Challenge a care assessment

The Care Act 2014 defines specific eligibility criteria for social care.

If you are unable to meet your care needs, you might be eligible for social care. By law, your local authority must provide care to meet the eligible needs in your assessment.

Care needs: looking at outcomes

If you have over £23,250 in savings and other assets, you have to pay for all your care.

How your financial contribution is calculated

An advocate can help you during a complaint or when you are challenging a social care decision. An advocate is someone who supports you to explain what you want.

Under the Care Act 2014, you have the right to take someone with you to a social care assessment or appeal if you want to. They can be a professional advocate or someone you know. They are there to support your rights.

Advocates for social care assessments and appeals

If you need legal advice

You can contact Citizens Advice if your complaint may need legal action.

Find your local Citizens Advice (Citizens Advice)

Legal action

Paying for your care

During your complaint, you might not receive the care you need. You will receive the care agreed in your care plan. This is the same if you’re waiting for the Ombudsman to make a decision.

Paying for your care during a complaint

Not having the right support and making a complaint can be stressful.

Everyone should have access to a social care needs assessment if they want one.

You can ask:

• social services
• a health professional like a consultant or your GP

Getting a social care needs assessment

If you’re ignored when you ask for a needs assessment, ask again. If this continues, make a formal complaint.

Writing a formal complaint about your social care needs assessment

If you think it is a legal issue, get legal advice.

Legal action

If you think you meet the eligibility criteria for support, but social services say you're ‘not eligible’, you can make a complaint and challenge the decision.

This includes if social services say you’re eligible for some support, but ‘not eligible’ for everything you need.

Writing a formal complaint about your social care needs assessment

Social care does not have to meet eligible needs which are already met. For example, if your relative or friend helps you as an unpaid carer.

But social care must check that your unpaid carer is willing and able to continue meeting those needs. The unpaid carer can say no. This will mean that social care will have to meet those needs.

For example, if a carer prepares meals for you, a meal delivery service could meet these needs too. 

Contact your local social care team or social worker if you would like a review.

Your care and support plan is a document that explains the care package you get. You might have problems if:

• it is not meeting your needs
• it is not followed
• social services reduce or stop your care package or personal budget

A personal budget is money from your local authority that helps to fund your care and support. Your social worker can explain how to use a personal budget.

Not meeting your needs

Your care package might not meet your needs if:

• you need your care delivered in a different way
• your condition has changed and you need more support

If your care package is no longer meeting your needs, ask for a review with your social worker.

A review is similar to a needs assessment. It will look at your current support and what your needs are.

You can ask for the support you want. For example, you want to try a personal budget to hire personal assistants rather than an agency.

Getting a social care needs assessment

Not following your care plan

Social services must follow your care plan.

You should contact your social worker or social care team. If they do not resolve the problem, you should get legal advice.

Legal action

Reducing your care package or personal budget

Even if your needs have changed, social services cannot reduce your care package or personal budget without an assessment or a review.

This is illegal. You can take legal action if your local authority does this.

Legal action

If social services reduce your care package or personal budget after an assessment, you can appeal. Follow the complaints process. They might try to reduce your care package if they think your condition has improved.

How to make a complaint about your social care

If you are unhappy with your social care, ask your local authority about their appeals process. You can search online for the name of your local authority and ‘complaints procedure’.

This will include:

• contact details
• what should happen and when

Get your evidence

Write down the reasons why you disagree with the decision.

You should look at the eligibility criteria and show how you meet the criteria. You can write down what you need support with. You might want to think about:

• What daily tasks do I struggle with or cannot do?
• Can I do the task consistently and safely?
• If I did a task without support, what could happen?
• What impact would it have if my needs were met?
• How would I like my social care needs to be met?
• What support do I have? Can they continue to give me this support?

Get copies of your:

• needs assessment
• care plan
• financial assessment
• complaint paperwork

Refer to social work legislation, guidance and local authority policies.

Care and support statutory guidance (GOV.UK)

You can get support from a friend, family member or advocacy organisation.

Support challenging or complaining about your social care

First, try to resolve your complaint informally. Speak with your social worker or local authority. Explain the situation and ask for what you need.

You can ask for a:

• review if your needs have changed or you would like your care to be different
• written explanation of their decision
• copy of their complaints procedure

If you do this face to face or over the phone, follow this up in writing so that you have a record. You can ask them for an email summary of your conversation.

If this does not resolve the complaint, follow their complaints procedure.

Support when challenging or complaining about your social care

All local authorities have a formal complaint procedure.

This will usually be a written complaint made online, either by email or using a form.

You should get an initial reply within 2 weeks. The local authority may decide to review your needs.

If you need a template, use:

Writing a formal complaint about your social care needs assessment

Support when challenging or complaining about your social care

Ask your local authority for an independent review if you are unhappy with how they respond to your complaint. Timescales can vary. Your local authority should tell you how long it takes to complete an independent review.

Write to them and explain why you are not happy.

For example, the assessor may have missed something or not considered important information relating to your condition or impairment.

The reviewer will usually be an independent social worker. They will look at the records of your assessment and consider your support needs.

You can ask for compensation if the wait for a response has been stressful and affected your health.

The Local Government Ombudsman investigates complaints from the public about councils and public services in England.

In Wales, this is Public Services Ombudsman Wales.

You have a year to submit a complaint to the Ombudsman. This is a year from the council decision, not a year from when you started the complaints procedure.

The Ombudsman has set targets for replying to complaints. This is not always met. They will reply to you eventually. If you believe you’ve waited too long, contact them and ask for an update.

Make a complaint to the Ombudsman if you:

• have made a formal complaint and
• have had an independent review

The Ombudsman:

• can ask your local authority to reconsider a decision or to provide an apology or compensation
• has the final say, except in rare cases that raise legal questions that need a judicial review

You can contact the Ombudsman once for each complaint. Make sure you give them all the information you feel that they need to know.

You can ask for compensation if the wait for a response has been stressful and affected your health.

Making a complaint in England (Local Government Ombudsman)

Making a complaint in Wales (Public Services Ombudsman Wales)

You have 3 months to start a legal claim. This is 3 months from the incident that you are complaining about.

For example, if your care plan is cut without warning, you have 3 months from when you found out.

You should get legal advice first. They can tell you:

• if your complaint means you can take legal action
• if you can get legal support
• what to do next

You can contact Citizens Advice or a law firm if you’re unsure if your complaint needs legal action.

Find your local Citizens Advice (Citizens Advice)

If your complaint needs legal advice, you can get support from:

• a law centre
• Disability Law Service

Check if you can get legal aid (GOV.UK)

Finding free or affordable legal help (Citizens Advice)

While they are looking into your complaint, you might not receive the amount of care you need. You will receive the care agreed on your care plan. This is the same as if you’re waiting for the Ombudsman’s decision.

You might have to pay for your own care during a complaint.

If the outcome of your complaint is a full care package, you can ask for compensation to reimburse the costs.

You also can ask for compensation if the wait for a response has been stressful and affected your health.

Funding for your social care costs

If you cannot afford to pay for your care, look at charities or grants that might be able to support you.

Finding and applying for grants