The Ombudsman's final decision
Summary: Mr X complained the Council failed to provide him with adequate social care support. The Council was not at fault.
The complaint
Mr X complained the Council failed to provide him with adequate social care support. He said in particular: the Council allocated him a social care assessor rather than a social worker; the social care assessor delayed in carrying out a needs assessment; the social care assessor acted inappropriately towards him; the Council did not provide adequate support to deal with his issues including his anxiety, PTSD and autism and with appointments and getting help with his accommodation; the support from his social care assessor ended abruptly leaving him without any help other than a crisis team telephone number; and the Council did not ask the mental health team to allocate him a female mental health worker.
The Ombudsman’s role and powers
We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended) If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
How I considered this complaint
I have considered the information provided by Mr X and discussed the complaint with him on the telephone.
I gave Mr X and the Council the opportunity to comment on a draft of this decision and considered any comments I received in reaching a final decision.
What I found
What happened Mr X has a diagnosis of autism and additional physical and mental health difficulties. Mr X had an allocated mental health nurse and was under the care of a consultant in the Community Mental Health Team. The following is a summary of the key events. It does not reference every contact between the Council and Mr X.
In late 2019 the Council allocated Mr X a social care assessor to provide support, guidance and signposting to other services. At that time Mr X did not want a needs assessment but sought support with moving house. The social care assessor made regular telephone contact with Mr X and in February 2020 supported Mr X to register with the Council’s housing allocations scheme.
In March 2020 the country went into lockdown due to the COVID-19 pandemic. Around that time the social care assessor referred Mr X to the mental health reablement team for support with re-housing, to access services and for support with an application for PIP (personal independence payments – a benefit administered by the Department for Work and Pensions).
The records show that between March and July 2020 the mental health reablement officer contacted Mr X most weeks by telephone. The officer agreed to contact the Council's housing department and later sent an email in support of a higher banding for Mr X on the Council’s allocations scheme. The notes record at the time Mr X did not want to pursue his PIP application further. The officer also supported Mr X with applying for a bus pass and referred Mr X to Company 1 (an organisation that provides services to help maintain people’s independence) for more longer-term support.
In July 2020 Company 1 assigned an officer to support Mr X. The officer contacted Mr X regularly by telephone. Mr X asked the officer to support him to attend hospital appointments but this was not within the officer’s remit. Mr X agreed to be contacted regularly but did not agree any goals to work towards.
Company 1 closed the referral in September 2020 due to Mr X’s unrealistic expectations with wanting staff to transport him to appointments and Mr X not wanting or setting any goals to achieve. They noted Mr X benefited from weekly calls which gave him the opportunity to offload and suggested a referral to a befriending scheme may be more appropriate. Mr X declined this suggestion.
In November 2020 the social care assessor contacted Mr X’s GP to discuss a referral to the community mental health team for further assessment.
In spring 2021, the social care assessor and another officer supported Mr X to virtually attend his initial assessment with the Autism Spectrum Disorder (ASD) team. Mr X says the appointment consisted of two parts and the officers left after the first part.
In April 2021 the social care assessor completed a needs assessment which noted Mr X was recently assessed by the ASD team and met the criteria for an ASD diagnosis. In the assessment they noted Mr X: was unable to do his shopping due to high anxiety levels. A relative supported him with this; was able to make meals and manage his own personal care needs; struggled in group situations; and avoided accessing the community but would attend appointments independently if necessary.
The assessment concluded Mr X had eligible needs in several areas.
The assessment also noted: Mr X was keen to receive support on a long term consistent basis; Mr X reported problems with his housing which they had referred to the Housing Association; Mr X had worked well with reablement but this was a short term intervention; Mr X was referred to Company 1 the previous year but declined their service after a few weeks; the Council had suggested referring Mr X to a befriending service but he had declined this as he wanted support from someone with knowledge of ASD; the ASD Team had provided Mr X with resources for accessing advice and support and he had been advised to use the local autism hubs; Mr X had a follow up appointment arranged with the ASD Assessment Team and would discuss some of his concerns at that time; and the Council would refer Mr X to an Occupational Therapist (OT) for a housing needs assessment.
Council records show the social care assessor spoke to Mr X in late April 2021 and advised they had completed the needs assessment. They discussed the possibility of a small care package but felt Mr X would struggle to engage if a provider was sourced. The notes record Mr X spoke about his difficulties engaging with male workers due to historic traumas. The assessor asked whether Mr X had accessed any therapeutic interventions to address this. Mr X said he had not and at that time did not want to. The assessor noted they encouraged Mr X to access resources provided by the ASD team. They noted Mr X’s priority was to move to a quieter location.
An OT completed a housing needs assessment in May 2021 which noted Mr X’s housing was having an extreme detrimental effect on his mental health and psychological and emotional wellbeing. It noted Mr X had difficulties ascending and descending the stairs to access the property and recommended he was moved as soon as possible to a more appropriate property.
The social care assessor attended Mr X’s follow up appointment with the ASD Assessment Team via telephone.
In June 2021 the social care assessor spoke to Mr X regarding the possibility of a package of care. At that time they noted Mr X was unsure whether this would be beneficial. They noted he felt he had managed well without support. They also noted he was not interested in befriending and agreed to allow him time to consider his options.
In July 2021 the social care assessor visited Mr X with another officer to discuss whether a package of care would be beneficial. At that time they noted Mr X felt it would not. His main priority was to move. The notes record the social care assessor advised Mr X that as he had declined various offers of support, he would now be discharged from their caseload. The notes record Mr X was unhappy about this and felt let down.
Mr X wrote to the Council about the lack of support provided by the social care assessor. He felt nothing had been achieved during the time they supported him. Mr X requested a package of care and also wanted support moving out of his flat.
In September 2021 the Council responded to Mr X’s letter. It agreed to offer Mr X another needs assessment to determine his eligibility for support at home and to allocate Mr X a social worker.
In September 2021 a worker from the community mental health team referred Mr X to the mental health reablement team again. The mental health reablement officer contacted Mr X regularly and supported Mr X to register with a housing association.
In December 2021 the mental health reablement officer made a joint visit to Mr X with the newly allocated social worker. The social worker explained their remit and what support they could offer. They agreed to complete a needs assessment. Mr X later refused to go ahead with this.
In January 2022 the mental health reablement officer re-referred Mr X to Company 1. Mr X was unhappy Company 1 allocated him a male officer. Mr X said he required support from females due to a past incident. Company 1 spoke with the social worker who advised Mr X had previously received reablement support from male workers without issue. Company 1 was unable to offer an alternative and so Mr X agreed to accept support from the allocated officer.
The officer from Company 1 contacted Mr X regularly. They completed a hospital referral for Mr X to received support with PTSD. The officer asked Mr X to come up with a list of the support he needed so they could build a support package and set some goals. Mr X advised he needed specific targeted support for autism.
The officer suggested counselling but noted Mr X was unwilling to pay the cost of £30 a session. The officer noted Mr X said he could not proceed with setting goals as he was not getting the therapy he needed. In March 2022 Company 1 ended its support to Mr X. It wrote to confirm that Mr X had expressed that until he had undertaken the correct therapies to aid his recovery from his various mental health conditions he could not reach or obtain any realistic goals. So he wished to end his support.
Mr X complained to the local NHS Trust which forwarded his complaint for the Council to respond to those parts which fell under its remit.
The Council responded in early 2022. It said: Mr X referred to the social care assessor not being a qualified social worker. It apologised if Mr X was unaware the social care assessor was not a social worker but considered they were very experienced in their field.
Mr X complained about a lack of support from the social care assessor in attending appointments with the ASD team and that calls were cut short. The Council said the social care assessor was unable to recall why they left between the two parts of the appointment on the first visit however said they had attended for around two hours. They recalled Mr X did very well with the assessment and answered the questions he was asked without support. The Council said the assessor did not visit to support Mr X at the second appointment due to minimising contact due to the pandemic. They supported Mr X over the phone but the call was cut off. The Council said this support was above and beyond what the social care team would ordinarily do. The social care assessor could not recall why calls were cut short. However often staff had to attend urgent work.
The social care assessor sought to assist Mr X with looking for alternative accommodation but it was not their role to source accommodation for someone. They had also referred Mr X for an OT assessment.
In relation to the needs assessment, it noted Mr X initially requested this wait until early 2020. In the meantime, the social care assessor supported Mr X through telephone calls during the COVID-19 pandemic. It said at that time Mr X had other priorities such as support with housing and ASD assessments. The Council made referrals to the mental health reablement team and Company 1 which were considered more beneficial to Mr X. Following the needs assessment, the Council offered Mr X a small care package at home but Mr X was unsure this would be beneficial.
Mr X complained his support from the social care assessor was ended without notice. The Council said the assessor visited with a colleague in July 2021 and at the visit Mr X said he felt a package of care would not be beneficial. The assessor explained that because Mr X had declined various offers of support he would be discharged from the social care assessor’s caseload. The Council said Mr X was offered all the support and signposting within its ability.
Mr X complained the social care assessor had not requested that he be allocated a female mental health worker from Company 1. The Council said this was not something the social care assessor could decide on.
Mr X complained about the behaviour of the newly allocated social worker. The Council said it had spoken with the mental health reablement officer that attended with the social worker who said the social worker was pleasant and professional at the visit and honest about the support they could offer.
Mr X remained unhappy and complained to us.
Findings
Social care assessor, needs assessment and closing of Mr X’s case The Council allocated Mr X a social care assessor to assist with providing care and support. That is not in itself fault. Mr X said he was unaware the officer was a social care assessor and not a social worker. I cannot know exactly what the social care assessor told Mr X their role was, however the Council has already apologised if Mr X believed he was misled and there is nothing else I could achieve by investigating this further.
Mr X said the social care assessor behaved inappropriately. I cannot know exactly what was said between Mr X and the social care assessor. However, I have seen no evidence the social care assessor acted inappropriately in their dealings with Mr X.
Mr X complained about delay in carrying out a needs assessment. Mr X did not initially want a needs assessment as his priority was to be re-housed. Instead, the social care assessor took appropriate steps to offer Mr X other support to meet his needs. This included a referral to the mental health reablement team, which led on to a referral to Company 1. There was no evidence of fault in the decision not to complete a needs assessment at that time.
In any case, when the social care assessor undertook a needs assessment in July 2021, Mr X was unsure whether a care package would be beneficial. Mr X later refused the offer of another needs assessment from the allocated social worker. So I cannot say, with any certainty, that Mr X would have received any additional support had a needs assessment been completed sooner.
Mr X turned down the offer of support the Council made after carrying out the needs assessment because he considered it was not suitable. As Mr X declined to access the support the Council offered, and the Council did not consider it could provide alternatives, it was not fault for it to close his case. The Council promptly reopened Mr X’s case when he subsequently requested a package of care and offered him another needs assessment.
Support offered It was not the role of the social care assessor to support for Mr X with his health concerns. If Mr X feels he was not supported adequately by health professionals it is open to him to complain separately to the Parliamentary and Health Service Ombudsman about this. The social care assessor’s role was to provide support for any eligible needs arising from his health issues and they sought to do this.
The social care assessor attended the first part of Mr X’s assessment by the ASD Assessment Team. I cannot now know exactly why they left before the second half of the assessment. However, there is no evidence this caused Mr X a significant injustice. Mr X was able to complete the assessment and received his diagnosis. Mr X may have wanted the social care assessor to be present during appointments but that was not their role.
Mr X is unhappy in his current accommodation. The social care assessor assisted Mr X with joining the housing allocation scheme and later referred him to an OT who completed a housing needs assessment in support of Mr X’s need to move. They also referred Mr X to the mental health reablement team for support with his housing. An officer from the mental health reablement team wrote a letter of support to improve his banding in the allocations scheme and a second officer assisted with registering with a housing association. The social care assessor sought to support Mr X in pursuing alternative accommodation, but it is not for them to source alternative accommodation. It is for Mr X to liaise with housing to pursue alternative accommodation. The Council was not at fault.
Male mental health worker The records show Mr X told the social care assessor he was not comfortable being supported by male workers. However, I have seen no record that Mr X specifically asked the mental health reablement office to request that he be allocated a female mental health worker. In any case it would be for the Mental Health Trust to consider and act on this request and it was open to Mr X to raise this direct with the Trust.
Final decision
I have completed my investigation as there is no evidence of fault by the Council.
Investigator's decision on behalf of the Ombudsman