Decision Date: 7th March 2025
Summary
Complaint was made about the Council failing to make adequate arrangements for the delivery of a care plan for a person with a diagnosis of mental ill-health and an underlying physical disability.
What happened
Ms B has a mental health diagnosis as well as an underlying condition which is described as having an impact on her mobility.
Ms B spent August through to December 2023 in a mental health hospital. At the hospital various professionals conducted assessments in order to construct a care package which would meet the needs of Ms B for her discharge. She does not appear to have been entitled to s117 aftercare services.
Ms B had a meeting with an occupational therapist on October 6th 2023 where her mobility was assessed. The therapist positively noted that Ms B was able to mobilise without her zimmer frame even if she chose to use one, and recommended she try to walk with a stick instead. The therapist noted she could dress and feed herself independently. She was also described as having “shown a capacity to develop and consolidate occupational performance”.
On the other hand, Ms B was incontinent and had declined the offer to investigate this aspect of her difficulties any further, such that the occupational therapist regarded her as unlikely to achieve further independence here.
Ms B was known to have a high level of anxiety about general skill level with regard to planning and sequencing of tasks, the report noted.
Ms B told the therapist that she would like 7.5 hours per day of input. It was felt that as she had already displayed a good ability to develop and consolidate further skills, 7.5 hours a day was not recommended as it would not allow for Ms B to further develop her occupational skills.
The therapist recommended for Ms B should try a care package consisting of two daily 45 minute visits (one in the morning and one evening) along with a separate 90 minute visit once a week. The package would offer Ms B personal care, management of shopping and would also give Ms B the ability to further develop her occupational skills.
A further assessment from the Council in early December 2023 led to the completion of Ms B’s Care Act care plan. She was eligible with regard to maintaining a habitable home environment and a number of other domains (personal care and continence, managing her nutrition). The package consisted of one 60 minute and two 30 minute visits per day as well as one weekly visit of 45 minutes for shopping. A one-off clean of Ms B’s property was also offered.
A review of the care plan was carried out on 19th February 2024. Ms B commented that the visits did not include enough time and that the workers were “too slow”. Ms B declined to participate in the formal review of the plan. She made it clear she would not be paying for her care.
Following this, the care agency working with Ms B contacted the Council. They described how Ms B has refused care workers, displayed aggressive behaviour towards the workers and was using the care plan solely for shopping and cleaning. The agency said it was unsure it would be able to remain with Ms B due to her behaviour.
The Ombudsman referred a complaint direct from Ms B to the Council. It said that the Council had failed to arrange a suitable care plan for her following her discharge from hospital. Ms B also requested an advocate to support her as the Council were pursuing a debt of £38,000 owed to them by Ms B.
The Council contacted advocacy agencies on behalf of Ms B on 27th March 2024 and issued a formal complaint response on April 12th 2024. The response urged Ms B to engage with the care package process so that it could be seen if that assisted in securing the best outcome. The Council also wrote off the debt of £38,000 owed to them by Ms B.
What was found
The Ombudsman found no fault with any of the Council’s exchanges with Ms B.
No fault was found with the manner in which the Council assessed Ms B on December 6th 2023. Both her needs and the opinions of professionals were accounted for when deciding the care plan. This is evidenced by the fact that the care plan was more extensive than the one originally suggested by the occupational therapist, showing an attempt to engage with Ms B’s views of her needs.
In addition to this, the Ombudsman also acknowledged that the provision of the care was not implemented neglectfully. A review in February 2024 was attempted (in line with statutory guidance) but Ms B refused to participate with this review, through no fault of the Council or anyone else involved.
The ombudsman concluded that the Council and all other professionals tried as best they could in order to assist Ms B and that all relevant statutory guidance was followed. The fact of the waiver of £38,000 was also noted but not commented upon.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
Promotion of well being is the underlying general duty of local authorities when arranging care and support for individuals. ‘Wellbeing’ within Section 1 of the 2014 Care Act is not just an exercise in providing an individual with whatever it is they wan or personally think would be the best for them, however.
The Council was not regarded as responsible for any wrongdoing in the way they handled the care package. The relevant professionals were consulted (Chapter 10.31 Care Act Statutory guidance) and from what we can tell, Ms B was actively involved in the process throughout, even though she chose to not engage with it.
If the Council had only considered the suggestions of Ms B for shaping its decision, the package would not have been an effort to genuinely promote her well-being. An excessive care package can be de-skilling, much as one might appreciate the care.
The individual should be provided with control over their day-to-day life (Section 1(2)(c) Care Act) but does not get to tell councils what they must do: that is a professional decision, using values, judgment, experience and knowledge of what is working for other people.
The Council based its plan on an active effort to maintain and hopefully improve her occupational skills and functional ability. This decision was based on the evidence given by an occupational therapist who said that she had “shown a capacity to develop and consolidate occupational performance”.
The Council acted in line with both the statute and the best interests of Ms B, even if that meant to offer her less support than what she initially requested.
It does seem as if the Council here acted in a professional way regardless of Ms B’s debt and her refusal to pay her charges. The Ombudsman recorded that the Council and the agency had to balance the duty to provide a care package to Ms B, with its duties towards its employees, regarding the aggression that Ms B sometimes displayed.
There is a question to be raised about whether the Council should have acted sooner with referring Ms B to an advocacy agency. A referral was made on the 27th March 2024 (we believe the ombudsman has made a typo when mentioning the advocacy referral, saying ‘2023’ instead of ‘2024’), by which it should have been somewhat clear that Ms B was failing to engage with the plan.
Based on the facts it is not clear as to whether Ms B would have fallen into Section 67(4) of the Care Act prior to her request for an advocate on 15th March 2024. Where it thinks that the lack of an advocate is affecting an individual’s ability to engage with the process in one of a number of ways, an advocacy appointment should be considered by the local authorities (Chapter 7.22 Care Act Statutory guidance).
Unfortunately, the Ombudsman keeps the facts and discussion on this matter to a minimum. We are not told whether the Council at any point prior to March 15th considered the appointment of an advocate for Ms B. We also are not told whether Ms B’s circumstances changed leading up to her request and it may have been the situation that a relative was no longer able to advocate on her behalf.
These uncertainties do raise questions as to whether Ms B would have been more willing to engage with the support plan from the beginning if she was represented by someone willing to assist her through the process.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s London Borough of Ealing (23 020 398) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
Did you enjoy this analysis? Want to stay informed with our weekly Alert Service?
Then do click here to find out how you can receive the latest insights from experts and commentators and stay updated on key judicial decisions, ombudsmen’s reports, and critical law and policy changes, all for just £50 per YEAR and sent straight to your inbox or WhatsApp!