Summary: Mr B complained on behalf of Mr C, about failings in respect of his social care needs and housing situation. Mr C has been without care since January 2021 and his sister, Ms D has been his main carer. We found fault in the actions of the Council. It has agreed to apologise to Mr C and Ms D, make a symbolic payment to each of them, arrange a care act review and a housing meeting review and improve its procedures for the future.

The complaint

1. Mr B complained on behalf of Mr C that the London Borough of Tower Hamlets (the Council) since January 2021:
• failed to adequately assess or meet Mr C’s social care needs;
• failed to produce an adequate care plan or review/update the care plan as appropriate;
• failed to ensure direct payments were implemented for provision of the care or pay an adequate hourly rate to employ a suitable personal assistant to deliver the care;
• failed to carry out a carer’s assessment of Mr C’s sister, Ms D, or appreciate the amount of care she did; and
• failed to ensure Mr C could move to his late father’s property in a supported way.
2. These failings have caused Mr C and Ms D significant and ongoing distress over a prolonged period.

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The Ombudsman’s role and powers

3. 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)
4. 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)

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How I considered this complaint

5. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Mr B, Ms D and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

What happened

6. Mr C has a mental health condition and care needs. His sister, Ms D, provides most of his care. He had complained to us previously. We made a decision in August 2020, finding the Council at fault for delaying care assessments and failing to create care plans.
7. The Council carried out a care review in December 2020 and made a referral for Ms D to have some respite. Mr C’s carers had stopped working with him as the agency was unable to find workers he was happy with. The Council issued a new care and support plan in January 2021 with ten hours of support a week for Mr C, by direct payments.
8. In March 2021 the Council started to set up the direct payments. The social worker corrected some information on the forms and in April 2021 sent a copy to Ms D. She said the details were wrong and the support plan did not provide for flexibilities and weekend/holiday cover. She said she would pass the document to her solicitor (Mr B) to discuss and then get back to the Council. The social worker intended to talk to Ms D about her concerns in mid-April 2021 in order to resolve the issues.
9. On 16 April 2021 Mr B sent a letter before action to the Council highlighting deficiencies in the care and support plan. The Council agreed to review the plan. On 4 May 2021 it sent an amended copy of the support plan to Ms D
10. Ms D responded to the Council saying she could not sign the plan because the hourly rate was insufficient to hire a specialist support worker and it did not provide the flexibility to use other agencies. She said she would forward it to Mr B.

Formal complaint

11. There is no record of any further progress until 16 July 2021 when Mr B submitted a formal complaint to the Council. It said the Council had failed to:
• adequately assess or meet Mr C’s needs under the Care Act 2014;
• prepare an adequate care and support plan;
• review and update the care and support plan;
• respond to material changes to Mr C’s circumstances; and
• facilitate a transfer of a tenancy from Mr C’s late father to Mr C.
12. Mr B provided more detail about the complaint. He said the care and support plan simply aimed to contain Mr C’s behaviours rather than treat the cause: his illness. He said the mental health service had suggested his condition could not be treated and provided research and literature disputing this.
13. He said the consistency and quality of care was problematic. Mr B needed a dedicated carer or small group of carers with specialist mental health knowledge and a precise care and support plan. He said the Council had failed to acknowledge or address how much care Ms D provided for Mr C.
14. He complained that Mr C had been without carers since January 2021 and it was only recently that one worker had restarted one hour of face-to-face support.
15. Mr C had been arrested twice in March and April 2021 due to his disabilities and the police felt he needed psychiatric help. He also experienced two significant bereavements around this time which were not reflected in the care and support plan.
16. Mr B said that although the direct payments had been agreed, they were still not in operation due to the inadequate care and support plan, insufficient hourly rate and lack of contingency for weekends and holidays. Mr C requested a new psychiatrist for Mr C and a new social worker.

Council’s complaint response

17. The Council responded to the complaint in November 2021. It said that following the care review in December 2020, Mr C’s provision was:
• ten hours of floating support
• three weekly sessions at Core Arts
• two hours from an independent living support worker and
• an agreement to fund via to Direct Payments.
18. It said one care agency had stopped providing care from the end of January 2021 as it was unable to find support workers who could work with Mr C.
19. The Council had offered a new review in April 2021 but neither Mr C nor Ms D had provided dates to go ahead with this.
20. In respect of the care and support plan the Council did not agree it was inadequate. While it acknowledged the plan did not address how Mr C’s mental health condition would be treated it did outline how Mr C’s social care needs would be met which would hopefully result in an improvement in Mr C’s condition.
21. In respect of the direct payments, it said efforts had been made to get the payments started but Mr B and Ms D disagreed with the rate offered and the details in the care and support plan did not provide sufficient flexibility to properly utilise the hours. The Council said the rate of direct payments was sufficient and similar to other service users with similar or higher levels of need.
22. The Council partially upheld the complaint as it accepted Mr C had been without care since January 2021 and the Council had not liaised with Mr C or Ms D since April 2021. It also agreed that the community mental health team and the housing department had not worked together as closely as they could in respect of resolving the tenancy issue.
23. As a resolution it proposed to:
• Offer Mr C a joint review with the autism outreach service in December 2021. This would be a holistic review to incorporate the impact of both his mental health and his autism on his abilities to meet his social care needs.
• The autism outreach service would undertake an assessment of daily living activities and input around sensory support to feed into the joint review.
• Review the budgeted hours as part of the care review and manage the case at three week, three month and six month intervals. But it considered Mr C needed a sustained period of at least three months of ten hours a week of floating support to assess if this was sufficient to meet his needs.
• Contact a different agency to try and provide the ten hours of support as a commissioned service while the review was carried out.
• Provide sufficient funding for a group of support workers specially trained in autism.
• Contact Mr C and Ms D to resolve the problems with the direct payments.
• Review Ms D’s needs as a carer.
• Pay Mr C £750 for the delays and failures identified in meetings his social care needs and £400 to Ms D for her time and trouble.
• Carry out multi-agency discussions with a view to transferring the tenancy to Mr C and preparing the house for him.
24. This joint review took place on 8 December 2021. Ms D attended but Mr C did not. The meeting confirmed Mr C currently had ten hours a week of support, but only one hour was provided by a support worker, the rest was done by Ms D. Mr C needed consistent and patient carers. He did not need help with personal care tasks but did need prompting to do things such as showering and cooking .He needed support to attend appointments/liaise with third parties and help with finances. He would benefit form support with recreational activities such as going to the park or gardening. The manager of the autism outreach service requested a copy of the care and support plan and said they would confirm what support could be provided.
25. In March 2022 the Council produced a new support plan confirming 10 hours of outreach support to commence on 28 March 2022.
26. In May 2022 Mr B responded to the Council’s complaint response from November 2021. He said Mr C’s case warranted an integrated approach from health and social care. There had been a lack of understanding of his autism which led to a failure to understand the root cause of his behaviours and treat them through therapy and treatment. He repeated that the ten hours of floating support had finished in December 2020, the Core Arts hours had finished in January 2021 and the independent living support was only one hour a week between March and July 2021.
27. He repeated that the amount of support was insufficient, and Ms D provided many more than 10 hours a week. He felt two hours a day was more appropriate. The hourly rate of direct payments was insufficient to provide specialist carers. Mr C and Ms D had provided good reasons for their non-engagement and that did not mean that care was not required. He also said the Council was responsible for the breakdown in the carers and that an occupational therapy assessment was required before Mr C could move into his late father’s property. The social worker who had reviewed the care and support plan in April 2021 was inexperienced and had failed to respond to Ms D’s queries apart from some confused contact in November 2021.
28. Mr B requested:
• an increase in support hours from ten to 14.
• confirmation that the hours can be used flexibly and made via Direct Payments.
• approval of an increased hourly rate for a specialist worker.
• a specific contingency to allow for work needed in transfer of tenancy.
• provision within the care plan to address Mr C’s problematic behaviours.
• a separate comprehensive plan for the transfer of the tenancy, including OT, housing, social care and autism outreach.
29. In addition he requested an independent investigation into discrimination, pro-active collaboration between different agencies involved in decisions concerning Mr C’s housing, a risk assessment regarding the management of the housing transfer, and a comprehensive independent review at a senior level of all aspects of the complaint not upheld.
30. The Council did not respond to the letter but planned a care review for June 2022. social care issues; Ms D cancelled it on behalf of Mr C. There have been no further reviews since then. The Council says its legal department corresponded with Mr B over the tenancy issues until August 2022 and made various offers of help to assist Mr C clear his late father’s property so the Council could carry out the necessary repairs. Mr C did not respond to these offers.
31. There is no more evidence of action until October 2022 when an occupational therapist visited the property of Mr C’s late father to carry out an assessment. Following this visit, Ms D requested specific works be carried out before Mr C could move in. The OT said not everything on the list was appropriate for the social care team to provide and said that Mr C needed to be assessed and spoken to before they could make any recommendations. They proposed a joint visit with social care but the meeting was postponed until November 2022

Complaint to us

32. Mr B chased up the Council on 2 August 2022 for a response to his correspondence from May 2022. He then complained to us on 6 October 2022, but we did not receive the letter. Mr B chased us up in early January 2023 and we asked for consent for Mr B to make the complaint on behalf of Mr C and for the Council’s final complaint response. Mr B sent the consent in July 2023 and the complaint response on 1 September 2023. We then spent time considering whether this should be a joint investigation with the Parliamentary and Health Service Ombudsman given the involvement of the mental health team. In April 2024 we concluded we would just investigate the actions of the Council.
33. In response to my enquiries the Council has said it is receptive to considering our recommendations to improve upon its response to Mr C and Ms D to date. In respect of a remedy it has suggested:
• a multi-disciplinary professionals meeting regarding Mr C’s housing is scheduled with all stakeholders in order to provide an update on Mr C’s current housing situation; and
• A Care Act review to be undertaken with dates and times facilitated through the legal advocate, to minimise potential communication delay.

Analysis

34. Mr C has assessed care needs requiring as a minimum ten hours of support per week. Since January 2021 he has only received one hour of this from a support worker and Ms D has provided everything else. In November 2021 the Council recognised that this was inadequate and arranged a joint review with a specialist service which again confirmed a need of ten hours per week. But this has never been put in place up to the point Mr B submitted a complaint to us in October 2022.
35. I do not consider the Council is wholly at fault for this failure, as there appears to have been drift and delay by all parties:
• there is evidence of non-engagement by Mr C and Ms D over long periods of time largely due to ongoing disagreements about the content of the care and support plan and the hourly rate for direct payments: Neither has provided dates when asked (May 2021, June 2022), to progress with a review of Mr C’s care needs in a timely manner, which would appear to be the only way of resolving the impasse or to sign the direct payment agreement and neither has Mr C responded to the offers in 2022 to assist with the house clearance. I agree with the Council’s view expressed in its complaint response that before agreeing to an increase in hours, Mr C needs to receive 10 hours of support consistently for a period of at least three months to assess whether this is sufficient.
• Mr B, while strongly advocating for Mr C, has at times taken a very long time to respond to the Council’s correspondence (he did not follow up the Council’s complaint response from December 2021 until May 2022 and then did not complain to us until October 2022). This has also been reflected in his communication with us taking eight months to provide us with the necessary consent and the Council’s final complaint response.
36. However, the Council has not responded proactively to resolve these communication issues and has simply ignored the case. For example:
• it did not chase up Ms D or Mr C following their lack of response in May 2021 to arranging a care review and instead took six months to reply to the complaint, during which time no action appears to have been taken to provide Mr C with the necessary support.
• despite promises to provide support for Mr C after the joint care review in December 2021, it did not produce a new care plan until March 2022 and the records are silent on any efforts to put that care in place.
• it did not take any action after the cancellation in June 2022 to arrange another care review.
37. These failures were fault which contributed to the complete lack of action over a prolonged period of time to provide Mr C with the care that he needs. This means he has missed out on some care during this period and Ms D has had to take on more care than she should have done.
38. Similar inaction has occurred in relation to Mr C’s transfer to his late father’s property. Again, there are contributions by Mr C and Ms D in failing to respond to offers of help or disputing the help that was offered resulting in another impasse.
39. I welcome the recognition of some fault by the Council resulting in an offer of payment in November 2021 and repeated attempts to review Mr C’s care needs. I also welcome its willingness to take steps now to improve the situation.

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Agreed action

40. In recognition of the injustice caused to Mr C and Ms D, I recommended the Council within one month of the date of my final decision:
• apologises to Mr C and Ms D in line with our guidance on making an effective apology;
• pays them each £1000 on top of the £1050 (£750 to Mr C and £400 to Ms D) already offered (a total of £3050);
• arranges a date for a full Care Act review copying communication to Mr B,
• once the review is complete arranges the care as quickly as possible, but in any event within two months, via direct payments if requested. The progress with this action should be monitored proactively by senior management who can intervene to exercise discretion over the hourly rate or other obstacle, if support workers are difficult to source.
• arranges a multi-disciplinary professionals meeting regarding Mr C’s housing with all stakeholders to progress his move to his late father’s property. Again progress with this action should be monitored by senior management to ensure it does not stall.
41. I also recommended within three months that the Council:
• reviews its case management of adult social care cases to ensure that cases where no action or communication has taken place for more than three months, are picked up and dealt with appropriately.
42. The Council has agreed to my recommendations and provided evidence that it has introduced a bimonthly spot audit of social care cases and a new guide for practitioners. It has also said it will endeavour to keep to the two month time-frame for arranging support for Mr C but this may be affected by factors outside its control.
43. The Council should provide us with evidence it has complied with the remaining actions.

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Final decision

44. I consider this is a proportionate way of putting right the injustice caused to Mr C and Ms D and I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman