Summary: Ms X complains about how the Council assessed her and her home for suitable adaptations. Ms X says the Council reduced the amount it said it would pay towards adaptations, proposed unsuitable adaptations, and delayed in its decision-making. We have found the Council at fault for delays in its decision-making and in its communication with Ms X. We have not found fault in how the Council made its decisions or that it reduced available funding. We have made recommendations to remedy the injustice to Ms X.

The complaint

1. Ms X complains about the Council’s actions when considering adaptations to her home. Ms X says the Council:
1. reduced the amount it said it would pay towards proposed adaptations;
2. proposed unsuitable adaptations that do not reflect Ms X’s health needs or take account of her concerns; and
3. delayed in its decision-making.
2. Ms X says this has caused frustration, uncertainty and distress.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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 information provided by Ms X and discussed the complaint with her.
6. I considered the Council’s responses to my enquiries.
7. Both Ms X and the Council were able to comment on a draft version of this decision. I considered any comments received before making a final decision.

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Relevant legislation, guidance and policy

Disabled Facilities Grants/Adaptations

8. Disabled Facilities Grants (DFG) are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to give grants to disabled people for certain adaptations. Before approving a grant, a council must be satisfied the work is necessary and appropriate, meets the disabled person’s needs, and is reasonable and practicable.

Amount of Grant and the Means Test

9. The maximum grant payable by a council is £30,000. A council can award other discretionary help if it thinks it is necessary. The council grant amount is subject to a means test. The test does not apply to applications from landlords, or from parents for grants for their disabled children. Regardless of who makes the application, the means test applies to the disabled person (the ‘relevant person’). If the relevant person has a partner, their finances are assessed jointly.

Processing a DFG

10. In March 2022 the government issued non-statutory guidance Disabled facilities Grant (DFG) Delivery: Guidance for local authorities in England (the Guidance).
11. This guidance advises councils in England on how they can effectively and efficiently deliver DFG funded adaptations to best serve the needs of local older and disabled people. It brings together and sets out in one place existing policy frameworks, legislative duties and powers, together with recommended best practice, to help councils provide an adaptation service to disabled tenants and residents in their area.

DFG Process

12. The March 2022 guidance identifies five key stages to delivering home adaptations:
• Stage 1: First contact with the service. Councils should ensure the public has access to information and advice about the DFG process.
• Stage 2: First contact to assessment and identification of the relevant works. An occupational therapist (OT) will assess the person’s needs and potential solutions through home adaptations.
• Stage 3: Identification of the relevant works to submission of the formal grant application. The person completes and submits the application form together with designs and costing for the works (where necessary).
• Stage 4: Grant application to grant decision. The Council will check the application and issue a decision letter. If a council refuses a grant, it must explain why.
• Stage 5: Approval of grant to completion of works. The works are arranged and carried out and the necessary quality checks made.
13. A council should decide a grant application as soon as reasonably practicable. In addition, the timescales for moving through the stages will depend on the urgency and complexity of the works required. The guidance gives the following timescales:
• Urgent and simple works – 55 working days
• Non-urgent and simple works – 130 working days
• Urgent and complex works – 130 working days
• Non-urgent and complex works – 180 working days
14. We expect councils to consider whether interim equipment or temporary works should be provided when it will take them a long time to secure a permanent solution.

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What I found

Summary of events

15. Below is a summary of the key events leading to this investigation. It is not an exhaustive chronology of every interaction between parties. Where necessary, I have expanded on some of these events in the analysis section of this decision statement.
16. In August 2020, following a Housing Occupational Therapist’s (OT) assessment that identified Ms X might benefit from adaptations to her home, Ms X was referred to the Council’s Complex Occupational Therapy Team.
17. In September 2020, Ms X’s case was allocated to an OT in that team. The OT helped get Ms X’s housing priority increased due to her medical needs and told Ms X she would not be eligible for major adaptations while she remained on the housing register. The OT offered to visit Ms X to assess her needs for other adaptive equipment. Ms X wanted to remain on the housing register until she understood what adaptations could be made in her home.
18. In January 2021, the OT visited Ms X at home and completed an assessment. The assessment noted Ms X’s medical conditions and recorded Ms X was sleeping in her living room. The OT documented that Ms X needed support from her carer to access the upstairs of the property and bathe, and sometimes needed help to reach the toilet. The Council later recorded that it could not complete a full mobility assessment of Ms X, as she felt unable to engage with this. In a file note about the meeting, the Council recorded that Ms X asked it to consider an extension with a level-access shower installed.
19. The OT said they would order Ms X a kitchen trolley and commode, contact her GP for more medical information, and seek advice on Ms X’s long-term access to bathing facilities. In January 2021, the Council wrote to Ms X’s GP, asking for medical information. The Council said it did not receive a response to this letter and sent it again in March 2021.
20. In March 2021, the Council completed a preliminary financial assessment of Ms X, deciding she would be eligible for a DFG and would not need to make a financial contribution. Ms X and the Council exchanged correspondence about what adaptations the Council would support. Ms X set out why she felt an extension to the property would be the best choice.
21. In April 2021, Ms X’s GP responded to the Council’s enquiries.
22. In June 2021, the Council wrote to Ms X, summarising the actions it had taken and setting out proposals to move the matter forward. It said it wanted to visit Ms X again, with an OT and a senior OT attending to explore all options.
23. The same month, Ms X made a complaint to the Council via post and told the Council she had done so. The Council says it did not receive this complaint and later contacted Ms X, in August 2021, to confirm a statement of complaint. In her complaint, Ms X said:
1. she lived in a property with two floors, but could not keep climbing the stairs to access the bathroom.
2. she would like her home adapted to include a downstairs wet room. There was already a toilet downstairs, but no washing facilities.
3. a stairlift was not a feasible option, as Ms X struggled to even get to the downstairs toilet and would still be reliant on her carer.
4. she needed the extension for the bathroom/wet room downstairs, so could gain some independence.
5. she could not afford to pay for an extension.
6. her medical evidence was being ignored and her disability and conditions were not being taken seriously.
7. the process had taken a long time and caused distress.
24. In July 2021, the Council and Ms X’s GP discussed Ms X’s case by telephone. The Council documented a written summary of this conversation.
25. In August 2021, Ms X’s respiratory doctor sent a letter to the Council, with details about Ms X’s medical conditions.
26. In September 2021, the Council responded to Ms X’s complaint at stage one of its complaints procedure. In its response, the Council:
1. set out the actions it had already taken;
2. explained the DFG assessment and funding process;
3. explained the role of OTs and surveyors in this process;
4. explained its approach to deciding what adaptations were necessary;
5. referenced information it had received from Ms X’s medical practitioners;
6. said it had not made a decision about adaptations yet, because it was still assessing Ms X’s needs and property; and
7. asked Ms X if it could visit her again with an OT and a Senior OT.
27. Ms X responded to the Council saying she understood her case had already been heard at a DFG Panel. She also asked for a copy of the information provided by her GP in July 2021.
28. The Council responded to Ms X, advising she was eligible for a DFG grant, but this was not the same as a DFG Panel approving funding for proposed adaptations. It said Ms X’s GP had provided information in a telephone call, so there was no written evidence.
29. In response, Ms X queried why further visits were necessary. She said her medical practitioners had confirmed her conditions and that she could not climb stairs. She said the Council was trying to find a way to compel her to use the upstairs of her property, but this would defeat the point of an adaptation. The Council said it needed to visit to complete a full mobility assessment of Ms X, as this had only been partially completed. It said the OTs were not disregarding supporting medical evidence, but were using it to form their own assessment.
30. The Council visited Ms X again in December 2021, with an OT and a senior OT attending. According to the Council’s records, this meeting was to:
• review Ms X’s occupational performance;
• review Ms X’s social situation;
• get a second professional opinion on the potential/feasibility of suitable adaptation schemes;
• confirm to Ms X the Council was considering her disability seriously; and
• explain the DFG process.
31. The Council later recorded it could not complete a mobility assessment of Ms X, as she felt unable to do this.
32. In January 2022, Ms X made a further complaint. In her complaint, Ms X said the recent visit had been the same as the first visit in January 2021. She said the types of adaptations put forward by the OTs in their recent visit were not suitable for her needs or for the layout of the property.
33. The Council responded to Ms X. It said it could not make a final recommendation, because an officer from the Housing Grants team had not yet completed a feasibility survey of the property. It said it had discussed this with Ms X in the recent visit and it was seeking dates for a further appointment.
34. An officer from the Housing Grants team and the OT carried out a feasibility visit of Ms X’s home in February 2022. The Council’s record of the visit shows:
1. The Council recorded information about the property layout and room sizes.
2. The Council told Ms X a DFG would likely not cover the cost of an extension and it appeared the property could be adapted in its current layout to meet Ms X’s needs.
3. Ms X explained why she did not believe these options were suitable.
4. Ms X said she wanted a walk-in bath, as this would be better for her medical conditions. The Council said a level-access shower would be more beneficial, in its professional view. Ms X disagreed.
5. The Council later recorded it could not complete a full mobility assessment of Ms X on this visit.
35. Following this visit, the Council held an internal discussion about how to continue. The Council thought the property could feasibly be adapted to meet Ms X’s needs, although it identified some difficulties. The Council would order some further adaptive equipment, such as perch stools and a cantilever table, to help Ms X in the meantime. The Council would also get further medical information to help it understand the therapeutic benefits of bathing, rather than showering, in response to Ms X’s preference for a walk-in bath.
36. In March 2022, Ms X and the Council exchanged correspondence about what adaptations may be put forward for the DFG Panel to consider. The Council got information from Ms X’s physiotherapist.
37. In April and May 2022, the Council exchanged further correspondence with Ms X’s medical practitioners.
38. In May 2022, the Council wrote to Ms X, setting out four possible proposals for adaptations in her home. These four options were:
1. A stairlift and level-access shower, with a wall-fixed shower seat, created in one of the upstairs rooms. The Council said this would allow Ms X to return to sleeping upstairs and free up the living room for use when socialising.
2. A level-access shower room with a wall-fixed shower seat, installed in the existing extension at the rear of the kitchen. The Council said this would remove the need for a stairlift, which Ms X had advised would worsen her claustrophobia and anxiety. The Council said this would be a short walk from the living room, which could be achieved using perch stools to rest on when needed. The Council said this would adhere to Ms X’s GP’s advice to maintain or increase activity levels, while also freeing up the living room.
3. A shower/cubicle being installed in the living room, which Ms X was using as a bedroom. The Council accepted Ms X’s anxiety at being in a confined space, but said this would have the benefit of being very close to Ms X’s bed, allowing completely independent access.
4. Ms X to choose an alternative or more extensive scheme, such as the extension she had requested, providing this met the minimum requirements of the OT. The Council said Ms X would need to pay the difference between any DFG funding awarded and the full cost of work, including any unforeseen work that might arise. The Council said the proposed scheme would need to be approved prior to commencement.
39. In June 2022, Ms X wrote to the Council to say she would not accept any of the options proposed and again requested a copy of the information provided by her GP. She also contacted her local Member of Parliament (MP).
40. Ms X’s MP wrote to the Council about the matter in June 2022 and the Council responded later that month. Ms X’s MP asked whether the Council could consider building an extension and meeting the costs. In its response, the Council said it could not justify an extension as Ms X’s needs could be met within the existing footprint of the property. It said the other adaptations proposed in its letter would be considered ‘reasonable and practical’. It said it could not provide funding to cover extra costs when somebody chose to carry out their own scheme of works.
41. In July 2022, Ms X referred her complaint to the Ombudsman.

Analysis

Complaint the Council reduced the amount it said it would pay towards the cost of adaptations

42. Ms X says she told the Council from the outset that her preferred adaptation would be an extension to her property, containing a level-access shower. She says the Council said it would pay up to £30,000 towards the cost of works and would need two quotes. Ms X says once she provided these quotes, the Council then said it would need to explore cheaper options.
43. In its response to my enquiries, the Council told me the maximum amount of £30,000 was not awarded in every case. It said it had a responsibility to spend public money properly and to ensure that available funding can help as many people as possible.
44. The Guidance confirms the Council has discretion to top-up funding beyond the upper grant limit of £30,000 if it believes this is necessary to meet an individual’s needs. The Guidance also makes clear authorities should not fetter this discretion, by failing to give due consideration to applications for higher funding on a case-by-case basis.
45. In this case, a DFG Panel did not consider an application for a DFG grant, as Ms X disagreed with the Council’s proposed adaptations before it reached panel stage. Because of this, there is no panel decision to scrutinise. I have therefore considered if the available evidence shows the Council committed to paying a specific figure from the outset. I have also considered whether there is evidence it refused to entertain adaptations that would likely exceed the £30,000 maximum early on, solely due to cost.
46. The Council’s records suggest Ms X proposed an extension to her property during the first assessment carried out by an OT in January 2021. The Council’s contemporaneous record of this visit states:

“(Ms X) stated that… wished OT to look into adaptations, i.e an extension with a level access shower in it. OT agreed to explore the most cost-effective options to offer her access to bathing facilities. (Ms X) asked if she could obtain quotes from contractors herself and stated that this was in the DFG guidance booklet.”

47. The day after this assessment, Ms X and the Council exchanged correspondence. Ms X said she would start getting quotes for an extension. The Council emailed Ms X and said:

“As I said in the email before -- its too soon to start getting quotes yet. The contractors have to have my recommendation and design brief first.”

48. In correspondence exchanged between Ms X and the Council in March 2021, about what adaptations the Council would support, the Council wrote:

“The amount of the grant will be decided when the cost of the works have been established. Now that we know that you have the grant I can begin my work to establish the most cost effective and feasible adaptation that meets your need of getting to a toilet and shower.”

49. In the same email, the Council addressed Ms X getting quotes for her own preferred adaptation:

“It might be possible for you to pay the extra for your preferred option but we can only decide that when we know all the facts. By all means get a quote for the downstairs wet room in the meantime but we always need at least 3 quotes for any work that costs above five thousand pounds and the grant will only be released if the work meets all the specifications that we expect.”

50. I consider these exchanges show the Council had not committed to a specific figure and explained the grant to be awarded had yet to be confirmed.
51. Ms X submitted quotes in May 2021. In June 2021, internal correspondence shows the Council considering the need for an extension:

“The existing bathroom has a shower cubicle set up on a block. The client insists this is because it wasn't feasible to put in a level access. The only other option for the LAS (level-access shower) would probably be an extension...(again I would need advice on this if this option is all that is feasible)”

52. Later that month, the Council wrote to Ms X’s Landlord to enquire whether there were any policies in place preventing extensions to the Landlord’s properties generally:

“I have a case…where an extension containing a toilet and shower area might be the only option. My supervisor has just advised me that she thought there might be a blanket policy stating that extensions to (the Landlord’s) homes would not be granted permission. Can you advise if this is the case?”

53. The correspondence above suggests the Council set out early on that it was not discounting the possibility of an extension. However, it said it would explore all possible adaptations, including those inside the existing footprint of the building.
54. I consider the available evidence shows the Council did not commit to paying a specific grant amount at the outset and advised the amount of grant awarded had yet to be decided. The evidence also shows the Council explored whether an extension would be possible, in the event it was deemed necessary. I have not therefore found the Council at fault regarding this part of Ms X’s complaint.

Complaint the Council proposed unsuitable adaptations that did not meet Ms X’s needs

55. Ms X says the adaptations proposed by the Council, outlined in paragraph 38, were not suitable for her needs. In summary, Ms X says the Council discounted her views, as well as those of her medical practitioners. She says it proposed adaptations she had already explained she could not accept and which were not suitable, because of her reduced mobility.
56. In its response to my enquiries, the Council said it had to be satisfied the relevant works were appropriate, necessary, reasonable and practical. This was a professional decision made by the OT and the Housing Grants team, considering Ms X’s identified needs and the age and condition of the property.
57. I have set out the Council’s efforts to get medical information in the summary of events in this statement. I have detailed below the advice the Council received:
1. Ms X’s GP wrote that Ms X had difficulty breathing and became breathless when walking. Ms X’s GP indicated Ms X had a permanent and substantial disability.
2. In a telephone call with Ms X’s GP, the Council recorded the GP saying they would prefer to see Ms X increasing her movement around her home, rather than decreasing it. They also indicated a more suitable home would be a good option.
3. Ms X’s respiratory doctor wrote to the Council to say Ms X had a significant lung condition and became breathless on minimal exertion. The letter said Ms X had moved her bedroom downstairs and was unable to climb stairs due to breathlessness. The letter recommended single-level accommodation without stairs be considered.
4. In further correspondence, the respiratory doctor confirmed Ms X had COPD and RB-ILD. They said Ms X’s main symptom was breathlessness and she had an element of breathing pattern disorder, a significant contributory factor for which she was seeing a respiratory physiotherapist. They also said they could not comment on whether a walk-in bath would be better than a wet room, saying this would be a decision best made by the OT.
5. Ms X’s respiratory physiotherapist advised Ms X had been assigned breathing exercises, but progress had been limited and she had missed some of her recent appointments. The physiotherapist also said they could not comment on whether warm moist air would influence Ms X’s breathing function.
58. There is clear evidence the Council sought relevant medical information from professionals to support its decision-making. It was occasionally limited by the quality and timeliness of responses to its enquiries.
59. The Council also asked questions to establish if there was a medical basis to support some of Ms X’s preferred adaptations, such as a walk-in bath, rather than the level-access shower. On these points, the Council recorded that advice from medical professionals was inconclusive. The Council also considered Ms X’s report of suffering from claustrophobia, but said there was no medical evidence to confirm the diagnosis or outline the impact of this on any proposed adaptations.
60. The Council concluded that while Ms X had clear difficulty mobilising, there were efforts being made to improve mobility through physiotherapy, and any adaptations should seek to support this by helping to maintain or increase movement. It set out this position in its response to Ms X’s stage one complaint.
61. The Council says it concluded that Ms X’s property was large enough to adapt without the need for an extension. It says neither its OT or Housing Grants Officer considered an extension to be necessary, appropriate, reasonable or practicable, and Ms X’s needs could be met using other means, leading it to propose the adaptations set out in its letter of May 2022. It cited a note recorded by an officer from the Housing Grants team following the visit in February 2022, which stated:

“There is sufficient space within the existing ground floor to accommodate a shower/loo cubicle or adaptations could be placed in the existing extension off the kitchen for a level access shower, there is already a wc on the ground floor.”

62. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether the complainant disagrees with the decision the organisation made.
63. Whether an adaptation is suitable for an individual’s needs is a matter of professional judgement. This is for the Council to decide, taking account of the relevant legislation and guidance, and relevant information. The evidence in this case suggests the Council made appropriate enquiries to get relevant information. It then made a decision based on the information it had been able to get and explained its reasoning. I have not therefore found fault with the Council’s actions relating to this part of Ms X’s complaint.
64. I note the Council confirmed it had not been able to fully assess Ms X’s mobility in the letter it sent to Ms X in May 2022. The Council said its proposed adaptations would be subject to further assessment and feasibility surveys. I therefore understand the Council remains prepared to assess Ms X’s mobility and account for the outcome in its decision-making.
65. The Council said it sought to assess Ms X’s mobility on three occasions, but could not fully complete this, with it being only partially completed. As the Council attempted to carry out this assessment on more than one occasion but could not, I do not consider it is at fault for not completing it to date.

Complaint of delay by the Council

66. The different stages of making home adaptations and the relevant timescales are set out in paragraphs 12 and 13.
67. The Guidance says the date on which a first enquiry is made should be taken as the starting point for measuring action against these timescales. I consider the first contact in this case to be the referral made to the Complex Occupational Therapy team in August 2020.
68. I have not seen any evidence the Council formally assessed Ms X’s case as falling into any of the specific priorities set out in paragraph 13. I consider Ms X’s case would be categorised as either Urgent & Complex, or Non-urgent & Complex. This would provide a target timescale of up to 180 working days from first contact to approval of the grant and completion of the works.
69. Identifying the relevant works falls into stages two and three of the adaptations process. The Guidance says this should take around 90 working days at most. The Council outlined its proposed adaptations to Ms X on the 31 May 2022, around 460 working days after the referral to the Complex Occupational Therapy team on the 10 August 2020. This is a delay of around 370 working days beyond the timescales set out in the Guidance.
70. The Council’s records show that some delays in this process were beyond its control. Ms X was occasionally reluctant to allow further visits from the Council, particularly during the complaints process. At other times, Ms X could not allow visits, as she was shielding in line with the Covid-19 guidance in place. The Council also had to wait longer than anticipated to receive some medical information.
71. However, even when taking this into account, the time taken to identify the eligible works in this case is excessive. The Council has said Ms X’s case was complex, but the timescales set out in the Guidance account for complexity. The Council appears not to have had regard for the timescales set out in the Guidance at any point, or considered what steps it could take to minimise further delays. I have found the Council at fault for the delay in carrying out the assessment process. I consider this fault caused an injustice. In her correspondence with the Council, Ms X was clear the prolonged process and the resultant uncertainty were causing her distress.
72. Ms X asked the Council on several occasions how long the process would take. I have seen no reference to the timescales set out in the Guidance in any of the Council’s responses. The Council frequently asserted Ms X’s case was complex and the implication was she should simply expect the process would take a long time. On one occasion, it said Ms X “could accept that the process is drawn out and work with (the Council) instead of against (the Council).”
73. When Ms X suggested she would seek independent advice, the Council told her this would slow the process further. It said it would “…have to spend extra time communicating with (the advice agency) and (Ms X)… instead of gathering the information together and forming a report that goes to Panel”.
74. I have found the Council at fault for the way it communicated with Ms X. This fault caused an injustice. The Council missed multiple opportunities to clearly explain what the timescales were, meaning Ms X did not know when she should expect certain actions to be taken. Had Ms X been notified of how the Council categorised her case, and the timescales involved, it is likely this would have mitigated much of the frustration and uncertainty she felt. It may have meant that a complaint to the Council at that point was not necessary.

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Agreed action

75. Within four weeks of the final decision being made, the Council has agreed to:
1. apologise to Ms X in writing for the faults and injustice identified in this statement.
2. pay Ms X £350 in recognition of the avoidable frustration and distress caused. I have considered the Ombudsman’s Guidance on Remedies when recommending this figure.
3. remind relevant officers of the importance in adhering to the timescales set out in the DFG guidance for complex cases.
76. The Council should provide us with evidence it has complied with the above actions.

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Final decision

77. I have completed my investigation with a finding of fault causing injustice. I have made recommendations to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman