Autistic woman left without proper support after care plan not reviewed or updated for five years

The Local Government and Social Care Ombudsman found Salford council failed to review the woman's care plan, that led indirectly to her care package ending.


An autistic woman was left without proper support after Salford council failed to review her care plan for more than five years, the Local Government and Social Care Ombudsman has found.

The watchdog found that the failure to review led indirectly to the woman’s care package ending, leaving her without support for more than six months, which was a “serious injustice”.

The ombudsman’s investigation also found the council had not carried out any autism awareness training for staff, despite statutory guidance under the Autism Act 2009 stating councils should provide this. While there was no evidence this caused personal injustice to the woman, Mrs W, the lack of training was a significant concern given the potential impact on other service users.

In Salford, the council has delegated its adult social care functions to two NHS trusts, Salford Royal NHS Foundation Trust, on behalf of the Salford Integrated Care Organisation, and Greater Manchester Mental Health NHS Foundation Trust. However, the ombudsman said that the council retained responsibility for these services, so the report refers to any actions in Mrs W’s being taken by the council, rather than the delegated providers.

In 2013, Mrs W was issued with a care plan under which she would receive support with domestic tasks such as managing her medication and dealing with mail, as well as to help her access the community.

No care plan review for five years

Under statutory guidance issued under the Care Act 2014, which came into force in 2015, authorities should review care and support plans at least every 12 months. The review should ensure the plan is up-to-date in regard to the person’s needs and desired outcomes.

However, in Mrs W’s case this did not happen.

According to the council, Mrs W instead received regular reviews at a nurse-led clinic, after which a letter was sent to her GP with up-to-date information and these “counted as her care plan”.

The council provided the ombudsman with two letters to Mrs W’s GP, one from April 2017 and one from March 2019.

But the ombudsman decided the letters were not an adequate substitute for a proper care plan because they didn’t explain Mrs W’s needs, the risk and difficulties her needs created, the support she needed or when and how this support would be provided.

Her 2013 care plan referred to Mrs W being prescribed a particular medication; however since then, she was diagnosed with a serious illness meaning she could no longer use it

The ombudsman said this highlighted the importance of an updated care plan.

‘Significant fault causing serious injustice’ 

Another element of the complaint was the funding of Mrs W’s care.

Originally in 2013, the council paid both fees and expenses to Mrs W’s provider but it subsequently changed arrangements so that providers recovered expenses directly from service users. This was not a fault, but the fact this was never explained to Mrs W was.

Her failure to pay the expenses led to the support agency terminating the care package in October 2018. The ombudsman concluded that had Mrs W had an updated care plan, she would not have been unaware that she was expected to pay the agency’s expenses, so the lack of a review indirectly led to her losing her support package.

This was a “significant fault causing a serious injustice”.

Lack of autism training for council staff a ‘significant concern’ 

Meanwhile, the investigation of the woman’s complaint found there was a lack of autism training for Salford council staff, contrary to the expectations of the statutory guidance under the Autism Act 2009. Though this is not law, councils are expected to follow the guidance unless they have good reasons to depart from it.

“It is a significant concern that this training has not been done, as other vulnerable people could well have been negatively affected,” the report said.

As a result of the investigation, the ombudsman recommended the council immediately arrange to review and update Mrs W’s care plan and pay her £1,200 for distress caused and the time it took her to bring the complaint.

The council has agreed to this and also committed  to carry out an audit of all adult social care service users to ensure they have up-to-date care and support plans, arrange training for all relevant staff to ensure they are able to assess and create care plans and provide training for relevant staff in autism awareness.

Gina Reynolds, lead member for adult services, health and wellbeing at the council, said: “The council, along with our health partners, has accepted the findings of the Local Government Ombudsman report published on 10 October and we apologise again fully to the complainant.

“As the Ombudsman recognises, we have put a robust action plan in place to improve the service above and beyond their recommendations,” Reynolds said.

“This is developing a new and stronger approach to how we manage and develop the quality of our practice to ensure a case like this does not happen again. I have welcomed the Ombudsman’s view which agreed this action plan was a satisfactory response.”



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5 Responses to Autistic woman left without proper support after care plan not reviewed or updated for five years

  1. Colin Quiller October 14, 2019 at 4:25 pm #

    Questions for Gina Reynolds – how on earth could she, as lead member of the council in this area of responsibility, not have been aware of the statutory guidance on autism?

    Are the relevant officers to get the blame because they failed to inform her? Or, was she aware but failed to act?

    I know budgets are under pressure, but how can such glaring omissions continue to occur in so many areas of adult social care?

  2. A Man Called Horse October 17, 2019 at 5:48 pm #

    My Council also has no training on Autism for Social Workers presently. The move back to Generic Teams has left many people dealing with issues that they are not specifically trained to deal with. It is, however, in my opinion not reasonable to expect Social workers to know everything about such complex conditions as a general part of their training. The fact is that the job is now very complex and increasingly revolves around legal duties. Most Social Workers have a knowledge of Law, however, they cannot be expected to have the same level of expert knowledge as Solicitors. I expect we will see much more of Local Authorities failing to meet legal requirements due to a combination of ongoing cuts, Austerity and inadequate internal cheap none expert training being provided.

  3. Su Seymour October 18, 2019 at 8:33 am #

    I waited 2yrs for update then about four months ago was done with well extra needs (partly due to high support being taken away) I didn’t bath for 20 months..I still not had the extra funds asked for and been told social isn’t allowed tho can’t do alone to groups or shop and it on plan. I am level 2/3 autism and constantly unable to function due to meltdowns failing health and needs not met I am 68. But as I don’t have a learning disability of course as I clever I am assumed to be able to just stop the autism or am wanting own way ..One day I will be not here due to how treated. I have no voice no choice

  4. Anonymous October 22, 2019 at 6:39 am #

    If adult social care was inspected nationally like children social care is, I think things would be very different for the people use services.

    I would imagine that long overdue reviews are a common finding in many authorities.

  5. Kay George November 6, 2019 at 10:12 am #

    I have known ‘Mrs W’ for some years. She is aware that I am writing this and agrees with its content. Unfortunately, what has been reported is just the tip of the iceberg in terms of mismanagement of her case. A case of mistaken identity resulted in her being accused of violent and disruptive behaviour and excluded from user involvement events. Despite the Ombudsman telling the Local Authority to apologise, this never happened. ‘Mrs W’ lost a substantial amount of money by trusting a ‘friend’ and the mental health trust didn’t believe that this was a safeguarding matter. There was a meeting where concerns were dismissed but to this day the minutes were never circulated. Further safeguarding requests by voluntary agencies regarding her loss of support were ignored. The recent Local Authority response to the case reported by the Ombudsman considers that the report in the press, which ‘Mrs W’ was not aware of until I found it on line, was considered to be her apology. Autism is very badly understood and training on autism has been heavily slanted towards people who have learning disabilities, not the majority who do not but have areas where they struggle badly. To date, despite promises, the Local Authority is not training staff on autism.