Date of decision: 18 March 2026
Summary
An adult woman with physical and mental health conditions asked the Council for a Care Act assessment and a substantial personal assistant package but instead experienced a lengthy, confusing process and unclear messages about what support she could expect. The Ombudsman found the Council’s poor communication, especially about the possible outcome and the role of her partner’s care, caused avoidable distress, and ordered an apology, an explanation and £150 for that injustice.
What happened
Miss B, an adult woman with mental and physical health conditions, lived with her partner, Mr C, and asked the Council to assess her needs for care and support under the Care Act 2014. An occupational therapist (OT) assessed her in November 2024, and on 23 December 2024 a social worker visited her to start the Care Act needs assessment. The next day, 24 December 2024, Miss B emailed the social worker setting out a proposed care package of 37.5 hours per week from a personal assistant to help with morning routines, housework, study support, dog training, meal preparation and transport to social, leisure and medical appointments; the social worker asked for more detail on how hours would be used each day, which Miss B provided.
Because Miss B had mental health conditions, the social worker contacted the Community Mental Health Team (CMHT) so Miss B’s community mental health practitioner could contribute to the Care Act assessment.
On 8 January 2025 the CMH practitioner visited Miss B, then emailed the social worker saying Miss B did not believe she had mental health problems and instead believed she had autism and ADHD, that she was “totally dependent” on her partner for emotional, physical and daily living needs but could in fact complete those tasks herself and “chooses not to,” and that Miss B appeared to think a full-time personal assistant had been approved when funding responsibility between mental health and social care had not even been discussed. The social worker and CMH practitioner planned a joint visit on 23 January 2025, but this was cancelled as Miss B was unwell, and the joint visit eventually took place on 6 February 2025.
In February 2025, the OT sent Miss B’s assessment to the social worker, summarising that Miss B did not engage in preparing food but had the physical capacity and functional ability to go to the kitchen and complete tasks; that no kitchen assessment was done because the main issues concerned fainting and reported problems which might affect her physical, emotional and self‑efficacy aspects of wellbeing, and that a shower board had been provided and Miss B could transfer in and out of the bath shower and did so when Mr C was at home. The OT recorded that Miss B could dress and undress. Furthermore, Miss B often did not take medication even when prompted by an AI prompter or Mr C and that a medication device had been suggested but Miss B declined it because of the impact on her OCD symptoms.
Separately, the social worker asked the Council’s Outreach service to assess whether it could support Miss B, and Outreach visited her on 25 February 2025. Outreach reported it had offered support with kitchen skills but Miss B said she could not stand for long; when Outreach suggested she could sit while preparing food, Miss B said chemical sensitivity and an eating disorder meant she could not be around food, and she likewise declined offers of support with shopping, community access and travel to appointments because she said she could not stand for long and had incontinence issues that prevented bus or taxi travel, leading Outreach to conclude there was no support it could offer.
On 26 February 2025, Miss B complained to the Council that over about two months with multiple visits there had been excessive delays in her Care Act assessment. The cause of the delays were due to uncertainty and disputes over whether adult social care or CMHT should fund her care package. Miss B argued that eligibility should be based on needs not funding availability and she stated that Outreach had confirmed it could not support and they told her she needed a personal assistant. Also, Miss B complained that the CMH practitioner made inappropriate and distressing statements at the last joint visit.
On 5 March 2025 the Council replied saying it had forwarded her complaint to CMHT’s complaints service, but Miss B immediately submitted a further complaint insisting her concerns about the Care Act assessment were the Council’s responsibility rather than the CMHT’s. Further, Miss B requested an urgent response, and threatened legal escalation if the Council did not respond. The Council then agreed it would respond to the elements relating to the Council’s role.
In March 2025 the social worker completed Miss B’s Care Act needs assessment. The assessment recorded CMHT’s views, including that the CMH practitioner had reported Miss B could complete daily living activities without difficulty and, during the joint visit, had told Miss B she was able to manage activities of daily living but chose not to engage, which Miss B disputed. The social worker also incorporated the Outreach email, after checking Outreach’s recollection, and recorded that Outreach did not recall telling Miss B she definitely needed a personal assistant, contrary to Miss B’s account.
The social worker considered support with medication, suggesting assistive technology involving a virtual care worker telephoning Miss B for 10 to 15 minutes to prompt and supervise medication, and explained this would involve a real person calling; Miss B said she would find this intrusive and would have to remember the calls but accepted that a call to her mobile might help, and she agreed to provide updated information about her changed medication and medical history.
The social worker then applied the Care Act outcomes and decided Miss B had one eligible need – maintaining a habitable home environment – while noting that Mr C provided support with nutrition and food shopping (where Miss B cited executive dysfunction and limited standing tolerance, contrasted with the OT’s view that she had physical capacity and no cognitive impairment affecting meal preparation), personal hygiene (where Miss B reported showering only under Mr C’s supervision because of fainting risks, though no recent falls were recorded), clothing and laundry (which Mr C managed, with Miss B saying stairs and autism-related distress about clothes were barriers, although there was no autism diagnosis), safe use of the home (where Miss B was able to mobilise but was anxious about fainting), and maintaining relationships (where both Miss B and Mr C said his caring role impacted his life and put their relationship at risk).
On 11 April 2025 the Council gave a detailed complaint response, addressing Miss B’s allegations and its own findings. It rejected her claim that the assessment had been delayed because she complained, saying the social worker needed input from multiple professionals which extended the timescale but did not amount to retaliatory delay. However, the Council accepted in part that it had not properly considered carer breakdown: it said the social worker had involved Mr C, signposted him to the Carers Trust and considered a separate carer’s assessment, but acknowledged this carer’s assessment was not completed. Therefore, the Council partially upheld her complaint on that point, noting it would not now proceed because the relationship had ended and Mr C no longer provided support.
In response to Miss B’s allegation that the Council focused on diagnosis rather than functional impact, the Council said diagnosis was not the determining factor but did play a significant role in confirming eligibility under the Care Act; it said the social worker had needed a full understanding of her health conditions and had in fact focused on the impact of those conditions on her abilities, drawing on OT and CMHT assessments. On the complaint that the social worker misrepresented professional evidence, the Council said some professionals accepted they might have advised Miss B she may have care and support needs before the Care Act assessment was finished; it upheld this aspect, apologised for misinterpreting the assessment process and for misleading statements, and confirmed that the OT and social worker would receive refresher training on Care Act assessments and communication.
The Council maintained that CMHT and Outreach feedback had been correctly represented in the final assessment.
On Miss B’s criticism that the Council refused a reasonable adjustment for medication support, it said medication was a health need but explained it would always consider supporting medication where other care was already provided; it said it had explored options, all of which Miss B rejected.
Concerning Miss B’s allegations of unprofessional social worker conduct, the Council, without detailing specific comments, upheld this complaint and said the social worker would be spoken to about expected professional standards.
What was found
The Ombudsman found no maladministration in the length of the assessment itself because the Council appropriately undertook a holistic, multi‑professionals Care Act assessment, which reasonably extended the timescale beyond three months.
There was also no evidence that any internal funding dispute between adult social care and CMHT caused delay or that the Council had promised a care package which was then withheld over funding.
However, the Council was at fault for its handling of carer issues and communication: it failed to complete a carer’s assessment for Mr C despite recognising his substantial caring role and offering one, and produced an unclear and internally inconsistent Care Act assessment that gave the impression his care was meeting eligible needs while formally recording only one eligible need for Miss B. This muddled presentation of its position on the carer’s role and the impact of potential carer breakdown amounted to poor communication and left Miss B reasonably feeling the Council had not seriously considered the consequences if Mr C could no longer support her.
The Ombudsman said that Miss M was correct in that the physical or mental impairment in itself does not determine whether a person is eligible for support. The question is how the impairment or illness affects a person’s ability to meet the eligibility domain outcomes. The Ombudsman expected the social worker to establish firstly whether an impairment or illness exists and then to determine what the impact was on each outcome. That is what happened in this case and the Ombudsman found no fault with this approach. Miss B disagreed with her mental health diagnosis and said she had Autism and ADHD but the social worker could only rely on the diagnoses that had been made by mental health professionals. If Miss B disagreed with these diagnoses, she would need to direct that complaint to the mental health team.
Miss B said the social worker misrepresented the evidence from the professionals involved with Miss B. The Ombudsman saw no evidence of this. Miss B strongly disagreed with the assessment by the CMHT, but that would be a complaint that should be directed to CMHT.
The Council also acted inappropriately when professionals, including the OT and social worker, made premature and misleading statements during the assessment which suggested Miss B might have care and support needs before the Care Act assessment was finished, raising her expectations inappropriately.
When the final assessment then found only limited eligibility, this miscommunication caused avoidable distress and frustration.
The Ombudsman accepted the Council’s position that its social worker’s conduct at the final visit was unprofessional, as the Council had upheld this complaint and said it would address behaviour and standards internally, although the exact remarks were not specified.
On the core assessment methodology, the Ombudsman found the Council followed the Care Act and statutory guidance by focusing on needs arising from physical or mental impairment or illness and then analysing how those needs affected specified outcomes and wellbeing, relying appropriately on professional evidence from the OT, CMHT and Outreach.
It found no fault in the Council’s view that medication support was a health responsibility and not an eligible social care need, noting that medication can be supported as part of a broader care package where there are eligible social care needs. The Ombudsman noted that ‘it makes good sense for the medication support to be included in the general care package but that in this case, the Council assessed Miss B as not eligible for Care Act Support, so therefore strictly speaking, it had no duty to meet her medication needs.’
In her response to the draft decision, Miss B explained she had made a complaint to the CMHT and the ICO about the accuracy of the CMHT’s assessment. She said that her needs had changed and were now related more to physical rather than mental health conditions. She was no longer receiving any support from the CMHT or any other mental health support. The Ombudsman explained to Miss B that if she had new information, it might mean the threshold for a fresh assessment by the Council was met but that she would have to present this to the Council in the first place.
The identified faults lay squarely in communication and in the failure to complete a carer’s assessment, which together caused Miss B distress and uncertainty but no direct financial loss. The Ombudsman therefore considered a modest financial remedy appropriate and recommended, and the Council agreed, that it apologise, explain its position on Mr C’s support in writing, and pay Miss B £150 as a symbolic redress for the injustice.
The Council had already decided to give refresher training to the OT and social worker on Care Act assessments and communication and to remind staff about information‑sharing duties, and the Ombudsman did not require any other additional service improvements.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
Part of Miss B’s complaint related to assessment and communications by the Community Mental Health Team. The Ombudsman decided not to investigate this on the basis that the CMHT is part of the NHS and that complaints about the NHS are investigated by the Parliamentary and Health Service Ombudsman. This could have been dealt with as a joint complaint, but the Ombudsman does not appear to have considered this appropriate although the reasons for this are not stated within the report.
The Ombudsman’s analysis of law in this decision is generally in line with community care law on eligibility and the separation of health and social care, but it underplays some distinct legal issues highlighted by public law principles and community care case law.
First, the report treats the three‑month assessment period as justified solely by multi‑disciplinary involvement, without asking whether the council had a duty to use its prevention and interim input powers to manage Miss B’s urgent day‑to‑day risks while the professionals were being consulted. Community care law makes clear that councils can and sometimes must use interim powers to meet apparent urgent needs before completing a full assessment and care plan, particularly where there is evidence of strain on an informal carer and risks around nutrition, personal care and safety in the home. That framework suggests the Ombudsman could have asked whether the council considered temporary support pending completion of the assessment, rather than focusing only on whether the total elapsed time was defensible.
Second, the decision recognises fault around carer issues but narrows it to communication and failure to complete a carer’s assessment, whereas community care law on carers’ rights and eligibility goes further and expects explicit analysis of the carer’s willingness and ability to continue, and of the impact on the cared‑for person’s eligible needs if that support reduces or ceases, as a separate issue.
In this case the evidence shows that Mr C was providing regular practical and emotional care across several Care Act domains and that both he and Miss B described strain on their relationship attributable to his caring role, yet the Ombudsman does not question the lawfulness of an eligibility decision that effectively discounts those domains once Mr C’s input is taken into account. Instead, the ombudsman found that the Council’s position was that Mr C was providing support that was not necessary to meet eligible needs – which means he was not going to be seen as an eligible carer. The finding was that the Council should have made THAT position clearer in the Care Act assessment.
This is a difficult finding to make, defensibly, in fact, when the person has had involvement from the mental health team, because a dissociative condition is different from a situation where someone is ‘choosing’ not to bother to look after themselves. Ignoring existing informal care at the eligibility stage, and ensuring that any care plan does not silently assume unlimited family input, are requirements in the Guidance. We do not KNOW how the CMHT worker concluded that Miss B was making that choice. The Council’s reasoning should have been tested against the requirement to assess Miss B’s needs as if that care were not being provided and then to state transparently what, if anything, it was lawfully expecting from Mr C and on what basis.
Third, the report accepts without challenge the council’s position that medication support is a health need and therefore outside Care Act duties, when community care law treats medication prompting and supervision and administration support as perfectly capable of forming part of daily living and thus social services activities where it is embedded in daily living support to meet other eligible needs. That is because it is ancillary and incidental to social care needs and not prohibited from a care plan by s22 of the Care Act.
In Miss B’s case, the records show medication was bound up with her mental health, OR how her ASD was affecting her executive functioning, and safety around fainting, and that the Council itself explored tele‑support as a social‑care‑style intervention before concluding she was ineligible overall. Public law principles on rationality and consistency suggest that, once a council has decided a person has at least one eligible need and is considering how to meet it, it should ask whether combined support with medication is reasonably required to ensure wellbeing and safety, rather than drawing a rigid line based on service label (health versus social care) or the threshold of TWO or more domains of inability to achieve without assistance – under s19 Care Act, if nothing else.
Taking these issues together, there is a gap between the Ombudsman’s relatively narrow focus on communication faults and the wider legal duties under the Care Act to assess without discounting informal care, to consider urgent interim provision, in our view.
The report does not state the nature of Miss B’s diagnosis with the CMHT team but the fact that her case was open to them suggests that her needs were at least at one stage considered to be significant. We would expect Miss B to have had a CMHT care plan which ought to have been considered during the Care Act assessment. We note that Miss B was requesting a personal assistant, but was offered ‘outreach’. She declined support offered by outreach, but we think she might have accepted support from a personal assistant perhaps by way of direct payment. The outreach team offered support with kitchen skills, shopping, community access and transport which at least suggests Miss B might have had eligible needs in those areas but it is unclear how the social worker took this information into account when completing the needs assessment.
For councils and practitioners, the practical lesson is that they should record clearly when they are using interim powers during lengthy assessments, and show that they have considered the full impact of potential carer breakdown on eligibility, and avoid treating medication support as automatically excluded from social care where it is intertwined with eligible daily‑living needs. For people using services and carers, this decision illustrates that even where the Ombudsman finds only communication faults, there may still be scope under community care law to press the council for a fresh, law‑compliant assessment that treats informal care and medication‑related support in a more rigorous and transparent way.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Coventry City Council (25 003 190) 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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