Lincolnshire County Council at fault for its delegate, the Partnership Trust, delaying an increase of care and support hours, following several safeguarding referrals

Date of decision: 13 April 2025

Summary

A disabled woman with complex mental health needs was left without the care and support she was entitled to after moving into a new council area, contrary to the Care Act. The Council (through its delegate, the Partnership Trust, as a s75 partner) failed to ensure her needs were being fully met, following a Care Act assessment, resulting in distress and a negative impact on her wellbeing.

What happened

In April 2023, Ms X arrived in the Council’s area, presenting as homeless and requiring adult social care. The District Council accommodated her in a hotel pending its own inquiries under the Housing Act. The Trust could not complete a Care Act transfer, under the continuity of care provisions in the Care Act (s37), due to her refusal to share information from her previous authority, so it arranged a new assessment. 

The process was delayed by difficulties arranging advocacy and her consent for information sharing. 

During the first stage of her assessment in May 2023, she was not provided with a Care Act advocate but was nevertheless asked about her views on her needs. 

The first meeting took place in her family member’s home who also attended. No Care Act advocate was in place, and two Trust officers attended. The notes showed:

• Ms X wanted supported living and freedom, rather than residential care or her own tenancy. 
• She felt she needed support to check on her and 1:1 support with some needs, in and out of her home. 
• She wanted consistency in carers and for carers to be familiar with her conditions and needs.
• Two friends were currently in the process of obtaining power of attorney for her health & welfare and her finances. 

The Trust found Ms X was currently low risk to herself and was independent in several areas, but had eligible needs. It had no concerns about her ability to manage the hotel accommodation. However, a further visit and more information was needed to complete the assessment.

In terms of care planning, initial care support was set at three hours per day, and later increased to six hours following safeguarding concerns and a hospital admission.

Throughout the following months, there were problems with the consistency and adequacy of care providers, changes in accommodation, and communication with Ms X. She continued to experience distress, hospital admissions, and periods without appropriate care until emergency respite was arranged in November 2023.

Ms X’s complaint was that as a result, she became isolated, her mental and physical health was impacted, and she experienced distress and uncertainty.

After 6 months of failed arrangements with providers and liaison with the district council, In November 2023 emergency services found Ms X in a flat that she had been persuaded to take a tenancy of, in a poor condition. She expressed a willingness to consider respite care. The Council found a placement and she moved in soon after.

What was found

The Ombudsman found fault and service failure by the Council for not involving an advocate at the start of the assessment, failing to provide consistent and adequate care as set out in the care and support plan, and missing opportunities to arrange respite care even when recommendations to this effect were made by an advocate. 

But the lack of an advocate was not the reason for why a limited amount of care was set out in its initial care and support plan. There were several other reasons for the 3 hours a week being thought to be enough.

• Ms X had not agreed for the Trust to obtain information which was already available about her care and support needs;
• The Trust obtained Ms X’s wishes and views, including what support had worked or not worked in the past;
• Ms X said she had friends who were in the process of obtaining power of attorney to support her with health & welfare and financial matters;
• Ms X had some support from her previous carer and her previous advocate, and the Trust considered the information provided by that person. 
• It also made a referral for an advocate who became involved at the end of May 2023
• The Trust had made referrals to get Ms X registered with local services to provide her with further support
• The Trust then had to ensure the provider was familiar with her reasonable adjustments, could meet her needs, and the care staff it allocated had the appropriate training. 
• As part of this process, it had to obtain Ms X’s consent to share her information, Ms X wanted to have a visit from the provider, and it had arranged for training for the Care Provider Y.

The increase in hours did not happen until formal safeguarding referrals were made and she was admitted to hospital. 

The evidence showed that the extra hours acknowledged now to be needed could not be provided as Care Provider Y was not able to do so at weekends; nor at all once Ms X was moved to another hotel in another area by the district council, and not at all once provider Z was selected because she did not ‘consent’.

Although the Trust faced challenges due to Ms X’s changing accommodation and her refusal to consent to certain providers, it was not unreasonable for her to seek support that better met her needs. Care provider Z did not appear to have had the same level of experience regarding Ms X’s specific needs, nor the training which care provider Y had received and Ms X had to repeatedly try to get her carers to understand her specific needs. 

The investigator did not regard the Trust staff to have failed to make reasonable adjustment in relation to its own dealings with her.

However, the investigator found it not unreasonable for Ms X to refuse some care and support offered; this was therefore service failure and resulted in distress and an adverse impact on her physical and mental health between July and October 2023.

The Ombudsman recommended the Council apologise for its delegate’s faulty delivery and pay £500 to acknowledge the loss of care and support. The Council was also told to review its provision for domiciliary care and respite placements, because it had had a duty to consider whether it should provide her care and support in a different way. This could have been in a care home or through temporary respite care. The evidence shows the Trust did consider this and sought placements for her, but it was unable to source any placement which had availability, could meet her needs, or had not already refused her. This was a service failure in its own right.

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

The complaint was late but the LGSCO exercised discretion as Ms X had initially asked the Parliamentary and Health Service Ombudsman to consider her complaint which caused a delay – which is understandable, because nobody would know that the NHS Trust was discharging Care Act functions on behalf of the Council, which remains liable for the Care Act duty in any event.

The Care Act 2014 requires councils to assess any adult who appears to need care and support, regardless of financial circumstances, and to involve the individual and any carer or anyone else they wish to be involved. Assessments must be timely, involve the person, and consider their wellbeing and desired outcomes. Care and support plans must be co-produced, include a personal budget, and be responsive to changing needs. 

When a person moves between council areas, there are statutory duties to ensure continuity of care (section 37), but they do depend on the destination council knowing that the person is on their way. 

Councils must also consider reasonable adjustments for communication and mental health needs, and ensure advocacy is provided where it is triggered by the concept of the person’s substantial difficulty engaging in the Care Act processes of assessment, care planning or revision (regardless of having a willing relative) without one being appointed. 

The failure to provide adequate care and support, or to arrange advocacy, is a breach of statutory duty.  It renders the assessment invalid, in community care and public law and that has been the case since the Haringey judgment in 2015.

Councils must have sufficient provision for domiciliary care and respite options to meet assessed needs, including for people with complex or fluctuating requirements. Inadequate support undermines rights, wellbeing, and public confidence in social care, and can lead to distress and harm. Councils should ensure robust systems for assessment, care planning, advocacy, and service provision, and act promptly where needs are unmet or support arrangements break down.

No thought seems to have been given to this woman’s mental capacity, with regard to what appears to be a complex mental health problem of a long-standing nature and which may have been affected by autism.

And yet her refusal to consent to information sharing was simply accepted, as justifying leaving her without care.

That is a stance that should only be taken if there is no concern as to capacity.

But of course if someone is being told that their consent to information sharing is necessary before they can receive care, they are not likely to be able to make an informed decision in the first place.

They can of course refuse a service, but information sharing is not quite the same: there is express provision for sharing information with providers under the Care Act regardless of capacity to consent, so that they can do a decent job! 

We can’t be sure that this was a person where the specialist care provider was being regarded as the real expert for care planning, but Section 25 provides as follows:

25(7) The local authority may authorise a person (including the person for whom the plan is to be prepared) to prepare the plan jointly with the authority.

(8) The local authority may do things to facilitate the preparation of the plan in a case within subsection (7); it may, for example, provide a person authorised under that subsection with—

(a) in the case of a care and support plan, information about the adult for whom the plan is being prepared;

We thought it of note that the Council made a referral for a Transforming Care team to access other health services. This suggests to us that she may have had s117 status which is something that would have changed the legal framework, under which her care was being provided; would have made her first approach to the PHSO appropriate because section 117 is a joint duty owed by both the council AND the ICB.

We also think it is interesting to note that the Council does not have the legal power to accommodate directly through social services, since the decision of the Court of Appeal  in Campbell in May 2024, which was decided on the basis that it would mean disabled people would jump the Housing queue. 

That is why the Ombudsman says that the only other options were temporary respite in a care home.

However, that is not the case if she was either without mental capacity to contract for a tenancy, or was in fact a s117 aftercare recipient. If she was not, we do not know on what basis the Transforming Care Team would have accepted a referral. 

Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Lincolnshire County Council (24 003 962) report. 

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