Leave a Comment / Delay and non-commissioning, Delay In General LGO, Direct Payments and Personal Health Budgets, Direct Payments LGO, Intro to Ombudsman reports RE Delay in General, Intro to Ombudsman reports RE Direct Payments / By Aidan Miller
Date of decision: 09 February 2026
Summary
Miss X, who was receiving direct payments, complained that the Council mishandled her annual care review, failed to send her final assessments or a clear care plan, and left her uncertain about increased support and surgery arrangements. She complained that the Council had arranged an unnecessary repeat assessment. She had been given confusing and sometimes inaccurate information about her support hours, direct payment surplus and contingency planning, causing months of avoidable distress, uncertainty and effort.
What happened
Miss X received direct payments from the Council to meet her eligible care and support needs, paid into a shared account that also holds direct payments for another family member. In January 2025, the Council carried out its annual review of Miss X’s care plan, during which she requested an increase in support hours to improve community access and informed the Council she had forthcoming surgery that would require additional support.
In February and March 2025, she emailed her allocated social worker asking for an update on her request for more support, but received no reply. In late March, she made a formal complaint to the Council about poor communication, saying the social worker had not contacted her since the January review, that she lacked needed support and was struggling to manage her care, and she asked the Council for an urgent update.
In April 2025, the Council telephoned her in response to the complaint, explaining that the social worker had been absent from work and had not written up the January review before going off. The Council offered a further review of her care and support needs, but she refused, saying a full review had already happened in January.
Later in April, Miss X received a letter from the Council about an increase in hourly rates for personal assistants, inviting direct payment recipients to contact the Council if they needed an uplift; internally, the Council accepted she was entitled to the higher rate but decided not to adjust her payments because of what it saw as a surplus in the direct payment account. The Council did not inform Miss X of this decision.
In May 2025, the Council issued its stage one complaint response, saying the social worker had been absent from February with an out‑of‑office message giving alternative contact details, and that because she had declined a new review, it could not consider her request for increased support.
It also said her care plan included 25 hours per week for community access, that the direct payment account showed a surplus, and that the social worker had returned to work, written up the January review, and would contact her within the next week.
Miss X escalated the complaint, saying she had not received any out‑of‑office replies and had no response following her contact in April. She stated her plan provided only four hours and that she had requested an extra three to four hours because her health had deteriorated.
She explained the surplus in the direct payment account related to her family member, not her own care, and that she would need that surplus for additional support when recovering from her upcoming surgery. She asked for a full reassessment, approval of the increased care, acknowledgement of errors in the stage one response, better practice on out‑of‑office replies, when absent, and a clear explanation of how support would rise ahead of surgery.
In June 2025, the Council issued its final complaint response, accepting it had wrongly said she received 25 hours of community access and confirming it had now sent her a copy of the January review. It said a reassessment had been scheduled for later that month, at which her surgery and the use of the account surplus could be discussed, and that her request for more hours would be considered after the reassessment.
Miss X then brought forward her complaint to the Ombudsman.
In response to Ombudsman enquiries, the Council said it could not evidence any out‑of‑office replies to Miss X in February and March emails because such messages are not held for longer than 30 days, and its response to that issue came about 60 days after her March contact.
The Council confirmed that the reassessment was carried out over two meetings in June and July 2025; it sent Miss X a draft assessment, she confirmed it was accurate, and the assessment was finalised, but the Council did not send her the final version as it was considered unchanged from the draft. After the reassessment, the Council agreed to provide her with an extra three hours per week for community access on a temporary basis from October 2025.
Over the following months, she repeatedly chased for clarity about the increased hours, how long they would last, and what would happen after her surgery, but the Council’s responses remained unclear and sometimes inconsistent. She also queried why her direct payment rate had not been uplifted in line with the letter relating to personal assistants and why the Council continued to refer to a surplus in the joint account without separating her funds from her relative’s.
What was found
The Ombudsman found that the Council did not provide her with copies of her final care and support assessments from January and July 2025, relying on the fact that the July final version did not differ from the draft as a reason not to send it. The Ombudsman considered that once an assessment or plan is finalised, the individual should receive a copy so they have a clear and accurate record of needs and support, and the failure to share final documents promptly caused her uncertainty and extra effort to chase information.
Failing to share the final assessments in a timely manner was fault, causing Miss X uncertainty about her care arrangements. She had to spend her time and effort pursuing information that should have been given to her already.
In April 2025, the Council had offered another assessment because the January review had not been written up before the social worker’s absence, and it said it could not progress her request for more hours without that. Although the offer was intended to avoid delay, she declined because she believed the January review was complete. When the social worker returned around May and wrote up the January review, the Council still did not then use it either to decide on the requested increase or to clearly explain why a full reassessment was necessary due to changed needs, despite the January review containing information about her community access needs and planned surgery. The Ombudsman found that this failure to act on the January review or to explain the need for reassessment amounted to fault, causing frustration, uncertainty and delay.
Regarding contingency planning for surgery, she had told the Council in January 2025 that she would need extra support during and after surgery, and this was revisited in the June 2025 reassessment.
The Ombudsman could not be sure whether contingency arrangements were properly discussed and agreed, but concluded that either the Council had not adequately discussed and agreed plans or had failed to record this. This left the client unclear about what support would be in place, so there was fault, causing Miss X uncertainty.
The Ombudsman found the Council should have ensured appropriate managerial oversight of open cases during the social worker’s absence and that service users were informed and given an alternative contact; failing to do so was fault and a missed opportunity to avoid the complaint.
The Council acknowledged that it did not respond to her April 2025 contact about increased personal assistant rates and her direct payment, which was fault and caused her further distress and uncertainty. Its stage one complaint response contained inaccurate information, including the incorrect statement about 25 hours’ community access, which was fault and caused her avoidable time and trouble pursuing her complaint.
To remedy the injustice, the Council agreed to apologise in line with Ombudsman guidance and pay her £300 to recognise the distress, uncertainty and time and trouble caused by its communication failures, delays in sharing assessment documents, and failure to act promptly on the January 2025 review.
Within three months, it also agreed to remind adult social care staff of the need to give service users copies of finalised assessments and plans, even where unchanged from drafts, and to review how it manages cases when social workers are unexpectedly absent, ensuring suitable managerial oversight and clear alternative contact arrangements; it must provide evidence of compliance to the Ombudsman.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
The Council’s failures over review, reassessment and care planning illustrate how easily public bodies can drift away from core Care Act duties to assess needs, record decisions transparently, and act within a reasonable timescale once eligible unmet needs are identified, and provide follow-up documentation.
A first legal issue is the handling of the January review and later reassessment: the Ombudsman criticises delay and poor use of information, but could have explored whether the Council met its duty to keep the existing care and support plan under review and to revise it, if needed, following a lawful reassessment.
Community care law stresses that a review is not itself a reconsideration of eligibility but is an enquiry into whether the current plan is working to deliver outcomes and meet statutorily eligible needs, and that any change to the plan (a revision) must follow a proportionate re‑assessment of needs and a fresh eligibility judgment.
It was ‘unclear why the Council did not then consider Miss X’s request for additional support based on the January review, particularly as her requests remained the same: increased support to access the community and additional support in relation to her upcoming surgery. The January review should have provided sufficient information for the Council either to decide on Miss X’s request or to clearly explain why a full reassessment was required due to a change in her needs.’
A second legal issue is the treatment of the direct payment, the purported surplus and the uplift to personal assistant rates.
There seems to have been confusion about the surplus on Miss X’s direct payment account. Miss X suggested her account was shared with a family member. The report does not explore this, but to share a direct payment account in this way seems an unwise arrangement which is likely to lead to confusion. We have never heard of even a consensually combined plan being used or operated in this way
The Council internally accepted that she was entitled to the higher hourly rate but withheld any adjustment on the basis of a perceived surplus in a joint account, without clearly distinguishing her budget from her family member’s and without telling her that this judgment had been made.
Community care law on care planning and personal budgets requires a defensible link between assessed eligible unmet needs, the points and the pounds, and obliges councils to ensure that direct payments and commissioned rates are set at a rational market level rather than left to arbitrary assumptions about “spare” funds. Miss X may have been managing direct payments for another family member, or it may have been a combined pair of budgets, but it is astonishing to us that this is not clarified in the context of assumptions being made by Surrey about what the money could be used for.
Where an authority decides not to uplift a rate despite acknowledging the contractual cost of care has risen, it risks severing the nexus between needs, the cost of meeting them in the local market and the personal budget figure, and also undermines transparency: service users must be able to challenge sufficiency of the budget and understand the reasoning behind decisions, rather than discovering only later that financial judgments have been made about shared accounts or contingency funds without consultation.
For councils, the wider lesson is that resource pressures, staff absence and shared financial arrangements can never justify opaque decision‑making: assessment, review, reassessment, care planning and personal budget setting must all be done lawfully, with reasons, clear documentation and proper involvement, so that people know what support they will get and can plan their lives, especially around predictable events such as surgery.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Surrey County Council (25 005 242) report. If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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