Summary: There is evidence of fault in this complaint. Between March 2018 and September 2019, the Council failed to ensure all Mrs X’s needs were met. It focused only on her personal care needs and failed to take account of her domestic situation. The Council’s failures caused an injustice to the whole family, but particularly to Mr X who suffered the strain of an increased caring role.

The complaint

1. Mr X complains the Council failed to meet all his wife, Mrs X’s care needs, and his needs as a carer between March 2018 and October 2019

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The Ombudsman’s role and powers

2. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’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)

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How I considered this complaint

4. I have:

• considered the complaint and discussed it with Mr X
• considered the correspondence between Mr X and the Council, including the Council’s response to the complaint
• made enquiries of the Council and considered the responses
• taken account of relevant legislation
• offered Mr X and the Council an opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. The Care Act 2014 introduced a requirement that local authorities should promote ‘wellbeing’ and signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. (Care and Support Statutory Guidance, Ch1)
6. A council must carry out an assessment of any adult who seems to need care and support. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). Having identified eligible needs through a needs assessment, the council has a duty to meet those needs. (Care Act 2014, section 18)
7. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. It must say whether and to what extent, the needs meet the eligibility criteria. It must specify the needs the council intends to meet and how it intends to meet them. (Care Act 2014, ss 24 and 25)
8. The care and support plan must set out a personal budget which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, s 26)
9. Where the council is meeting some needs, but not others, the care and support plan should clearly set out which needs it will meet and which ones it will not. It should explain this decision.
10. A person with eligible care needs can have a council arrange their care or, if they wish, they can arrange their own care using a direct payment. (Care Act 2014, s 31)

Carers

11. The Care Act puts carers on an equal footing with those who have care needs. Councils have a duty to promote the wellbeing of carers and to prevent burn out and crisis. Wellbeing is defined in Section 1 of the Care Act 2014.
12. A council must consider whether to carry out a carer’s assessment if it appears the carer has need for support. It must assess the carer’s ability and willingness to continue in the caring role. It must also consider the results the carer wishes to achieve in daily life and whether support could contribute to achieving those results. (Care Act 2014, s10)
13. The Act says the local authority can meet the carer’s needs by providing a service directly. In these cases, the carer must still receive a support plan which covers their needs and how they will be met. (Care Act 2014, s 25)
14. The Council can also provide a carer’s personal budget, which must be sufficient to enable the carer to continue to fulfil their caring role. The Council should consider the carer’s wishes for their day-to-day life. The Council should try to agree the personal budget and its use during the planning process. (Care and Support Statutory Guidance 2014)

What happened

15. Mrs X is in her thirties. Prior to 2017 she was fit, well and in employment. In late 2017 she unexpectedly developed a serious health condition and spent nine months in hospital. The illness resulted in a significant and life changing disability. She is now visually impaired. She uses a wheelchair inside and outside of the house and is dependent on others for all daily living activities. She also needs support to be involved in the care of her children. She has capacity to make decisions about her care and support needs.
16. Mrs X lives at home with her husband and two small children.
17. In January 2018, whilst Mrs X was still an inpatient in hospital, the Council completed an assessment of her needs. I have seen a copy of this document. It shows Mrs X to have complex needs and that on discharge from hospital she would require care during the day and night. It records Mr X would provide much of Mrs X’s daily care and support and that he would also be looking after their two small children. A referral for NHS continuing health care (CHC) would be completed. The assessor recorded the couple’s home required major adaptations, but Mr X said he preferred to move to a more suitable property. Mr X says he was advised by an officer from the Council disabled facilities grants team (DFG) not to apply for a grant because the cost was likely to exceed £60,000.
18. The needs assessment concluded Mrs X needed 49 hours a week care:

• 60 minutes am x 2 carers seven days a week
• 45 minutes lunchtime x 2 carers seven days a week
• 45 minutes teatime x 2 carers seven days a week
• 60 minutes evening x 2 carers seven days a week

19. The assessment did not include any domestic tasks, access to the community/leisure, or support to parent the children.
20. The assessment recorded Mr X’s views as a carer, that he would like to consider respite for Mrs X sometime in the future, and that he may consider direct payments in the future. I have seen no evidence a formal carer’s assessment was completed at this point
21. Mrs X was discharged home from hospital in February 2018 with the allocated care package in place.
22. Mrs X says no family support was provided and Mrs X was unable to contribute to the parenting of her children. Whilst attending to Mrs X’s needs he had to leave his young children in another room. He says in one year, Mrs X had nearly 100 medical appointments all over the country, which he coordinated and escorted her to, in addition to parenting two small children. He says this placed the family under great strain.
23. The Council completed a review of Mrs X’s needs in late March 2018. I have seen a copy of this document. It records “[Mr X] provides the majority of [Mrs X’s] daily care and support. He also looks after their 2 children”. Under ‘tasks of daily living’ it records “[Mrs X] requires full support with all daily living activities, which include shopping, laundry, keeping her environment clean and tidy and making appointments”.
24. Mr & Mrs X reported they were satisfied with the care and that no changes needed to be made. Mr X says he did not ask for more support because he did not understand the system and he believed Mrs X to be receiving the maximum support available.
25. At the time Mr X’s intention was to pursue alternative accommodation as Mrs X has no access to a bathroom and the children’s bedrooms which impacts on her ability to be involved in caring for them. Mr X says he has not pursued a house move because he is overwhelmed with the situation.
26. The review concluded Mrs X would continue to receive 49 hours a week care. No additional hours were allocated for domestic support, parenting the children or access to the community/leisure.
27. The Council allocated Mrs X a direct payment for 21 days a year respite care. Mr X is unsure exactly when this was. He says at the time he did not understand what the term respite meant and for the first year did not use any of the budget. When he did attempt to use it a year later he was told the money could only be spent on care hours, and the daily spend could not exceed £60. Mr X says he used the money for the first time to pay for a carer to support his wife to attend their small son’s birthday party. He later used it to fund a holiday just before the CHC assumed responsibility for funding Mrs X’s care.
28. The Council completed a review of Mrs X’s needs in July 2019. I have seen a copy of this document. It records Mrs X to need “…full support with all daily living activities, which include shopping, laundry, keeping her environment clean and tidy and making appointments. She will continue to have involvement in financial matters… The current level of support from [Mr X] - husband- is taking its toll on their relationship due to his caring role. [Mr X] feels he is doing too much with working, looking after the kids, running the home and providing support to [Mrs X] both physically and mentally by organising all of her care and appointments”. The reviewer noted Mrs X received a direct payment for 21 days respite care, and that she had been using this to pay for support for family events. The reviewer made a referral for community support to enable Mrs X to access the community and allow Mr X a break.
29. An officer from the community support team visited Mr & Mrs X and provided information about local groups/volunteering/courses which Mrs X would be able to participate in. The records show “Family are open to exploring these groups further, however, [Mrs X] would require the support of a carer to attend”.
30. Mr X says the care package was not meeting all Mrs X’s needs, that it did not include time for domestic tasks and consequently he was spending a significant amount of time carrying out domestic tasks arising directly from Mrs X’s disability, instead of supporting her as a husband and caring for their young children. Mrs X is incontinent, and Mr X says he was struggling to manage the laundry. He also says there was no time allocated for social or family support, consequently the family were unable to access the community together. Mrs X was also unable to contribute to the parenting of her children. Mr X says this caused the family siginificant stress.
31. The Council says “Mrs X’s responsibilities as a parent are captured within the various assessment documents. In particular, the Person Led Assessment completed in September 2019 which for example, documents the time and activities [Mrs X] likes to spend with her children”. The Council has not explained what hours are allocated for this and why these needs were not met before September 2019.
32. The Council reassessment of Mrs X’s needs completed on 17 September 2019 recorded Mrs X “…spends the vast majority of her days in her bedroom, which is downstairs, and then in the kitchen”. She spends some time with her children in the kitchen before they go to school and nursery. She is usually in bed when the children return, and she spends some time with them whilst she is in bed”. The assessor recorded Mrs X’s views, that on discharge from hospital she accepted the allocated care package as “they did not know anything else at the time”. She said the care package was not sufficient and her relationship with Mr X was at breaking point. The assessor recorded Mrs X’s care needs were impacting on her wellbeing, she was unable to care for her children, and she required a carer to facilitate her caring role and relationship with her children. She had limited access to the community, which was the sole responsibility of Mr X. Consequently, Mrs X was at risk of isolation and withdrawal. The assessor noted Mr X had a full time job and went onto say “It is clear to see that the current arrangements are not sustainable… there is a real risk of care breakdown if the care arrangements are not dramatically changed”.
33. The assessor concluded Mrs X’s personal care needs to be the same as previous assessments, but more support was needed using the “Whole Family Approach”, and that he had spoken to the Council’s Children and Families team and explained the situation, “I asked if there was any support that could be offered to the family but I was told there was not”.
34. The assessor recommended an increase to Mrs X’s care package to include extra support from 1 carer to support Mrs X to access the community and attend any relevant groups/appointments. The Council increased Mrs X’s care hours to 83 hours 20 minutes care per week, this included time for domestic support. It also allocated Mrs X 56 days a year respite care.
35. Mr X completed a carers assessment on 18 September 2019. I have seen a copy of this document. Mr X records his difficulties and the resulting stress and strain in detail. Following the carers assessment, the Council allocated Mr X an annual carers budget of £1,040, which the Council says included two hours cleaning at £10 per hour.
36. Mrs X says carers told him they were not permitted to do Mrs X’s general laundry, that they could only do laundry if it was soiled as a result of bladder or bowel issues.
37. Mr X submitted a formal complaint to the Council saying officers had told him carers were not permitted to do Mrs X’s general laundry. He said Mrs X had excessive laundry, and he was responsible for this “whilst also being solely responsible for our then 3 & 4 yr old children. I was also meeting most of my wife's other unmet needs, the ones the council omitted from her assessments. Every hour I spent doing laundry is an hour I spent away from my kids, leaving them without both a capable mother and present father”.
38. Mr X says a council officer telephoned him two weeks later and said the Council did not provide a laundry service. Mr X asked that the officer put it in writing. He heard nothing from the Council, so he chased the matter up five weeks later. He then received a response dated 4 October 2019.
39. The Council response dated 4 October 2019 says, it “…is not council policy moreover there is no council policy with regards to domestic tasks, as all tasks are evaluated on each individual circumstances in line with individual outcomes. I did explain that the council have to be cautious when commissioning domestic tasks that do not require skilled carers”
40. Mr X was dissatisfied and submitted a further complaint using the Council’s formal complaints procedure. He received a response on 4 November 2019. The author confirmed Mrs X had recently been awarded full NHS CHC funding, and consequently the NHS was responsible for her care needs and support package. He acknowledged the outstanding complaint relating to Mrs X’s needs, specifically the issue about laundry and said “the issue of a potential for a retrospective payment from the council to cover the laundry costs you have highlighted, and I have discussed this with the service. They tell me that there were some hours included in your wife’s care allocation of 80 hours a week provided, which related specifically to support for her laundry needs. Therefore it would seem that her personal laundry needs were considered”.
41. Mrs X’s care has been fully funded by CHC since November 2019.

Analysis

42. The scope of an ombudsman investigation does not have to be limited to the issues a complainant first raises with us. The courts have held (R v Local Commissioner etc, ex parte Bradford MCC [1979] QB 287.) that a member of the public when making a complaint does not have to know exactly what has gone wrong and be aware of all the facts when making that complaint. In this case, the complaint Mr X presented to the Ombudsman related to laundry and domestic tasks. During the investigation it became apparent there were wider issues relating to the whole family.
43. It is not the Ombudsman’s role to decide if a person has social care needs, or if they are entitled to receive services from the Council. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law. In this case it failed to do so.
44. Between March 2018 and September 2019, the Council focused only on Mrs X’s personal care needs and failed to take account of her domestic situation. Mrs X missed out on services she was entitled to. She was totally dependent on Mr X for domestic support, access to social/recreational activities, accessing the community and enjoying family time.
45. The law is clear, authorities must assess the total extent of a person’s needs and produce a care and support plan explain how the needs will be met, ignoring the care and support Mr X provides. It should then go on to specify clearly which of those needs are ‘eligible’ needs, where care and support should be provided by the Council. It is only at that point that the Council can consider which of the total needs Mr X, as carer, is ‘able and willing’ to provide and therefore which it is not required to meet.
46. A careplan should be clear about which the needs the Council will meet, and which ones it will not. In this case the Council failed to do so.
47. Mr & Mrs X had no previous experience of social services and were coping with life changing events. They lacked sufficient understanding about Mrs X’s rights to services, and Mr X’s rights as a carer. The Council has a duty, under section 4 of the Care Act, to provide information and advice and must take an active role. Information and advice are fundamental to enabling people, carers and families to take control of, and make well-informed choices about, their care and support.
48. The review of Mrs X’s needs completed in March 2018 identified she needed full support with shopping, laundry, keeping her environment clean and tidy and making appointments, but no additional hours were allocated for such tasks. The Council was aware Mr X was undertaking all these tasks whilst caring for two small children. This placed him and the whole family under significant stress which brought them to near breaking point.
49. Mr X says carers and officers told him they were not permitted to do Mrs X’s general laundry, that they could only do laundry if it was soiled as a result of bladder or bowel issues. The Council says “The service would like to apologise for the confusion caused by the email in question, in relation to laundry, which resulted in [Mr X] feeling compelled to make a complaint against the Council. It is clear there was a misunderstanding internally within the service and it seems some staff were not fully briefed on the Council’s approach. Please accept my apology on behalf of the Council for any confusion this caused as a result”.
50. In July 2019, a social worker identified the situation was taking its toll on Mr X. However, it was not until September 2019, after a further reassessment of Mrs X’s needs that changes were made. The assessor recorded a “real risk of care breakdown if the care arrangements are not dramatically changed”. The Council subsequently doubled Mrs X’s allocated hours.
51. The assessing officer identified “a whole family approach” was needed. Despite the officer’s attempts to liaise with the Council’s children’s team, such intervention has not been implemented. I am unclear why this is.
52. There is no evidence of a formal carer’s assessment before September 2019. It should have been completed in March 2018. This is fault by the Council. Mr X missed out on services he was entitled to and which may have provided relief from his caring role.
53. I am unclear why the Council told Mr X that respite funds could only be spent on care hours, or that spending could not exceed £60 a day. This is not helpful to Mr or Mrs X, not person centred, and contrary to Statutory Guidance.
54. Direct payments are designed to give people more choice and control over the care and support services they are assessed as needing. The Care and Support Statutory Guidance 12.35 - says “The direct payment is designed to be used flexibly and innovatively and there should be no unreasonable restriction placed on the use of the payment, as long as it is being used to meet eligible care and support need”.

Summary

55. Between March 2019 and September 2019, the Council failed to ensure all Mrs X’s needs were met. It focused only on her personal care needs and failed to take account of her domestic situation. This impacted on the whole family.
56. The Council also failed to properly assess and take account of Mr X’s needs as a carer. This caused him significant and unnecessary distress.
57. Mr X has been put to significant time and trouble pursuing this complaint with the Council and the Ombudsman. This has added to his stress.

Agreed action

58. To remedy the injustice caused the Council will within four weeks of the final decision:

• provide Mr & Mrs X with a written apology for the failings highlighted above
• make payment to Mr & Mrs X of £5000 to represent missed services and missed opportunities as a family between February 2018 and September 2019
• make a referral to children’s services for consideration of an assessment for family support
• reassess Mr X’s needs as carer

Within three months

• consider any training needs of officers completing or overseeing needs assessments under the Care Act
• ensure officers act in accordance with the Care Act.

59. Provide evidence of all the above to this office.

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Final decision

60. There is evidence of fault in this complaint. The recommendations represent a suitable remedy for the injustice caused.
61. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman