The Ombudsman's final decision
Summary: Mr X complained the Council failed to reduce Ms Y’s care package after it was temporarily increased. The Council was at fault for increasing the package without telling Ms Y, in how it decided to increase the package, for delay reviewing it and delay progressing obtaining a hoist for Ms Y. This caused Ms Y distress and meant she paid for care she did not need. The Council will reimburse Ms Y the extra money she paid during this time and issue staff reminders.
The complaint
Mr X complained the Council failed to reduce his relative, Ms Y’s, care package after it was temporarily increased to allow for care workers to turn her while she awaited a hospital bed and hoist. Mr X said this meant Ms Y paid for care she did not need.
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. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended) When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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)
How I considered this complaint
I have considered: all the information Mr X provided and discussed the complaint with him; the Council’s comments about the complaint and the supporting documents it provided; and the relevant law and guidance and the Ombudsman's guidance on remedies.
Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
Relevant law and guidance The Care Act 2014 says that if a person has eligible adult social care needs and capital below £23,250 the council must meet their needs. To do this, it must produce a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The Care and Support Statutory Guidance says if there is any information or evidence that suggests that circumstances have changed in a way that may affect the efficacy, appropriateness or content of the plan then the council should immediately conduct a review to ascertain whether the plan requires revision. In any case, councils should review plans at least every 12 months.
What happened The Council assessed Ms Y’s needs and in late November 2022, issued her care and support plan. The plan noted Ms Y needed a care package made up of one hour in the morning and 30 minutes at lunch, teatime and bedtime. All four visits were attended by two care workers. This totalled 35 hours of care per week. Ms Y pays for her care.
In March 2023, Ms Y’s needs increased following a period of ill-health and she was no longer able to safely get out of her bed and into a chair with the help of two care workers.
At the end of the month, the Council explained to Ms Y that she needed to be nursed in bed until she could be assessed for equipment to help with her increased needs.
On the same day the Council decided to increase Ms Y’s care plan by 15 minutes at the lunch, teatime and bedtime visits. This was to give care workers time to move Ms Y’s bed away from the wall, so they could turn her, to maintain her skin integrity. The Council’s records note the increase was temporary, while Ms Y waited for a hospital bed to be delivered to her home. Hospital beds are on wheels, allowing them to be moved more easily. The increase meant Ms Y would pay around £200 more per week for her care.
The Council told me it did not tell Ms Y about the increase in her care package, and therefore the increased cost because its focus was on coordinating professionals to get the support in place.
At the end of March, the Council contacted Ms Y’s GP to ask it to urgently review Ms Y and arrange a hospital bed. It appears that around the same time, the Care Provider (ICare (GB) Limited) began trying to obtain a hoist, to safely move Ms Y from her bed to her chair.
Council records note the bed arrived in early June but the Care Provider was waiting for a hoist to be delivered. The Council noted it would review arrangements once the hoist had arrived.
At the end of the month, the Care Provider contacted the Council to say it was still waiting for a hoist to be delivered. The Care Provider said it had contacted the joint service run by the Council and local NHS hospital trust which provided equipment to Disabled people, but could not get a response. The Care Provider said the delay in getting the hoist was affecting Ms Y’s mental health.
The Council responded to say the fastest way to get the hoist was through a GP’s referral. It noted it had contacted Ms Y’s GP. The hoist arrived in late August, but without the necessary sling to hold Ms Y.
The sling arrived in late September. The care workers tried to use the hoist to move Ms Y from her bed a few times, but it caused her too much pain.
In early October, the Council carried out a review of Ms Y’s care and support plan and found care workers were not using the hoist. It noted the Care Provider should have told it sooner so it could reduce the care package to the previous level.
The Council removed the temporary increase in the care package in early October. Between late March and early October, Ms Y had paid around £5,500 for the extra care.
Findings
The Council increased Ms Y’s care package in late March 2023 without telling her. This was fault. Mr X manages Ms Y’s care bills on her behalf, so the fault did not cause Ms Y a significant personal injustice. It would, however, have caused Mr X undue upset and confusion.
The Council’s decision to increase Ms Y’s care package was not properly made, which was fault. I have set out my reasons for questioning the Council’s decision making below.
Before Ms Y’s needs increased, care workers were already helping her get out of bed and into her chair. Moving Ms Y’s bed and turning her is unlikely to have taken much longer than this so it is unclear why the Council concluded a further fifteen minutes three times a day was necessary.
There is no evidence to show how the Council considered whether Ms Y’s bed could stay pulled away from the wall through provision of extra equipment to keep her safe, like bedrails.
Ms Y’s hospital bed arrived in early June. At that point, it would take even less time to move Ms Y’s bed from the wall to turn her. Despite this, the care package remained the same.
When the Council reviewed the care package in October 2023, it found the care workers were not using the hoist and therefore that the extra time was no longer needed. This indicates the Council felt it was the use of the hoist that would take up more time, not the alternative arrangements of moving Ms Y’s bed and turning her, while waiting for the hoist to be delivered.
Ms Y now has her original 35 hour per week care package and care workers are able to support her appropriately within that time.
On balance, had the Council properly considered the facts around Ms Y’s increased needs, it would not have concluded they warranted an increase in her care package. This means Ms Y paid around £5,500 for care she did not need.
The Care Provider and Council also failed to take decisive action to obtain the hoist for Ms Y without delay. The Care Provider did not tell the Council it was having trouble getting a hoist until late June, by which time Ms Y had been unable to leave her bed for two months. The Council’s response was to contact Ms Y’s GP. It took no further action to chase up the hoist and there is no evidence it considered whether there were other ways to obtain the hoist than going through Ms Y’s GP. Ultimately, the hoist did not arrive in its entirety until late September, six months after Ms Y’s needs changed and she was unable to safely leave her bed. This delay caused Ms Y significant distress. However, when it arrived the hoist caused Ms Y too much pain to use. I cannot say, even on balance, that had it come sooner she would have been able to use it.
Once the care package had been in place for a short while the Council should have reviewed it, to ensure it was meeting Ms Y’s increased needs. The Council did not do this until October 2023, six months after the increase. This was not in line with the Care and Support Statutory Guidance, was undue delay and was fault. The fault caused Mr X uncertainty about what an earlier review would have concluded about Ms Y’s need for extra care and whether it would have resulted in it getting the hoist sooner.
Agreed action
Within one month of the date of my final decision, the Council will take the following action.
Apologise to Ms Y for the distress she felt because of its, and the Care Provider’s, failure to obtain the hoist without delay.
Apologise to Mr X for the uncertainty and confusion he felt due to the Council’s failure to tell Ms Y about the increase in her care package and due to the delay in reviewing Ms Y’s care package after it introduced the temporary increase.
Reimburse Ms Y the money she paid for the temporary increase between late March and early October 2023.
Remind staff they must discuss a proposed change in a care package with the person receiving care or the person acting on their behalf.
Remind staff that changes to care packages, even if temporary, should be reviewed within a short time after the care package changed. Six to eight weeks is an appropriate time frame in such circumstances. This is to ensure the new package meets the person’s needs.
Remind staff that when equipment to support a Disabled person is delayed, they should take decisive action to chase it up, including considering if they should obtain the equipment from a different provider.
The Council will provide us with evidence it has complied with the above actions.
Final decision
I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman