Council doubles care package after ombudsman orders new assessment

A council has more than doubled a man’s care package after the local government and social care ombudsman found fault with its assessments and recommended an independent social worker revisit them.

Waltham Forest council increased the support offered to the man, ‘Mr X’, from 25.5 to 66.25 hours following the independent assessment conducted in late 2017.

The London borough has also since reinstated nighttime care for Mr X, which had been a key bone of contention between him and the council since it cut his care package when the Independent Living Fund (ILF) ended in 2015.

‘Package cut by 75%’

Before the demise of the ILF, Mr X, who is blind and incontinent as well as having diabetes and severe arthritis, had received almost £800 a week from the fund as well as just over £400 from Waltham Forest. His care package included day and night support.

But after being reassessed in 2015, a funding panel agreed Mr X would receive just 23.5 hours of support per week – despite the assessment recording that he had “high support needs” in most activities.

‘Mr Y’, the legal rights officer who brought the complaint on behalf of Mr X, reckoned his package had been cut by 75%. While Mr X intended to pursue legal action against Waltham Forest, he was unable to do because of being ineligible for legal aid.

In July 2016 Mr X’s package was reassessed by a social worker and occupational therapist, but this resulted in only an extra two hours of care being offered.

Mr Y, who attended the assessment, “considered that the officers were mindful of what the funding panel would approve rather than what Mr X required”, the ombudsman’s report said. The completed document and resulting care plan also made no mention of Mr X’s eligible needs in line with the Care Act 2014.

‘Dignity undermined’

Mr Y raised particular concerns that Waltham Forest had failed to consider the impact of Mr X’s incontinence.

This not only undermined his dignity, when he was left overnight, but left him vulnerable to falls if he attempted to use the toilet, and meant morning carers’ time was taken up by cleaning him.

Mr Y also drew attention to a perceived lack of transparency around how funding was calculated, and what bearing the council’s electronic resource allocation system (RAS) had on the process.

Mr X was left with an “arbitrary package that does not genuinely involve the individual’s view on what is needed, and is a far cry from the person centred model that is required by the Care Act,” Mr Y said in a statement.

In response, Waltham Forest said it had “robustly reassessed” Mr X. It argued that Mr X was able to get out of bed at night, and stressed that its RAS produced only an indicative budget.

‘Difficult to understand’

The ombudsman described Waltham Forest’s decision to reduce Mr X’s care package as “difficult to understand”.

“The council failed to demonstrate what needed to be done at each care visit and no allocation was given to the substantial time required for Mr X’s toilet needs to be met,” the ombudsman said. “Moreover, Mr X was becoming reluctant to try to attempt to get out of bed at night time because he was prone to fall. This was also causing a decline in his wellbeing.”

The watchdog found the council had failed on several counts to properly identify Mr X’s eligible needs.

As well as not adequately assessing the impact of his incontinence, the report found the effects of his visual impairment were “not fully recognised” and that it was unclear how the local authority had allocated hours to need.

‘Close watch’

In the wake of the ombudsman’s initial recommendation, the independent assessor recommended a care package of 93.25 hours – almost four times what Mr X had previously been receiving.

But the new package was eventually agreed at 66.25 hours after Mr X became restricted to a wheelchair following a serious fall.

The ombudsman concluded that Mr X’s needs were for now being met but that the council must keep a “close watch” on this in light of his deteriorating health, as well as paying him £250.

The report also said Mr X and Mr Y were free to pursue a further complaint against Waltham Forest relating to compensation for lost care hours and for the personal cash he had spent on meeting his needs.

• For free essential learning on the key practice and management challenges facing social work and top-quality training on social care law, register now for Community Care Live London, on 25-26 September.