Well-being means more than merely ‘coping’

A recent important report by the Public Services Ombudsman for Wales[1] concerned a complaint made by the mother of young man with an Autistic Spectrum Disorder (ASD), mental health problems and Gender Identity Disorder.  Following a period of crisis he moved into supported living accommodation for people with severe and enduring mental illness.  Although he had capacity to make decisions about his care and support needs he experienced anxiety when presented with new information and asked to make a decision.

Although he was assessed as requiring 24 hours one to one support per week he did not receive this from his supported living provider.  In 2015 his needs were reviewed by an officer who had little understanding of ASD (and the effect of this on the young man’s behaviour and mental health problems) and who failed to ask him if he wanted his parents or an advocate with him during the meeting.   The assessment found that he had not been receiving the allocated 24 hours support and that cutting his support hours from 24 to 8 would result in a significant saving.  The assessment was not signed by the young man and did not state whether he fully understood and agreed with either the content or the significantly reduced package of care.

A complaint was made by his mother on his behalf.  As a result an assessment was undertaken by a care co-ordinator who had ASD expertise.  The assessment (which included input from the young man, his advocate, his parents and the supported living manager) recommended that his support hours be increased from 8 to 30 hours per week.  It stated that a lack of understanding by the care provider and the previous reviewing officer meant that his needs had not been fully recognised.

The local authority’s Funding Panel refused the request for additional hours.  It directed that another specialist assessment be completed to evidence why the increase in the hours should be provided.  This was delayed as the local authority had no one suitable to undertake it.

The ombudsman found that:

  • it was clear from the evidence that the council’s officers had insufficient knowledge and understanding of the effects of ASD;
  • that the young man had been ‘left in bed for lengthy periods of the day rather than motivated to get up and engage’;
  • the focus of the assessment was his mental health problems (not the needs arising from his ASD) ‘and financial savings’;
  • that ‘rather than reducing his hours the council should have considered whether the care provider was able to meet his needs;
  • although he was ‘continuing to function without the full complement of hours, he was not leading a full, varied and meaningful life, with many of the activities he enjoyed not being replaced and no opportunities to continue with his education or voluntary work’ (areas which appeared to be very important to him);
  • that it was wrong for the review to have taken place without considering ‘any reasonable adjustments’ that he may have needed to take part in the assessment, its outcome and its consequences: that there was a ‘stark contrast between the outcomes’ of the first and the second assessment (which had been undertaken with his input as well his parents, his advocate’s, and by a care co-ordinator with ASD expertise);
  • that the reduction had been recommended by the first reviewing officer despite being aware that the provider had reallocated the young man’s support ‘to bridge the staffing gap’ and there being no evidence that his support needs had changed enough to justify such a substantial reduction;
  • the council claimed that its focus was not ‘financial’ and yet it reduced his support despite there being no significant changes in his needs and then following the second assessment declined to reinstate the support: ‘this suggests financial motivation’;
  • the failings not only caused him significant injustice they also impacted upon his rights under Article 8 European Convention on Human Rights.

The report recommended that a payment be made to the young man of £1,500 and of £250 to his mother in recognition of the time and trouble that she experienced in bringing her complaint.  It concluded by stating (para 74):

It is my view that these failings have caused Mr A an injustice.  The Council actioned the content of an unsigned assessment that had been formulated without any input from Mr A’s family or advocate which resulted in a detriment to Mr A, yet failed to action signed assessments where all parties had been involved in the formulation and where consideration was given to Mr A’s ASD, leaving Mr A with no support.

[1] Public Services Ombudsman for Wales: Report No. 201700388 complaint by Mrs X against Gwynedd Council 4 July 2018.