No fault found with Nottinghamshire County Council after properly reaching a decision to reduce a care package

Decision date: 8/10/19

What happened

Ms D lived at home with her husband and three teenage children. She had limited mobility and specific dietary needs.

She had a personal assistant (PA) from Monday to Friday who provided support with personal care, domestic tasks and attending hospital appointments for Ms D and/or her children. Ms D’s husband worked full time and suffered from his own health conditions including stress, anxiety, depression, joint pain and Irritable Bowel Syndrome. He therefore felt unable to provide an extra two hours per week of support with domestic tasks.

Ms D did not have to contribute financially towards her care package and received DLA (Low Care and High mobility). She used this for buying dietary supplements, a vehicle loan and wheelchair maintenance.

The Council was alerted that over £6,000 had accumulated in Ms D’s direct payments account during the year between February 2017 and March 2018. It said that this indicated that Ms D was not using all her available support hours and so arranged a care review in October 2018.

However, Ms D claimed that this amount had accrued due to difficulties with recruiting and retaining staff, and had accumulated over a three-year period. She said she had only accrued £1,682 during the above 12 months period and was using all the 24 hours of PA support in October 2018, when the assessment took place.

Following the care review in October 2018, the Council made the following changes to Ms D’s support package:

  1. Domestic support: The Council reduced this from 45 minutes per day (3.75 hours a week) to one hour per week.
  2. Support with meal preparation: This was reduced from 90 minutes per day to just 30.
  3. Access to the local community: This increased from 45 minutes per day (3.75 hours per week) to 6 hours per week but now included support with attending medical appointments for Ms D or for her children.

This resulted in a seven hour weekly decrease in her care package from twenty four hours to seventeen.

The support plan no longer included support to prepare a packed lunch as the Council believed that her children should be able to prepare their own school lunch with support from their parents. The Group Manager also signposted Ms D to the Council’s Children’s Services, but Ms D rejected this offer.

The Council said that Ms D’s condition varied from day to day and that she can therefore move her hours around flexibly, according to her needs. She was also allowed a six weeks surplus of her Direct Payments should she need this for contingency hours.

Ms D was very unhappy with the seven hours’ reduction in her care plan as she felt that her needs had not reduced and that the contents of the 2018 assessment were very similar to the one in 2017. She said that the Council had failed to appreciate the healthcare problems of her children, with respect to them making their own school lunches. She also said that the Council failed to explain how the proposed seventeen hours would be enough to meet her needs, or why it believed her needs could now be met by seven hours less support than before.

The Council offered to carry out a carer’s assessment for Ms D’s husband, who initially turned down this offer. Mr D has since completed a carer assessment which resulted in a one off payment of £150 and found that Mr D is eligible for respite care funding.

The Council referred Ms D to its Reablement Service in an attempt to promote her independence. However, Ms D declined the offer as she did not believe that she would be able to achieve more independence. She had participated in a rehabilitation course in 2014, which actually increased her symptoms instead of alleviating them. She said that there was evidence that the reablement team accepted it was not ideal for her but the council could find no such record.

While the Council accepted that Ms D had limitations, they did not accept that 12 weeks of reablement support would not be able to identify areas, further equipment and ways of doing things that would have benefits for her.

The Council offered a reassessment in February 2019 which Ms D declined because she was satisfied the assessment document accurately reflected her situation.

What was found

The Ombudsman found that the Council considered the information and arguments Ms D provided, and used relevant guidance to come to a view as to how Ms D’s eligible needs should be met. There was no fault found in the way that the Council made its decision.

The Care Act Guidance (6.106f) says (maintaining a habitable home): “councils should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe”. At times, the Council had provided more support with this as needed. It only needed to provide support to ensure the person is safe.

This support was therefore focused on doing a thorough clean of the bathroom and kitchen once a week to keep them to a habitable standard. Furthermore, PAs were regularly cleaning up as they carried out support with personal care etc.

It was not unreasonable to expect this husband and the three teenage children to provide some support with keeping their own house clean, such as cleaning, hoovering and laundry.

The Council has said it will review with Ms D how her revised care package is working.

Points for the public, service users and family members

The LGO rightly investigated the approach and reasoning of the authority’s staff, in relation to the position that the disabled person would cope with the reduction in services. The LGO doesn’t sit as an appeal tribunal. The organisation can only find fault if there were inappropriate assumptions or stances taken – especially if those were ones that would be considered by a court to be indefensible.

Maintaining a habitable home environment is one of the criteria for overall eligibility for having a personal budget. Whilst it is true that the Guidance mentions safety, it should also be noted that all of the services that used to be presented as Supporting People services for people with learning disabilities to keep a tenancy secure – such as paying rent, utilities, service charges. So it’s not right to say that all a council has to pay for is enough cleaning for keeping a person safe.

What’s important in this case is that the major part of the eligibility of this woman seems to have been based on the need for assistance with parenting. In that context, of course another parent is equally responsible for parenting, but it is not that odd that one does the earning and the other runs the house. You can’t get help for earning, so it’s obvious that the less well partner is going to remain at home, and if they are unable to achieve without assistance, they are going to look to adults’ services for help.

However, domestic input is essential as part of parenting and thus for discharging parental responsibility, as well. THIS father had a wide ranging selection of problems of his own, but it’s not possible to tell from the report whether the council fairly addressed Ms D’s stance on why he could not do more – or what his own position was on his input.

Also, any decision about a defensible or an indefensible stance by a council, has to be taken with consideration of the culture and current attitudes to what teenagers should be doing for themselves. It cannot be wrong to expect children to be being encouraged towards taking more responsibility.

In a case where a person living with another person WILL NOT do their own fair share, let alone stand in for what the needy person would be doing for themselves or for their families, a council is not responsible for the dynamic in that particular family, and we can understand the LGO’s reluctance to find fault, because Ms D was offered some solutions but turned them down, including a reassessment.

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The full Local Government Ombudsman report on the actions of Nottinghamshire County Council can be found here:

https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/18-016-966

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