiting the gym (five hours per week, including three additional hours requested by Ms X’s physiotherapy team)
- Five hours every four weeks to attend a religious service.
The Investigator noted that the Council’s documentary record of the care funding provided to Ms X was inconsistent: the Council claimed in October to have increased Ms X’s time to go to the gym by three hours, but only did so by two. But in January 2023, the Council’s own records showed that they were providing only two hours in total, suggesting an error in the Council’s records here or the October 2022 entry.
Ms X’s legal representative complained on her behalf that her care needs were not being met satisfactorily. The Council had responded in March 2022, stating that Ms X would receive a payment to cover:
- Shopping (three hours)
- Gym and physiotherapy (seven and a half hours)
- Cleaning (one hour)
- Attending religious services (five hours a month).
The Council also informed Ms X that they had suspended her direct payments to prevent a build-up of funds, as she had not been utilising them. This was because Ms X had gone into hospital for a period, and then had not been able to secure suitable support through her care agency.
By September 2022, Ms X informed the Council that she had only been out of her own home three times in the past year (excluding shopping and medical appointments).
The Council engaged with Ms X again in December 2022 to produce a care plan setting out how she liked to be supported to be given to her care assistants. The next month, the Council informed Ms X of a social club she could attend, but she responded that she wanted to go out in the community and participate in her chosen activities, not attend a social club.
In February 2023 Ms X was reassessed by the Council once again. Her needs had not changed. This assessment found that Ms X had arranged for her own care provider to support her with shopping, medical appointments and attending religious services, but that care provider did not ultimately have the time to support Ms X in other activities. As a result, Ms X had not been to the gym for some time. The assessment also noted that Ms X had had problems in recruiting and retaining personal assistants and that the Care Provider could not support Ms X in the long term.
The Council agreed to pay her the direct payments portion of her budget at a higher rate so that she could contract with a care agency rather than at the lower personal assistant rate.
The Council’s own records revealed repeated failures properly to deal with Ms X’s complaint in 2023. Her Care Agency contacted the council three times in April and twice in May, but there is no evidence of the Council responding. Charities, care coordinators and community support practitioners all tried to raise Ms X’s case with the Council, but there is no evidence of the Council having responded substantively. The Council also failed to respond to the Wiltshire Centre for Assisted Living, which had asked if Ms ‘s direct payment was being paid at the agency rate and what her client contribution was.
What was found:
The Investigator identified two clear faults on the Council’s part. First, poor record keeping by the Council meant there was conflicting information about how much support Ms X was receiving. Second, there was little evidence of the Council engaging with Ms X or those who contacted the Council on her behalf during 2023.
The Investigator also claimed that Ms X’s care plan required a long-overdue review. The Investigator stated that Councils must conduct a review of an individual’s care plan when a reasonable request to do so has been made, referencing s27 of the Care Act, and the steer in the Guidance to a light review following the finalisation of a plan and personal budget. This had not occurred in Ms X’s case, with the Investigator noting that it had been over a year since the Council last reviewed Ms X’s needs.
The Investigator recommended that the Council apologise to Ms X, pay her £300 for her time and trouble, as well as reassessing her needs, updating her care and support plan, and adequately addressing her request for additional support, the Council being asked to provide evidence to the Investigator that it had done so.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public:
The Investigator identified a number of serious faults with the record keeping and communication practices of the Council in this report. But the investigator makes only one mention of s27 of the Care Act which is the source of the explicit statutory duty to review and the bottom line as to what must happen before any revision is made to anyone’s plan, whether for care or for support.
It’s true that there is no requirement of writing for a review or for written reasons as to the decision whether or not a plan needs to BE revised, but public law principles underpinning the Care Act, and basic common sense with regard to the scope for this sort of mess, if nothing is written down, should surely be enough to make writing up the review an obviously essential aspect of the process!
The communication issues in this case snowballed, and efforts to rectify Ms X’s situation by the Council were hamstrung by their poor record-keeping.
The report also demonstrates the limits of direct payments: direct funding and all the choice in the world is only useful when there is a suitable service provider available. Ms X’s care provider was not able to provide her with the assistance she required and received funds for.
Similarly, the Council’s suggestion that Ms X attend a social club, rather than pursue her own preferred community activities, was somewhat insensitive and unhelpful. There may well have been available assets in the community but the whole point of a direct payment is that it’s a compromise between person-centredness and the problem that if someone only wants to engage in expensive or unavailable activities, they have to manage within a reasonable and defensible amount for that aspect of their needs, because there is no obviously right or wrong answer to how much fun or how much respite is enough to make the impact of the disability or the caring, less than ‘significant’.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Wiltshire Council 23 014 484 report.
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