Slough Borough Council

6. Miss S complains the ICB has underfunded her PHB since 1 December 2020. She says the reduction in her PHB has caused her a significant amount of stress and worry, and it has put at risk the security of the position of the personal assistant (PA) she employs.

7. Miss S also complains the ICB failed to provide a suitably qualified carer through the care provider. This meant she did not receive the correct care when she had an epileptic seizure. She says the ICB did not meet her care needs, which could have had a fatal outcome.

8. Finally, Miss S complains about the ICB’s complaint handling. Specifically, she says it relied on paper documents rather than gathering new statements when it responded to her concerns about a carer’s suitability for the role. She says this has left her without confidence her concerns have been fully considered.

9. To resolve her complaint, Miss S wants the ICB to reconsider her health and wellbeing needs and its PA funding rates. She also wants a month of funding in advance to take away the fear she will be unable to pay for her care in the future.

10. At the time of the events complained about, Miss S had a primary health need which entitled her to NHS funded care to meet her needs. Miss S received the funding through a PHB from the ICB. In Miss S’s case, the ICB gave the contract to manage her PHB to the care provider.

11. On 21 August 2019, Miss S’s PHB amount was increased, as she was due to begin receiving care from an agency. The care provider says agency care rates are higher than for PAs employed directly, as there are additional costs associated with agency workers.

12. The agency did not provide the care as planned, and so Miss S hired and paid a PA to meet her needs instead.

13. In November 2020, the care provider said it had been giving Miss S too much money for her care. It reduced the rate it gave her on 1 December 2020.

14. Miss S said she could not afford to employ a PA to provide the care she needed on the reduced rate. This led to her raising the complaint.

Funding

17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so, we have found the ICB has already done enough to put right the impact of issues around funding.

18. Miss S complains her PHB has been underfunded since 1 December 2020, when the ICB reduced the funding of her PHB to an amount equal to £12 per hour. Miss S says this is not enough money to employ a PA who can meet her needs.

19. She says the reduction in her PHB caused her a significant amount of stress and worry. She also says it has put at risk the job security of the PA she employs at £28 per hour.

20. The PHB regulations outline what should happen when agreeing a direct PHB payment. The regulations say before a PHB is put in place the ICB should draft a care plan showing:

(i) the health needs identified in the patient’s care plan can be met by the services specified in the care plan, and (ii) the amount of the direct payments will be enough to provide for the full cost of each of the services specified in the care plan.

21. The ICB is responsible for this process. During the complaint investigation, the ICB accepted it had not correctly evaluated and established Miss S’s care needs before the contract was passed to the care provider for management.

22. This meant the ICB had not made sure the level of care Miss S needed could be met and funded by the PHB, as set out in the guidance. As the ICB did not act in line with the guidance, there are signs of a failing.

23. Miss S says the impact of the lower rate was the worry and distress she felt when she realised she could not continue to pay and employ her current PA.

24. If the ICB had acted in line with the guidance and correctly established Miss S’s needs and their costs, it would not have put her in this position. This means she would not have experienced the worry of meeting the cost and losing the service provided by her PA.

25. Miss S told us she wants the ICB to reconsider her health and wellbeing needs and its PA funding rates to put right the impact of its failing. She also wants a month of funding in advance to take away the fear she will be unable to pay for her care in the future.

26. We looked at what the ICB has done following its complaint investigation. The ICB has apologised for what happened. It identified the need to fully assess Miss S’s care needs, and it completed this work in November 2022. It is now managing the contract internally, to avoid the same issues arising as when the care provider managed the contract.

27. Our Principles for Remedy say organisations should offer fair and appropriate solutions.

28. The ICB identified Miss S’s need for further assessment, and in line with her request and the PHB guidance it has done this. We appreciate Miss S’s reasons for asking for additional funds as a form of security against future problems.

29. There is nothing in the guidance that allows for this. Additionally, in addressing the root cause of the problem and completing a further assessment, we are satisfied the ICB has provided a fair and appropriate solution in line with our guidance.

30. We recognise Miss S also disputes the way the care provider decided on the hourly rate for her PHB. It is possible there were additional failings in the care provider’s actions. We have considered if we should look at this point separately together with the Local Government and Social Care Ombudsman’s (LGSCO) joint working team, who handle local authority issues (like with the care provider).

31. It is our duty to identify failings, consider their impact and make recommendations to put them right.

32. The ICB’s actions following the complaint have put right the impact Miss S described. As there is nothing further for us to put right, we have decided it is not appropriate for us to look at the care provider’s actions as well.

Care provided by the care provider

33. Miss S complains the ICB failed to provide a suitably qualified carer through the care provider, which meant she did not receive the correct care when she had an epileptic seizure. She says the ICB did not meet her care needs and this could have had a fatal outcome.

34. The ICB says the carer was suitably qualified and provided appropriate care.

35. We have considered if we should complete a detailed investigation into this part of Miss S’s complaint.

36. We appreciate Miss S was concerned the actions of the care provider could have had a very serious outcome. Fortunately, this was not the case. We recognise the experience has left her very concerned about the service she received. We consider the impact of this part of the complaint to be the concern Miss S felt about the service.

37. As we must focus our work on the most serious cases, after careful consideration we have decided the impact is not significant enough for us to take this part of the complaint any further. We understand Miss S’s concerns and assure her they have been carefully recorded to track any trends in this area which may influence our work in the future.

Complaint handling

38. Miss S also complains about the ICB’s response to her complaint about the care provider. She says it relied on paper documents saying the carer could do the job, rather than on accounts from witnesses, who heard the carer say she was not trained in those areas.

39. Our Principles of Good Complaint Handling say organisations should investigate complaints carefully and fairly, while also being well balanced.

40. The ICB’s investigation considered Miss S’s statement, and it also gathered a statement from the care provider, which included evidence of the carer’s relevant qualification. Together, this evidence gave the ICB a clear understanding of Miss S’s concerns and an account from both sides.

41. The ICB had an opportunity to gather further statements from witnesses. While we recognise this would have provided further evidence, we have not seen any sign this would have been necessary for the ICB to reach a firm view. This is because we think the ICB had enough evidence from the accounts it had already gathered.

42. For these reasons, we are satisfied the investigation was fair and appropriate, and in line with our principles. We have not seen any signs of failings.

43. We were very sorry to hear how upset Miss S was by the events she described above. We hope this statement assures her of the careful consideration we have given to her concerns.

1. The Parliamentary and Health Service Ombudsman has carefully considered Miss S’s complaint about Frimley Integrated Care Board (the ICB, previously called Frimley Clinical Commissioning Group) and Slough Borough Council (the care provider). Having done so, we have decided to take no further action. We thank Miss S for her detailed explanation of what happened and her participation throughout our process. We also apologise for our delay in reaching this decision.

2. We have seen signs of failings in the way the ICB set up Miss S’s personal health budget (PHB, an amount of money provided by the NHS to purchase support for health needs).

3. The ICB has since put this right by providing a further assessment. This also puts right the impact of the issues raised about the care provider. For these reasons, we do not think we can add anything further to these parts of Miss S’s complaint.

4. We did not see any signs anything went seriously wrong with the care provider. We recognise Miss S’s concerns it might have. At this stage, this is not enough of a reason for us to take this part of the complaint further. We thank Miss S for taking the time to share her concerns with us, and we have logged these so we can continue to track any trends in this area.

5. Finally, we have seen no signs of failings in the ICB’s evidence gathering during its investigation into the care provider. We appreciate this is not the decision Miss S was hoping for. We hope this reassures her the ICB took her concerns seriously.