The Ombudsman's final decision
Summary: We do not uphold Ms X’s complaint the Council did not properly assess her care needs or financial contribution between May 2020 and November 2021. The Council carried out care needs assessments and put in place a care and support plan until Ms X asked for this to be suspended. The Council could not calculate Ms X’s personal contribution (charge) because she did not provide the necessary financial information. There was therefore no fault because the Council took all the steps it could to calculate the charge, but it could not complete the process without Ms X’s co-operation.
The complaint
Ms X complains the Royal Borough of Windsor and Maidenhead Council (‘the Council’) did not properly assess her care needs and financial contribution (charge) between May 2020 and November 2021.
Ms X says her care package was inadequate and her personal contribution was unaffordable. Ms X says this affected her health and mental well-being.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended) We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended) Ms X complained to us in November 2021 about matters in her knowledge since May 2020. This was six months late. However, I decided to investigate as Ms X said she was unwell. Our services were also closed between March and July 2020.
How I considered this complaint
I have considered the information provided by Ms X and discussed the complaint with her on the phone. I have considered the Council’s response to my enquiries and the relevant law and guidance.
Ms X and the Council had an opportunity to comment on my draft decision. I have considered their comments before making my final decision.
What I found
Relevant law, guidance and policy Care needs assessments, care and support plans and reviews of care and support plans Section 9 of the Care Act 2014 requires councils to carry out an assessment for any adult with an appearance of need for care and support. Sections 24 and 25 of the Care Act say where the council identifies care needs in line with national eligibility criteria, it will prepare a care and support plan that sets out how those needs will be met. The council can meet the person’s eligible needs by arranging for a care provider to provide care.
Local authorities must take all reasonable steps to reach agreement with the person for whom the plan is being prepared. (Care and Support Statutory Guidance, Paragraph 10.83) Section 26 of the Care Act 2014 says the care and support plan must include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for the person. The individual can choose to receive the personal budget as a direct payment. A direct payment is a cash payment which gives the individual independence, choice and control by enabling them to arrange and pay for their own care and support.
Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.
Charging for adult social care Care and Support Statutory Guidance (CSSG) is statutory guidance which councils should normally follow. CSSG says councils can charge people for care they provide and if there is a charge, this should follow national regulations on charging. National guidance from the government sets a minimum income guarantee (MIG). This is the minimum amount of money people must be left with before a council can charge them for their care.
Disability Related Expenditure (DRE) are expenses, a person has to pay connected to their disability. They are an allowance in a person’s financial assessment and reduce their weekly charge. DRE can include specialist items and services such as wheelchairs. They can include extra heating or laundry costs, equipment and aids and regular payments such as wheelchair insurance and gardening costs. (Care and Support Statutory Guidance, Annex C, Paragraphs 39 and 41) What happened Ms X told me she has long-standing health conditions and received care support for many years.
Care Assessments 2020 The Council records show, Ms X’s social worker (SW) assessed her care needs in March 2020. The care and support plan recommended 7 hours care to help Ms X with her nutrition and personal care. The plan set out her weekly personal budget.
Ms X then asked the SW to put the care needs assessment on hold as she wanted time to provide further medical evidence. The SW accepted Ms X’s request.
Ms X later told the SW she wanted 16 hours of care. The SW sought a breakdown. Ms X replied she wanted help with shopping, transport, and gym access. She also wanted her personal contribution to be affordable.
The records show Ms X did not give the SW consent to check her health information with her GP. Instead, Ms X asked the SW to provide a letter for her GP so they would provide the correct information.
The SW completed the care needs assessment without access to Ms X’s health records. A care and support plan went to the Quality Assurance Panel (‘the Panel’) which checks cases and approves funding in May. A financial assessment referral was completed at the same time.
Ms X then asked the SW to include further medical information about her diabetes in the care needs assessment. The SW told her that the assessment had already been sent to the Panel. The SW sought Ms X’s consent again to check her updated health conditions, but Ms X refused. The SW could not include the information without the appropriate checks.
The Panel approved funding for 7 hours of care and support in early June. Ms X’s care package started under emergency Covid-19 funding. This was a temporary care budget arranged by the government to help Councils manage increased care demands during the pandemic. However, Ms X believed 7 hours was inadequate for her needs.
Ms X then complained to the SW that her care times did not match her daily needs. The SW therefore adjusted Ms X’s care hours to suit her timetable.
In July, the SW completed a 6-week review of Ms X’s care package. Ms X told the SW she wanted to cancel her care package. The SW voiced her concerns about how Ms X would cope. But Ms X was insistent that she did not want care till an outstanding complaint was resolved. She said a complaints officer had told her it would take six weeks. Ms X has explained this complaint was about help with shopping being included in her care and support plan. The Council has confirmed that it had no records of this complaint.
The Council told me Ms X complained about previous care needs and financial assessments in late 2019. The Council did not uphold her complaint and discussed the outcome with her by telephone in December 2019. It also provided a copy of a stage one response. Ms X later brought this complaint to us. We decided not to investigate, as Ms X was still completing the financial assessment process. We sent Ms X a copy of our final decision in March 2020. The Council records also do not show an outstanding complaint for it to resolve in July 2020.
In September, the SW checked with Ms X if the care package should restart. Ms X refused again saying she was still waiting for a complaint resolution from the Council and the financial assessment to be completed before she committed to the plan.
Financial Assessment 2020 Following the SW’s referral in May (see paragraph 19), the finance team sent Ms X a form and requested evidence for the assessment. This was necessary to calculate Ms X’s personal contribution and any disability related expenditure.
The finance officer (FO) noted Ms X was not keen to send the form or the evidence. She reminded Ms X that the deadline was fast approaching.
Ms X told the FO she had difficulties with writing and wanted her advocate to help but because of Covid-19 restrictions, this was not possible. The FO extended the deadline and offered to help Ms X complete the form and copy the bank records. The FO noted Ms X was not keen to send originals.
The FO also gave Ms X the choice to drop the documents to the Council’s offices, but Ms X refused as she was not comfortable with travelling by public transport.
Ms X later called the FO and said she was upset with the care needs assessment. The FO informed Ms X that without financial evidence they could not complete the financial assessment. Ms X would therefore have to pay the full cost of her care.
Care Assessment 2021 In November 2020, Ms X sought additional support with shopping. The SW contacted Ms X to complete another care needs assessment and financial referral.
The SW explored all options to assist Ms X. This included online shopping by providing an iPad. The SW then gathered medical evidence to confirm Ms X’s health conditions and impact on her mobility.
It was agreed that Ms X could not order her shopping online. The SW completed a review in March 2021. The outcome was a recommendation for an extra two hours to help Ms X with her shopping. A financial assessment referral was also made at the same time.
The Panel approved the new care package and Ms X’s personal budget increased. Ms X informed the SW she did not want the care package to start till the financial assessment was completed.
Financial Assessment 2021 Following the SW’s referral, the finance team contacted Ms X in April to complete their assessment.
Ms X told the FO she had problems with the form. The FO therefore arranged a telephone appointment and helped Ms X complete the form. The following week Ms X told the FO she would not send the form or evidence. She said some medical information she had discussed with the SW was not included in her care assessment.
The FO was unable to complete Ms X’s assessment without the necessary income information. The records show the FO kept Ms X informed about the situation.
In May, Ms X’s advocate told the SW, Ms X was unhappy with her personal contribution. The SW suggested a meeting with Ms X, a senior manager, Ms X’s advocate, and the FO to try and resolve the issues. Ms X declined the meeting.
In September, the SW informed Ms X that her care package had been suspended for almost a year and her case would now be closed.
Ms X’s complaint The Council records show Ms X telephoned the Council and complained about the SW failing to sort out her care package and financial contribution over the previous 18 months.
The Council’s stage 1 response dated 4 October 2021 said: It did not uphold Ms X’s complaint about the Council neglecting her care needs. The SW had acted diligently throughout 2019-2021 to engage with Ms X and assist her as much as possible.
Ms X had often asked it to suspend the care package and failed to provide evidence so that her financial contribution could be properly assessed.
Ms X declined the meeting arranged by the SW, so everyone could meet in person to discuss her concerns.
Ms X should provide her financial evidence to allow the finance team to complete the assessment.
Ms X complained to us in November.
Ms X told me she had a telephone consultation with the Citizen’s Advice Bureau (CAB) during the Covid-19 pandemic. During the call, they took details of her expenses and completed a budget form. Ms X understood they would forward this to the Council. However, the Council has checked and has no records of receiving this form or any other financial documents. The finance officer required Ms X’s actual financial documents i.e., bank statements, receipts as opposed to the budget form to complete the assessment.
Was there fault and did it cause injustice?
i) Failure to properly complete Ms X’s care assessment and support plan I do not find the Councill failed to assess Ms X’s care needs between May 2020 and November 2021. The records show Ms X’s care needs were assessed in March 2020 and reviewed in March 2021. This was in line with Sections 9 and 27 of the Care Act 2014.
The March 2020, care needs assessment did not include any information from Ms X’s medical records. This was not fault as Ms X did not provide consent for the SW to consider the records while completing the assessment.
Ms X received care and support for six weeks in June 2020. Ms X cancelled the package as she wanted a response to a complaint. The SW tried to persuade Ms X to restart the care package, but Ms X declined. I consider the Council took reasonable steps to agree and put in place a care and support plan in line with CSSG paragraph 10.83, but this could not be achieved without Ms X’s consent.
Ms X made acceptance of care and support, in July 2020, contingent on a complaint response about help with her shopping. The Council was unable to provide any records of this complaint and Ms X does not have any copies of her complaint for us to consider. I am therefore unable to conclude if this complaint had any bearing on Ms X’s decision to decline care.
Ms X said she also cancelled the care package as she wanted to know her personal contribution. But this was not possible without her sending the necessary information and documents for her financial assessment.
In March 2021 Ms X’s request for extra care was assessed and approved by the Panel. However, Ms X again declined the care as she wanted to know her financial contribution. However, the Council could not provide her with this as she did not provide necessary financial information. This was not fault by the Council which is entitled to request evidence to assess Ms X’s charge.
ii) Failure to complete Mrs X’s financial assessment and properly assess her personal contribution I do not find fault with the Council for failing to complete Ms X’s financial assessment. The records show the finance team engaged with Ms X in and sought information in both 2020 and 2021. Unfortunately, Ms X did not provide the information in 2020. I am satisfied the Council took appropriate steps to help Ms X provide the information, for example by offering assistance with the paperwork and extending deadlines. So, there was no fault.
Ms X said she provided the Council a financial budget form in 2021 through a representative at the CAB. The Council has no records of ever receiving this. However, the budget form was not the information the FO required to complete the assessment. The FO needed Ms X to send copies of her bank statements and receipts. There is therefore not enough evidence to conclude the Council received the budget form from the CAB or any other financial documents from Ms X.
Ms X said her personal contribution was too high. However, the contribution is means tested. Without the completed form and supporting evidence the Council could not properly calculate Ms X's personal contribution and DRE's. This meant she was assessed as being responsible for the full cost of her care. This was in line with council policy where a person does not co-operate with the financial assessment process, and it is not fault.
Final decision
I do not find the Council failed to properly complete a care needs assessment, care and support plan or a financial assessment for Ms X between May 2020 and November 2021. I do not find the Council left Ms X without care. Ms X cancelled the care for reasons which were out of the Council’s control.
I have completed my investigation.
Investigator's decision on behalf of the Ombudsman