Date of decision: 28 March 2025
Summary
This complaint concerned a Council’s sourcing a care home placement for an adult with high care needs. It took several months, with family members providing care in the interim. The Ombudsman found the Council acted appropriately and did not uphold the complaint.
What happened
The Council received a referral for an adult with escalating care needs in late February 2024, with family members stating they could no longer provide the necessary support.
The Council started an assessment straight away and completed its Care Act assessment in early May 2024, concluding that 24-hour care in a care home was required.
A month went by before Care Providers were contacted.
Over the following months, the Council contacted multiple care providers, including those preferred by the family, but none was found willing.
The Council told the representatives that the providers the family had suggested were far beyond what the Council could reasonably pay.
The Council also asked if the family would consider widening the search area or paying a top-up for more expensive placements; both were declined.
The Council offered interim support, such as respite care and a budget for 9 hours of dementia nurse input, but these options were declined by the family. The family said they felt that if their relative were to be placed in respite she would fall down the Council’s priority list. The family carers declined a carers’ assessment for their own support needs, and carried on caring.
A suitable provider was eventually found in October 2024, and the individual moved in at the start of November.
What was found
The Ombudsman found that the Council completed the assessment within a reasonable timescale and made consistent efforts to secure a suitable placement.
The Council’s offers of interim support and alternative options were reasonable and in line with statutory duties.
The family’s refusal of these offers meant the individual remained without formal care for longer, but this was not due to Council fault.
The Ombudsman concluded that the Council had acted lawfully and reasonably, balancing its duty to meet eligible needs with its responsibility to manage public funds.
No breach of statutory duty or unlawful conduct was identified, and no 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 any adult who appears to need care and support, regardless of the person’s own financial circumstances. Assessments must be timely, person-centred, and involve the individual and their carers.
Councils are required to consider the sustainability of informal care and the carer’s willingness and ability to continue. To a certain extent, ongoing informal care is an indication of willingness, but not when there is no end in sight!
When eligible needs are identified, councils must meet them, but are entitled to take cost and resource constraints into account in relation to HOW they meet those needs. Thus, when sourcing placements, they can decline to take up availability in very expensive placements, as long as they have an alternative that is available, adequate and suitable in relation to the whole extent of aspects of wellbeing that amount to relevant considerations under public law.
Offers of interim support in cases of genuine scarcity, must be genuine and appropriate to the individual’s needs. If the person has capacity to refuse those options, then they can, but that makes them even more dependent on their relatives. If their representatives have no authority to refuse, their refusal of options should not be treated as denying the person the means to have their needs met in the meantime.
Councils are not required to fund placements beyond what is necessary to meet assessed needs, and may lawfully ask families to consider top-ups for more expensive options that involve wants as opposed to needs.
This complaint should have been upheld. We say that without any doubt: the complainants got it right when they framed their complaint. They had already put the Council on notice that they could not cope any longer.
- The Council did not properly consider the level of care Mrs X needed when sourcing a suitable care provider.
- The Council’s offer of interim support was not suitable
- The Council should have increased its budget to find a suitable placement.
The investigator’s rationale for finding no fault skirts around the issue, which is a cost cap on what it would be prepared to pay.
“The Council has been able to show that during this time it
- was consistently seeking placements for Mrs X and discussing her needs with providers, [but not at what price, nor why providers refused to admit the person]
- asked if it could expand the search area, [despite suitability being affected by location, for both the wellbeing of the person and the family members]
- asked if Mrs X could pay a top up to expand which care homes it could consult, [despite top ups being for wants and not because care homes willing to meet need regard the council’s offer of a fee arbitrarily low for the level of needs involved!]
- offered Mrs X’s representatives carers’ assessments, [which are not a mandatory pre-condition before downing tools, for an overworked reluctant carer who has already put the Council on notice that they are not to be taken to be a ‘willing’ carer any longer!]
- offered to fund a dementia nurse to provide respite, [despite nursing not being something that a social services council can pay for and thus cannot fund via a direct payment, if it is really qualified nursing input that is required] and
- offered Mrs X a four-week respite placement [this is the only thing that we can say was a lawful offer to have been made as an interim solution, but we do not know about what charging regime the council would have applied…]
The Ombudsman said that the Council has a duty to protect the public purse and must make reasonable efforts to find a placement within the financial constraints it has.
This is not a proper statement of the law at all, and amounts to saying that the Council can apply a cost cap, regardless of the local going market rate for the level and type of care professionally assessed as necessary. It has been the law since 1997 that the discretion and the right to take one’s resource difficulties into account only arises if there is an adequate alternative option, either in a different sort of setting altogether, or (within a context where the care is going to be in a care home setting) at least one option that is adequate and appropriate within the personal budget set (rationally and lawfully) for the individual’s specific needs. One cannot work back from a personal budget which has in fact been set by reference to the Council’s blinkered view as to what the cost of care should be.
This case reinforces the importance of clear communication, transparency in decision-making, and the need for councils to document efforts to meet needs within statutory and financial frameworks.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s London Borough of Haringey (24 011 598) report.
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