Somerset council took 21 months to properly reassess a woman’s needs, leaving her parents providing unpaid care that the authority should have funded, the Local Government and Social Care Ombudsman has found.
Had the woman, known as Ms Y, had an adequate assessment of her needs in September 2016, this would likely have resulted in an increase in her direct payments.
Instead, including because of long delays in allocating a social worker to Ms Y, her payments were not increased until June 2018, when a proper reassessment was completed. As a result, her parents, Mr and Mrs X, who she paid to be her personal assistants, had to meet her increased needs unpaid.
Departure from Care Act guidance
The 21-month delay came despite the Care Act’s statutory guidance saying that assessments “should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs”.
More learning from ombudsman cases
- Spike in ombudsman decisions against council adult social care practices ‘shows impact of rationing’
- Ombudsman lambasts council for using ‘flawed assessment’ to cut disabled woman’s care by 60%
- Council’s decision to stop majority of DoLS assessments left 3,000 without legal protection, ombudsman finds
The ombudsman also found the council was at fault for not backdating the increase in her direct payments to September 2016. Other failings included removing funding from Ms Y for four weeks’ respite care a year without explaining why, considering how she would manage if Mr and Mrs X took breaks or assessing whether Ms Y had an eligible need for short breaks or holidays.
The watchdog also found Somerset was at fault for breaching its agreement to make a one-off payment for a short break to Ms Y in July 2018, and for not increasing her payments to allow her to pay Mr X for managing her finances, which it knew he was doing on an unpaid basis.
Ms Y was assessed by the local clinical commissioning group as eligible for continuing healthcare (CHC) in June 2018. This was backdated to March 2017 – meaning the CCG, not the council, has been responsible for meeting her social care, as well as health, needs since then.
At the September 2016 review, Mr X requested an increase in Ms Y’s care and support package for social activities and said she now needed daily support with bowel management and subsequent personal care, rather than the thrice weekly support she was then receiving from district nurses.
The assessing social worker and her manager considered that Mr X’s request for additional support was to meet health, not social care, needs so did not increase her care package.
However, the ombudsman found no evidence that the council explored whether it was necessary for a district nurse to attend to Ms Y on a daily basis and, if so, whether there would be any other associated social care needs, such as hoisting. It also did not address Mr X’s request for increased support for Ms Y with social activities.
In November 2016, after Mr X had disagreed with the outcome of the September 2016 review, the council agreed to reassess the woman’s care and support needs, but in what the ombudsman called an “excessive delay”, she was not allocated a social worker until July 2017. It then took a further 11 months for the assessment to be completed, resulting in her direct payments being increased, in June 2018.
In July 2018, council records show a manager agreeing to Mr X’s requests for the council to backdate the increased payments for the period from September 2016 to March 2017 when she became eligible for CHC, and to provide a one-off direct payment for the woman to go on holiday. But the ombudsman found neither payment had been made.
Respite care removal
The council concluded, in October 2017, that the woman should not receive the four weeks of respite care a year, to provide Mr and Mrs X with a break, because she did not live with her parents and they were her paid carers.
However, while the ombudsman did not take issue with this decision, it criticised the authority for not addressing what arrangements Ms Y could make to provide respite for her parents, nor whether her direct payments would cover replacement care.
The council also did not consider whether Ms Y was eligible for short breaks or holidays or care when on holiday, in its assessment of her needs. While it said she could fund a break with her direct payments, this had not been addressed in her care and support plan, nor had the council assessed whether her payments were sufficient to fund a break.
Another issue was the council’s handling of Mr X’s request to be paid for managing Ms Y’s direct payment account. Council records from October 2017 showed that the council was aware he was managing her account, unpaid, that his request would need to be discussed and that he may need to relinquish his administrator role if he wanted to continue as Ms Y’s PA. However, there is no evidence that the council considered the request further.
According to council policy, a carer is not allowed to administer the direct payment account due to potential conflict of interest and safeguarding issues. However, the ombudsman said the council must consider the circumstances of each case and assess whether there are good reasons to deviate from the policy, otherwise it risked fettering its discretion.
They failed to do so, meaning the woman’s father was managing her account on an unpaid basis until she became eligible for CHC funding. In addition, there is no evidence that the council considered how Ms Y would administer her direct payments and whether she needed support to do so.
The council has accepted all of the ombudsman’s recommendations, which include:
- sending a written apology to Mr and Mrs X and paying them £200 in acknowledgement of the distress and trouble caused by failings including the long-delayed assessment and failure to provide backdated direct payments;
- sending a written apology to Ms Y for the uncertainty caused by its failures to assess whether she had an eligible need for short breaks and to address the arrangements for her care in Mr and Mrs X’s absence;
- backdating her increased direct payments for the period between September 2016 to March 2017 when she became eligible for CHC funding;
- providing increased direct payments for the period 2014 to March 2017 in acknowledgement of Mr X managing Ms Y’s direct payment account during this time;
- making a one-off payment to Ms Y for a short break, as it agreed to do in July 2018;
- reviewing its procedures to ensure social workers are allocated to carry out assessments in a timely and reasonable fashion;
- reviewing procedures to ensure officers give proper consideration to requests for a carer to be paid to manage direct payment accounts, and to ensure officers consider arrangements for care when a personal assistant is not available, such as during holidays, and detail these in care and support plans.
Direct payment review
A spokesperson from Somerset council said: “We work hard to get things right every time. In this case we did not meet the standards we set for ourselves. We have apologised to the individual and their family.
“The council has considered all the recommendations and is in the process of actioning them.
“Somerset is a learning authority and in light of the recommendations we are undertaking a review of our direct payments.”