Summary: We will not investigate Ms X’s complaint about the arranging and managing of her care package which is funded by Sheffield City Council and NHS South Yorkshire ICB. This is because further investigation by the Ombudsmen is unlikely to add to the Council’s own investigation. While Ms X has ongoing concerns about the Council’s safeguarding process, it is too soon for us to look at this.

The complaint

1. Ms X complains about the actions of Sheffield City Council (the Council) in arranging, managing and funding her care. Ms X’s care package includes a health funding contribution from NHS South Yorkshire ICB (the ICB). Ms X raised concerns that the Council changed her funding arrangement from Direct Payments against her wishes. She also complained that the Council and ICB failed to provide respite and activities which were previously part of her care plan. Ms X also complained that her previous care provider did not meet her needs and there was significant delay moving her to a new suitable care provider.
2. Ms X is particularly unhappy with how her safeguarding concerns have been handled and lack of assurance in relation to any future concerns. Ms X also feels some of the Council’s actions do not go far enough and her concerns about delay when changing care provider have not been fully addressed.
3. As a result, Ms X says she feels worried and vulnerable. Ms X would like more systemic improvements taken by the Council in response to her concerns, further answers to her questions and reassurances that her safeguarding concerns will be handled properly and involve her in the process.

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The Ombudsmen’s role and powers

4. The Ombudsmen consider complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
5. We provide a free service but must use public money carefully. We may decide not to start an investigation if we believe it is unlikely we could add to any previous investigation by the organisations. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

6. I considered information provided by Ms X and discussed the complaint with her. I also considered the Ombudsman’s Assessment Code and the organisations' complaint responses. I have shared this draft decision with Ms X. I have carefully considered the comments I received.

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What I found

What happened

7. Ms X has complex physical and mental health needs. Ms X’s care needs are met through a domiciliary care provider, funded by the Council and the ICB.
8. Ms X was receiving Direct Payments to pay for her care. In April 2023, following discharge from a hospital admission, Ms X’s payments were changed from Direct Payments (paid to Ms X) to Direct Award (paid directly to the care provider) without consultation. Ms X says parts of her care plan were no longer being met, including access to activities and respite. Ms X asked for her Direct Payments to be reinstated.
9. In September 2023, Ms X moved to a different care provider. This care provider was not able to meet her needs. Ms X asked to change to a new specialist care provider.
10. In December 2023, Ms X’s social worker began the process to change her to the new care provider. There was significant delay with this process.
11. In April 2024, a social worker took Ms X’s case to a Council panel to approve the change to new care provider. At this stage, the Council became aware Ms X was also receiving some health funding from the ICB for her care and this caused some confusion and delay. The panel also asked for a new Care Act 2014 assessment to be completed, as Ms X had a stoma fitted in mid-2023. A stoma is a small opening in the abdomen which allows body waste to be collected in a bag.
12. In October 2024, Ms X moved to the specialist care provider.
13. On 17 October 2024, the Council issued its final complaint response.

Analysis

14. Ms X complained to the Ombudsmen in August 2024. In mid-October 2024, the Council sent a final complaint response to Ms X. This letter acknowledged that many things had gone wrong with the way the Council handled Ms X’s care provider change, payments and safeguarding. The Council apologised to Ms X and has put several systemic changes in place as a result of her complaint. As such, some parts of her complaint have been resolved. However, Ms X remains unhappy with some aspects, particularly around the Council’s safeguarding process.

Changes to care plan and payment

15. Ms X complained the Council moved her payments from Direct Payment without asking her and took a long time to correct this. Some parts of her care plan, around access to activities and respite, stopped being met.
16. The Council has apologised that Ms X was changed from Direct Payment to Direct Award without her agreement and for not meeting parts of her care plan. The Council has agreed it took too long to reinstate the Direct Payments. There was a long delay correcting this, however the Council has now done this.

Delay moving Ms X to a new care provider

17. Ms X complains about delay moving her from an unsuitable care provider to a new care provider. Ms X is unhappy with the Council panel’s decision that she needed a new care needs assessment, when her needs had not significantly changed. Ms X says this decision increased the delay unnecessarily, which impacted on her mental health. Ms X says the Council has not properly explained its decision to insist on a new assessment.
18. The Council has accepted there was a lack of staff knowledge around jointly funded care and it took too long to complete the new needs assessment. The Council said this contributed to delay and it took too long to move her to a new care provider. The Council has made several changes to its processes because of Ms X’s complaint. This includes improving staff communication, additional training for staff, specific practice changes and speaking with individual staff members about their actions. As the Council has already acknowledged fault and offered a suitable remedy, it is unlikely further investigation by the Ombudsmen would achieve more.
19. While Ms X is seeking further explanation about the reason the Council decided a new needs assessment was required, there is not sufficient grounds to investigate this concern further.
20. It is possible the need for a new assessment could have been picked up earlier, when Ms X’s care plan was reviewed. However, the Council has already accepted there was delay and we are unlikely to be able to add to this.
21. Our role is not to ask whether an organisation could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did so, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome, regardless of whether Ms X disagrees with the decision the Council made.
22. The Council is obliged, under the Care Act 2014, to keep a person’s needs under review. Ms X previously had to change care providers several times, due to her complex needs not being met. We would be unlikely to find fault in relation to the Council’s decision that a new needs assessment was required as part of ensuring the new care provider would be appropriate.

Impact on Ms X’s mental health

23. Ms X feels the Council has not fully acknowledged the impact that its delays had on her mental health. Ms X says the Council was aware she is a vulnerable person but put her at risk by causing her significant stress.
24. The Council’s final complaint response accepts its actions were not acceptable, acknowledges Ms X was caused significant distress and apologises for this. The Council has also made systemic changes, including staff training and supervision.
25. Ms X does not feel this is enough. Ms X says more needs to be done to safeguard individuals and the Council needs to be clearer about how it will learn lessons on keeping people with serious mental health issues and known risk associated with stressful environments safe while assessing their needs.
26. Mental health, risk and safeguarding is a personal matter and often requires different approaches, depending on the individual person. It would be difficult for the Council to create a more specific policy on this which would meaningfully apply in practice. The actions already taken by the Council are in line with what we would likely recommend ourselves and its unlikely we would recommend further action as a result of an investigation.

Safeguarding

27. One of Ms X’s key outstanding concerns is about the Council’s safeguarding process. Ms X has ongoing concerns in this area and does not feel assured by the Council that these will be properly handled going forward. Ms X wants the Council to carry out the steps proposed in its complaint response and to properly monitor the safeguarding process to ensure it is being handled correctly.
28. The Council has accepted Ms X should have been more involved with the outcomes of its safeguarding process and said it needs to do better. The Council said it will summarise the outcomes of previous investigations and send these to Ms X. The Council also said it will have staff discussions to ensure Ms X is properly involved in future safeguarding enquiries.
29. The steps proposed by the Council appear reasonable. I understand Ms X is unhappy with the way a current safeguarding concern is being handled and says this is proof that the Council is not doing what it has promised to do. However, the Council only issued its complaint response around eight weeks ago. The Council needs sufficient time to have the opportunity to put its proposed improvements into action. It is too early for us to look at whether the Council has done what it said it would do. There are also current ongoing safeguarding concerns which we cannot look at yet as the Council’s process is not complete. As such, this complaint is not ready for us.
30. Once the current safeguarding process is complete, Ms X can complain to the Council if she remains unhappy. Following this, Ms X can return her safeguarding complaint to the Ombudsmen. At this point, we would be in a much better position to be able to consider whether the Council has improved its safeguarding process, as it will have had a reasonable opportunity to do so.

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Final decision

31. We will not investigate Ms X’s complaint. This is because further investigation by the Ombudsmen is unlikely to achieve any more than the Council has already offered. I am of the view that the Council has taken reasonable steps to put things right and further investigation by us is unlikely to achieve more.
32. It is too soon for us to meaningfully look at the Council’s actions around improving its safeguarding process.

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Investigator's decision on behalf of the Ombudsman