Summary: Miss X complains the Council failed to promptly pay direct payments for care she received while she was abroad, and there was a delay in restarting her care package. We found there was no evidence the Council agreed to pay Direct Payments and this had since been remedied by a retrospective payment in any event. However, we found Miss X was avoidably left without care on her return from abroad due to Service Failure and Fault by the Council, so a payment should be made to recognise this. The Council should also provide better communication for service users about the correct process to follow in situation where care is to be suspended and restarted.

The complaint

1. Miss X complains that the Council agreed to make direct payments for care provided by her sister while she was travelling with her sister in early 2024. She says when she returned the Council did not make the payment. This meant Miss X was put to the trouble of chasing the payment.
2. Miss X also complained that there was a delay in re-starting a package of care for her after she returned from travelling. The care did not restart for over three weeks and Miss X struggled without the care and was hospitalised for several days as a result.

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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 considered Miss X’s complaint and the information she provided. I asked the Council for information and considered its response to the complaint.
6. Miss X 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

Duty to arrange care and support for those with eligible needs

7. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. It must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 when doing so and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

Direct Payments

8. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.
9. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, a council must decide whether to provide a direct payment. In all cases, councils should consider the request as quickly as possible.
10. Generally, councils will not offer direct payments to pay for care provided by a partner or close relative. However, the Care Act allows it in cases where councils deem that it is necessary, usually in exceptional circumstances.

Council process for ceasing or suspending care

11. If someone wishes to make a planned change to their care arrangements, the Council told us it would ask someone to give them as much notice as possible. It would consider a reasonable period of notice to be 4-6 weeks. The Council stated, if someone requested a break in their care, it is likely this could be arranged in advance. This would ensure the person’s contributions ceased in the interim period and the care package restarted on the date the person specifies.

What Happened

12. Miss X received a package of care, at home, organised by the Council. I understand she needed assistance with personal care, food preparation and taking medication. In early February 2024 she emailed the Council to state she would be going abroad in March for a month and she asked the Council to change her care to direct payments so that she could pay a personal assistant (PA) who would be travelling with her.
13. The Council says it advised her that it would carry out a review of her care package but this had not taken place by the end of February.
14. At the end of February Miss X cancelled her care package with the agency providing care on behalf of the Council and she went abroad. The Council was advised of this by the care agency on 28 February. For contractual reasons it had to continue making care payments until the end of March.
15. The Council says there is no evidence that it had agreed to pay direct payments for Miss X’s sister to act as her PA before she left the country.
16. On 20 March Miss X contacted the Council to ask what was happening about her care when she returned to the UK. She stated her sister could no longer act as her PA. On 25 March she emailed the Council stating she had tried to call without success. She asked who would be providing her care when she returned the next day. In correspondence over the following days the Council explained that sourcing care at such short notice was difficult and it had been referred to the Council’s brokerage team. Miss X stated she needed care immediately and she had found an agency, but needed direct payments. When the Council contacted the agency it stated it had no knowledge of Miss X.
17. On 29 March Miss X stated she had expected care to begin after her sister returned to work. She stated she had had to cope since 26 March without care and was concerned that without intervention she would need to go to hospital. The Council stated it could offer a referral to the Community Response Team for short term care over the weekend. Due to an error this referral did not take place.
18. On 3 April Miss X chased for a care package. The Council told us the initial referral to its brokerage team was rejected as there was insufficient information. I understand by 8 April a support plan had been produced and was with the brokerage team to source the care.
19. The Council’s brokerage team had not been able to source care for Miss X by 16 April. At this point, Mr X was hospitalised for several days following a paramedic visit. Paramedics stated Miss X was very frail. Miss X was discharged from hospital on 19 April with a care package in place.
20. The Council told us that it was not uncommon for people to wait one to two weeks for a care package to be secured. The Council accepted that while it had told Miss X about the process for arranging direct payments when she made her initial contact, it should have taken steps to understand Miss X’s situation and expectations. The Council told us it would have been useful to discuss at the outset about how her care needs would be met on her return from abroad.
21. The Council has agreed to make a direct payment to Miss X to pay for the care provided by her sister, as a PA, while she was abroad. However, this had not been agreed with Miss X prior to her leaving the Country.

What should have happened

22. A council needs a certain amount of notice to enable it to review and potentially change someone’s care package. Miss X contacted the Council around 3 weeks before she intended to leave the country for four weeks. This was arguably insufficient notice to enable the Council to properly consider whether to provide Direct Payments and to act on what Miss X proposed. There is no evidence that the Council had agreed to pay Direct Payments before she left. I found no fault in this part of Miss X’s complaint as the lack of notice from Miss X was a factor. The Council has also remedied any impact from this issue by agreeing, retrospectively, to pay Direct Payments for care received while she was away.
23. However, when Miss X first contacted the Council I would have expected officers to find out sufficient information to understand what she proposed and the likely implications if this. It should then have provided information to enable her to make an informed decision. I found communication from the Council was lacking at this stage, and this was fault.
24. When Miss X returned from abroad, there was a delay in finding a new care provider. It seems this was partly because the council did not have sufficient availability of urgent/available care placements. This was Service Failure.
25. This was exacerbated because an error in the initial contact with brokerage caused a delay. This was avoidable fault. Miss X’s needs were fairly clear as she had recently been provided with a package of care by the Council.
26. There was a further error which resulted in a failure to contact the Community Response Team who may have been able to provide some urgent assistance while a care placement was found.
27. While I recognise that Miss X’s actions in cancelling her care package presented an issue on her return, I found that the period she was without care was Service Failure by the Council and the period without care was slightly prolonged by the errors it made. This resulted in Miss X being briefly hospitalised. As a result, I consider a remedy is due to Miss X to recognise that, but for these issues, a care package would have been found sooner.
28. Had communication been better, it seems likely that Miss X may not have needed to be without care for the period concerned. To recognise that communication could have been better, I have also recommended the Council produces some guidance for service users about what process should be followed in circumstances where someone seeks a break in their care package. It should explain when this is possible, the factors considered and how the Council can work with service users to ensure there are no breaks in care. Clarity about this process may also ensure sufficient notice is provided to care providers, avoiding the Council having to continue to pay for care that is not being received.

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Agreed action

29. Within four weeks of my final decision:
30. The Council should apologise to Miss X for the fault we have identified. The apology should adhere to our guidance on making effective apologies. This can be found on our website, within our Guidance on Remedy here.
31. To recognise there was an avoidable period during which Miss X did not receive the care she needed, the Council should pay her £200.
32. The Council should publish advice on its website for service users to explain what process should be followed in circumstances where someone seeks a break in their care package, what factors will be considered, when this is possible and how the Council can work with service users to ensure there are no breaks in care.
33. The Council should provide us with evidence it has complied with the above actions.

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Final decision

34. There was service failure and fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman