By Ashley Young-
Sefton Council restricted the budget of a disabled man by capping respite payments at the matching cost of residential care, even though it was an unsuitable way of meeting the man’s needs.
The blunder meant the man’s parents had to top up payments for carers so that the respite could be provided in the family home. The man had gone 16 months without respite altogether because of a failure to agree the amount between Sefton council and the family.
This prevented his parents having a break at a time when his father had health problems of his own. The Ombudsman concluded that the man suffered an injustice by missing out on sixteen months of respite care and being forced to contribute to carers’ wages.
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The identity of the man cannot be revealed because of legal reasons but he has a severe learning disability and autistic spectrum disorder and lives with his parents. He had been in receipt of council-commissioned 2-1 care, five days a week, at a day service run by a nearby council for over 20 years.
The man also had a direct payment for three hours’ care a week and four weeks’ respite a year, provided at home by carers from the day service.In May 2016, the council began a reassessment of his needs, which was not finalised until July 2017 because, the council said, it was pursuing continuing healthcare funding for them.
POOR PRACTISE
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The ombudsman said it was “poor practice” for the council, in March 2017, to invite Mr and Mrs X to a meeting about the reassessment without providing them with a copy of it in advance and informing them of the formal nature of the meeting.
The watchdog cited the statutory guidance under the Care Act, which states that, though councils may take financial considerations into account in how they meet need (though not whether they should be), they should not set arbitrary limits on how much they will pay to meet a need .
The Ombudsman explained that this was because setting such limits“would not deliver an approach that is person-centred or compatible with public law principles”.
ORDER
Sefton Council was asked to provide the couple with a written apology and make a total of £750 payment to the pair. The figure was broken down into two: £250 to acknowledge the time and trouble they have been put to, and £500 to acknowledge the uncertainty and worry caused by the council’s failure to provide sufficient direct payments to cover the cost of Mr Y’s respite care in 2017-18.
CARE AND SUPPORT PLAN
The couple were asked to review and produce a care and support plan which reflects his needs over a seven-day period and explain how these needs will be met, including respite care, in consultation with the couple
The assessor recorded that Mr Y spent a great deal of his week in the community and that incidents involving challenging behaviour had “greatly reduced over the years”, recommending he continue to attend the day centre five days a week but his support decrease from 2-1 to 1-
The assessor also said that he should continue to receive four weeks’ respite a year, but that this would cost £500 a week, equivalent to the cost of a week’s placement in a care home. This was despite Mr and Mrs X wanting to continue with respite within the family home funded by direct payments.
The couple were invited to a “formal meeting” with the council in March 2017 to discuss the assessment but weren’t given a copy of it beforehand. The unnamed woman expected to meet with the reviewing officer but was instead presented with seven council officers, which she found intimidating. During the meeting, council officers queried why Mr Y needed two carers when outside of his home.
Mr Y’s assessment was completed in July 2017 and a copy was sent to Mr and Mrs X, who disagreed with the outcome. In October, Mr Y’s case was transferred to a different team and a new social worker was allocated.
No direct payments were received for the man’s respite care in 2017, which the newly allocated social worker out down to the lack of conclusion over how much funding he should receive.
In an assessment in April 2018, the social worker recorded Mrs X’s “frustration that there is an outstanding issue relating to [Mr Y’s] respite which has prevented them from having an extended break from their caring role last year”. The assessment also recorded that Mr his needs had not changed, apart from in respect of accessing the community, for which the assessor said that his needs had reduced but that he still needed two carers.
The council’s legal team then advised the social worker that Mr Y receive funding for respite in line with the equivalent cost for residential care despite a care home not being a suitable way to meet his needs. The social worker recommended in the April 2018 assessment he continue to receive four weeks’ respite a year at home through a direct payment. A further assessment in June 2018 recorded that his needs had not changed from the April assessment.
The woman formally complained to the council in June 2018 saying she received no respite at all during 2017 and had received no payments for respite in 2018. She submitted a further complaint in July 2018 in response to the decision to pay Mr Y’s respite care budget at a residential respite rate that Mrs X said wasn’t enough to provide respite care in the home.
On 11 August, two weeks before a planned holiday, Mrs X contacted the council and said she hadn’t yet received direct payment to fund respite.
When Mrs X received the respite money it was less than had previously been paid, equivalent to the cost of a residential respite stay at £570 per week.
Forced to top up carers’ wages
The regular carers agreed to provide respite for Mr Y in the home at a reduced rate (£4.41 per hour) because Mrs X’s holiday was imminent, so Mrs X offered to top up the carers’ wages.
At a further meeting in December 2018, the social worker and her manager reiterated that the council would only pay for respite at the residential care rate, and the authority subsequently offered Mrs X two weeks’ respite at this rate by way of apology for the failure to provide it in 2017-18.
After Mrs X’s complaint was referred to the ombudsman, the council told the watchdog that the social worker had concluded that Mr Y’s needs could be met in a residential setting, but that the respite payment was provided as a direct payment in line with the family’s preferences.
It added: “The most cost-effective way to meet [Mr Y’s] needs was via a residential respite placement. As such, if the family chose another method to meet his needs, the council would only pay for a service up to the same value as the most cost-effective option”.
Failings
However, among a number of identified failings, the ombudsman found that all evidence showed residential care to be unsuitable for Mr Y, and it was unclear how the council concluded that it was.
Despite the April 2018 assessment concluding residential respite was unsuitable and the June 2018 assessment recommending he receive respite at home, the council reduced his respite payment, wrongly setting an arbitrary upper limit, the ombudsman found.
“In setting the amount of a direct payment…the council must ensure it is enough to buy services which will meet the person’s eligible needs,” the report said. “In Mr Y’s case, it failed to do so.”.
The watchdog cited the statutory guidance under the Care Act, which states that, though councils may take financial considerations into account in how they meet need (though not whether they should be), they should not set arbitrary limits on how much they will pay to meet a need as this “would not deliver an approach that is person-centred or compatible with public law principles”.
The ombudsman also criticised the April 2018 assessment for finding that Mr Y’s needs to access the community had reduced despite concluding that his need for 2:1 care in the community was unchanged.
‘Confusion and delay’
He also found evidence of “confusion and delay”, saying the pursuit of CHC funding should not have delayed the completion of the reassessment started in May 2016 and ending in July 2017.
had suffered an injustice by missing out on sixteen months of respite care and being forced to contribute to carers’ wages.
The ombudsman also found that the council’s offer of two weeks’ respite at the residential rate in acknowledgement of its failure to provide respite in 2017-18 was insufficient because Mr and Mrs X missed out on a service which would have provided relief from their caring role.
This was particularly important because Mr X was experiencing his own health problems, the ombudsman added.
The ombudsman also said it was “poor practice” for the council, in March 2017, to invite Mr and Mrs X to a meeting about the reassessment without providing them with a copy of it in advance and informing them of the formal nature of the meeting.
In response to the findings of the ombudsman, a spokesperson for Sefton said: “Since 2018 Sefton Council has worked with the Social Care Institute for Excellence (SCIE) to roll out a programme of mandatory training and development for adult social care practitioners which covers the recommendations outlined in the report.
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