Date of decision: 28 March 2025
Summary
The complaint concerned a council’s reduction of personnel involved in care at home for an elderly woman with poor mobility and very high care needs. The decision led to distress for her family, who believed it caused her harm. The Ombudsman found no fault in the council’s assessment or process.
What happened
Mrs Y, an elderly woman with significant physical health issues and poor mobility, lived with her daughter and son-in-law, Mr and Mrs X. Mr X held a welfare power of attorney for his mother-in-law. Her daughter, Mrs X, had needs for care and support in her own right, and Mr X provided informal support to both.
In spring 2023, Mrs Y was hospitalised with a chest infection, returning home in July 2023 with six weeks of reablement support.
Following a significant health decline, Mrs Y received 24/7 care from two care workers, one for daytime, one for night-time, both due to her high risk of falls and poor mobility.
In February 2024, an Occupational Therapist (OT) assessed Mrs Y and recommended a hoist for transfers. Care Provider A insisted two care workers were needed for hoisting and requested extra funding, which the Council initially approved, pending a care package review.
In June 2024, the OT and social worker reviewed Mrs Y’s care. The council’s OT determined she could be safely transferred by one care worker, demonstrated this, and advised that single-handed care would better manage her pain and provide more privacy and flexibility – because it would mean that particular tasks did not have to be done on a schedule.
The social worker completed a decision support tool (a document used to assess whether a full assessment for NHS continuing health care funding is needed) and it was later decided she was not eligible for continuing health care funding. [The report says nothing about whether a contribution was then agreed to what was a very high cost care package, from the NHS under s256 of the NHS Act 2006.]
The OT noted that as long as what was happening was explained to Mrs Y it was safe for one care worker to do the moving and handling – she still had capacity to co-operate. The OT advised the care workers to change her routine and provide personal care later on, when her pain was better managed.
Care Provider A brought in its own moving and handling trainer to assess the risks of using one care worker.
The Council [it may have been the commissioning team rather than the care management team, but the report does not say] told Care Provider A that care was funded based on need not on provider company policy. The night time provider agency was managing the needs without difficulty with one care worker.
The social worker completed Mrs Y’s care plan.
The possibility of needing to move the care from the daytime provider generated a willingness to negotiate further and the Provider said it would provide one to one support subject to the right training and risk mitigation. The Council agreed to keep the second care worker coming in until the staff had been able to complete training. [The report does not say whether any increase in fee was negotiated or whether the extra training was funded by the Provider or the Council.]
Mrs Y agreed to be hoisted and the OT demonstrated how to do this single handed. Everyone noted that tasks may take longer but this may be beneficial as Mrs Y experienced high levels of pain and reducing the pace may help alleviate this. They also said this allowed for increased privacy and dignity, and increased flexibility as care could be provided at any time rather than set times in the day.
Care provider A updated the Council following the visit and confirmed that staff had attended the office to receive training and it confirmed double up support could end.
Mrs Y passed away several days later and Mr X complained to the Council citing costs concerns as the real agenda behind the move.
The Council explained the actions it had taken and that Mrs Y had the mental capacity to understand and cooperate with the process and that the option taken was the least intrusive option.
What was found
The Ombudsman found the Council followed correct procedures in reassessing Mrs Y’s care needs and in involving relevant professionals.
Mrs Y still had capacity to consent to being cared for through being hoisted, so her agreement was sought rather than her welfare power of attorney holder.
The Council responded appropriately to concerns, provided additional training, and only implemented changes when the care provider was satisfied.
There was no evidence the decision was motivated by cost, nor that the change contributed to Mrs Y’s death.
No fault was found, so no remedy or compensation was recommended.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
Under the Care Act 2014, councils must assess adults with apparent care needs (sections 9 and 10), regardless of finances, and must involve the individual and relevant others in the process.
Councils are required to keep care and support plans under review (section 27), with statutory guidance recommending at least annual reviews and timely responses to requests for reassessment.
This report illustrates the importance of thorough assessment, clear communication, and involving all parties—including care providers—in decisions, while ensuring that statutory duties and individual rights are upheld.
The Ombudsman will not substitute its judgment for that of the council if the correct process is followed, even where there is disagreement with the outcome.
It is telling that it is not actually possible to be SURE whether the family was funding the night time care as a top up, quite separately from the day time care, but the inferences one would draw from the report are that the Council was commissioning all of it.
In our experience, most councils would long since have moved a person with this profile of need to a care home, and whilst it might be noted that the cost of the additional carer for particular tasks may well have been the trigger for re-assessing this woman, that is not unlawful at all. Councils are allowed to take account of the cost of two different ways of meeting need, as long as both are appropriate in terms of professional judgement and therapeutic impact, and choose one rather than the other, as long as it is not always the cheapest. So in that context, the extra dependency reflected a change in circumstances which drove the interim arrangement pending the insistence that the Care Provider make its election: do what it was commissioned to do, in the way that was being asked for, through the care plan review, or else make way for a provider who would oblige.
That is how social care commissioning should work, with professionals responsible for care planning actually taking that role on, and owning it in full! We would like to have been told, though, whether the extra skill required for the single handed management of the needs was funded with an increase in the hourly rate, or a contribution to the training costs for the Care Provider!
We also note that the NHS could well have decided to make a contribution to the cost of the care given that the need was clearly underpinned by health needs, and health condition management requirements, even if the woman did not qualify for CHC.
We do not often see Telford & Wrekin complained about and we think that it must be abiding by the Care Act in a generally more legally literate way than those who appear regularly in the LGSCO reports.
We would say full marks to the OT, here, and to the council for NOT simply reverting to the care home option.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Telford & Wrekin Council (24 012 629) 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.
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