Summary: Mr X and Mrs Y complain about the Council’s lack of timely transition planning for Mr X when he recently turned 18. The Ombudsman finds the Council failed to put in place suitable respite care for three months. This is not in accordance with the requirements of the law, guidance and the Council’s own policy. The Council has agreed to a remedy for the injustice caused by the Council’s actions.

The complaint

1. Mrs Y and her son, Mr X complain the Council failed to appropriately plan for his transition from children’s services to adult social care. In particular, they complain about:
1. Delay in making suitable arrangements. The panel decision about funding (which was since overturned) was only made days before Mr X’s 18th birthday.
2. Failure to include transport provision to the respite care service out of term time.
3. Failure to provide respite care for three months between January and March 2019.
4. The unsatisfactory response to her original complaint. Whilst it was upheld, no apology or other remedy was offered.
5. The way the social worker dealt with Mr X’s transition to adult services.
2. Mrs Y says her effort to ensure a smooth transition to adult services has been a difficult process. This has caused great uncertainty, anxiety and time spent trying to resolve matters.
3. Mrs Y has made this complaint on behalf of Mr X, as well as in her own name. As his Deputy appointed by the Court of Protection she has authority to do so.

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The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. If we are satisfied with a council’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)

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How I considered this complaint

6. I discussed the complaint with Mrs Y and considered the written information she provided. I made written enquiries of the Council. I took account of all the information before reaching a draft decision on the complaint. This was sent to both parties to comment upon. Comments received have been taken into consideration before reaching my final decision.

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What I found

Relevant law and policy

Care and support statutory guidance

7. Section 16 of the guidance – which accompanies the Care Act 2014 – provides instructions to councils on how to manage transitions between children’s and adult services.
8. Paragraph 16.51 says that, having carried out a transition assessment, a council must indicate which eligible needs a young person will have when they turn 18, to ensure that they understand the care and support they are likely to receive.
9. Paragraph 16.53 says:

It is critical that families are able to understand what support they are likely to receive when the young person or carer is in the adult system, and that the transition period is planned and managed as far in advance as is practical and useful to the individual to ensure that there is not a sudden gap in meeting the young person’s or carer’s needs.

10. Paragraph 16.68 says, if adult care and support is not in place on a young person’s 18th birthday, and they have been receiving children’s services (and should be receiving adult services), a council must continue providing the existing services until the adult services are in place, so there is no gap in provision.

The Council’s policy on transition to adult services

11. The Council’s policy echos this guidance.
12. It states there should be no “cliff edge” where someone reaching the age of 18 who is already receiving support will suddenly find themselves without the care and support they need at the point of becoming an adult.

The facts

13. I have set out below a summary of the key events. But it is not meant to show everything which happened.
14. Mr X is a young adult with a wide range of complex care and support needs including Autism Spectrum Disorder, ADHD, epilepsy and a learning disability. He requires support in most areas of daily living and has received services from the Council since childhood, including respite care in a short break provision. He attends a special school but lives at home with his mother, Mrs Y and sister.
15. When Mr X was 16, he was allocated a new social worker from the adult team (Ms D). She was tasked with putting in place transitional support for his transfer from children’s to adult services.
16. In January 2018 (11 months before Mr X’s 18th birthday), Ms D visited Mr X and Mrs Y at home to start this transition process. She carried out a child in need review in March 2018. She also completed a Pathway Plan in May 2018.
17. One aspect of the transition process was to identify a suitable short break service once Mr X became an adult. His existing provider was only registered to care for children under 18.
18. Mrs Y spent some considerable time identifying a suitable resource, Placement B. It was important that arrangements were made at an early stage to allow Mr X to meet the staff and get used to the new environment before his current placement came to an end.
19. The notes of the first meeting state, “Placement B confirmed that with information available to them now, they are able to meet Mr X’s needs. Mr X would require staff supervision of a 1:1 ratio. I (Ms D) agreed to liaise with Placement B and get funding agreed in due course”. Mrs Y says she was led to believe this was just a formality.
20. Mr X’s Pathway Plan set out his care and support needs. This stated that arrangements for overnight respite would be completed by November 2018. It said a transition plan would be completed to make Mr X’s transition seamless.
21. The Council agreed to fund a number of transitional visits to Placement B between August and October 2018.
22. The decision about whether Placement B would be funded in the long term took place in December 2018, by a panel of social work managers (the Panel). Ms D requested funding for 1:1 support. Due to other commitments, she was unable to attend the Panel in person, but sent a colleague to make the request on her behalf. The Panel agreed to fund the placement but not with 1:1 supervision.
23. In reaching this decision, the Panel relied on information from his current provider. It had said Mr X was relatively independent, had not had a seizure whilst with them and is not doubly incontinent as claimed by Mrs Y. The Council decided a fresh assessment of his needs was required.
24. When she was told about this decision, Mrs Y objected strongly. She said Mr X could not go to Placement B without 1:1 support. She said it was dangerous.
25. The overnight transition stays with Placement B during December that had been arranged had to be cancelled. Mr Y could not attend his previous Placement because he was now 18 and they were not registered to look after him. As a result, there was no short break provision and Mrs Y was forced to cancel a number of important events including a wedding and a funeral so she could look after Mr X.
26. On 19 December 2018, Mrs Y lodged a formal complaint with the Council. She said by refusing to fund 1:1 supervision it was effectively setting him up to fail. She gave a number of reasons why their conclusion was wrong:

• The Panel had made a dangerous assumption about the risk of seizures without any medical input.
• His current provider’s assessment of Mr X’s continence was incorrect. They only see him three nights per month so are not in a position to form a view. She said Mr X regularly soiled himself at home and deliberately refused to use the toilet at respite care.
• She said other providers could corroborate the fact Mr X often displayed challenging behaviours that could only be safely managed with 1:1 supervision.

27. She also complained about the delay in reaching the decision that was made a week before Mr X turned 18 and could no longer attend his current short break service.
28. In response to her complaint, the Council made further enquiries about Mr X’s care needs.
29. On 17 January 2018, Placement D told the Council that Mr X did require 1:1 support, “at least initially”.
30. On 18 January 2018, the Council responded to her complaint. The Council agreed to fund 1:1 for 8 weeks to allow for an assessment of his needs to take place. Her complaint was upheld because the Panel “did not have all the facts available to them when making their decision”.
31. Mrs Y was worried about what would happen at the end of this 8 week assessment period. She also told the Council that Mr X was not ready to go to placement B overnight yet. Because he had not attended since October 2018, Mr X would need more settling in sessions before he could attend regularly.
32. Mrs X was advised by Ms B to liaise with Placement B about this.
33. Mrs X was also dissatisfied with the Council’s proposed arrangements transporting Mr X to Placement B. The Council said it would arrange transport during term time but during non-term times it would be Mrs X’s responsibility. If this was not possible, notice would be required so the Council could make alternatives transport arrangements.
34. A number of transition days were “booked in” in March and April 2018.
35. Because of the delay, Mrs X said she was “owed” nine respite care overnight stays because Mr X had been unable to attend respite care between December and March. She asked for these to be added to his support plan. The Council said it would give her a direct payment instead to fund a personal assistant to care for Mr X at home. Mrs Y said this was unsuitable as it would mean she had to leave home. She only got received the benefit of respite care if Mr X was cared for away from home.
36. Although her original complaint about 1:1 supervision was upheld, Mrs Y complained to the Ombudsman the way Mr X’s transition was managed generally and about a number of issues that had arisen since:

• The delay in finalising Mr X’s short break support which meant nothing was in place when he turned 18.
• The failure to make consistent transport arrangements.
• The failure to “make up” the lost provision, rather offering an unsuitable alternative.
• The uncertainty about what would happen after 8 weeks.
• Ms D’s lack of understanding about Mr X’s care needs properly.

Analysis

Poor transition planning

37. Both the law and the Council’s own policy state that transition planning should start at an early stage.
38. In its response to my enquiries about it the Council said transition arrangements started at an early stage and funding for the introductory visits to Placement B were made in good time. I agree. The process did start well, but the reality was that when Mr X’s children’s respite came to an end there was no new placement for him to go to. The crucial decision about long term funding did not take place until a week before Mr X’s 18th birthday. And when it did do so, it made the wrong decision. The Council says it was Mrs Y’s choice not to send Mr X to Placement B. I do not agree.
39. I note Mrs Y refused to sign minutes of a meeting that recorded her agreement to Mr Y attending Placement B without 1:1 supervision. It is evident from the timing of Mrs Y’s complaint about this that she would not have agreed this.
40. It is entirely understandable why Mrs Y felt it was impossible for her to agree to Mr X going to placement B without 1:1 support. Her position was vindicated by the Council upholding her complaint and agreeing to put in place 1:1 to allow a further assessment of his needs to take place.
41. The only record of a discussion with Ms D about finding was during the first introductory meeting. In my opinion, Ms D’s own case note is suggestive that agreement to funding was just a formaility and the existing arrangements would continue. Taster sessions were agreed and funded. There was no reason for Mrs X think the decision in the long term would be a negative one. There is no record of her being advised of such a possibility.
42. In reaching my decision, I have also had regard to the case note reporting what happened at the Panel meeting to Ms D. This stated, “your assessment is an old one and a reassessment is needed urgently”. My reading of this note is there was a clear discrepancy between Ms D’s Pathway Plan and what the Council has been told by the current provider.
43. These inconsistencies should have been identified and resolved much sooner than at the Panel meeting. If they had been, there would have been time to further consult with his current provider and Mrs Y before reaching a decision about funding.
44. What happened afterwards was avoidable if the assessment process had been done properly and in good time. Failure to do so is fault.

Transport

45. The Council has said it does not provide transport to short break services and Mrs Y was told this at the outset verbally by Ms D. Because Mr X has a Motability vehicle, the Council expected this to be used by Mrs Y to transport him to respite care out of term time.
46. It is both reasonable and sensible to discuss with a parent who has use of a Motability car if they are able to assist with transport. The Council’s position on transport should be made clear in a policy which I have not seen. There is no legal obligation on Mrs Y to transport her adult son to respite care so the Council should not expect her to do so. Nor should it apply blanket policy decisions about refusal to fund transport to adult care services. This is what appears to have happened here.
47. But there is further confusion because the Council seems to have accepted that transport was necessary during term time but not in the school holidays. No reason has been given about this to either the Ombudsman or Mrs Y.
48. There is no reference to transport in Mr X’s Pathway Plan. I would expect to see this. There is little point in making a service available if a disabled person has no means of getting there.
49. When Mrs Y said she was unable to get Mr X to the service on a certain day the Council commissioned a taxi. This was the correct approach. While I note there have been some issues about the precise nature of the service, as these have been resolved, mainly by Mrs X’s intervention, I do not find fault here.
50. However, the Council’s failure to properly consider transport to the service within the assessment process, its inconsistent approach and application of a blanket policy is fault.

Failure to offer a suitable alternative to the “lost” respite

51. The Council has accepted that it should remedy Mrs Y’s injustice at being without respite care for approximately three months.
52. Mrs Y is clear that the direct payment initially offered would not help her. The Pathway Plan is not clear about what the assessed need that respite care is meant to meet is. It refers to “My mum gets regular respite when I go to respite” under the heading “Where I live”. My reading of this is that in order for Mr Y to continue to live at home, Mrs Y needs regular breaks for her demanding caring responsibilities. This is entirely understandable.
53. In response to my enquires about this the Council has agreed to offer Mrs Y and Mr X an additional five days at Placement B. I welcome this. But this is what she should have received earlier in the year and does not adequately remedy the stress, disruption and disappointment at having to miss important engagements. I have therefore recommended an additional remedy below.

Uncertainty about the future

54. Mrs Y says she remains concerned about what will happen the Council has finished its assessment. She remains of the view that 1:1 support for Mr Y is essential.
55. Whether or not the Council will fund 1:1 support in the longer term is a professional judgement for the Council to make. The Ombudsman will only intervene where there is fault in the decision making process. The Ombudsman cannot at this stage direct the Council to continue with its previous supervision levels indefinitely. Its decision must however be informed by a robust assessment of Mr X’s care needs.
56. For this reason I do not find fault with the Council’s decision to only fund 1:1 supervision for a limited period pending further assessment.

Inadequate complaint response

57. While her original complaint was upheld, Mrs X says the letter from the Council did not include an apology. In response to my enquiries, it has referred to an apology being given near the start of the complaint response which said, “I am sorry that you feel let down an not supported by Social Services in caring for Mr X”.
58. The Council says this was a statement of apology made on behalf of the Council. I disagree. It is rather a statement of fact rather than an apology for the fault the Council accepted later in the letter.
59. The letter goes on to set out two learning points from the complaint, both of which I welcome. But there no apology for the fault was given to Mrs X personally for either the premature decision made about funding, the avoidable delay and the fact Mr X was not receiving a service. There was also a failure to follow up a complaint about another mater. Taking all of this into account I have found fault in the way the Council dealt with Mrs X’s complaint.

Conduct of the social worker

60. Mrs X says she has lost confidence with Ms D. It is not the role of the Ombudsman to make a finding on the professional competence of individual officers, as it is the Council who has corporate responsibility for the faults identified in this case. This aspect of the complaint is adequately covered by the number of areas of fault I have identified.

Conclusion

61. I have found that Mr X missed overnight respite provision for approximately three months. This caused him great anxiety and uncertainty about his future. While the Council has now agreed to offer additional days in future, this does not properly recognise the injustice caused to both Mr X and Mrs Y.
62. Mrs Y’s injustice comes from the loss of respite from her caring responsibilities. It is clear she derives great benefit from this and allows her the opportunity to continue with her full time caring responsibilities.

Agreed action

63. To remedy the faults causing injustice identified in this decision statement, the Council has agreed to do the following:
1. Apologise in writing to Mrs Y and Mr X.
2. Pay £500 to Mrs Y in recognition of the avoidable break in service provision she experienced and the time and trouble she has spent dealing with this matter.
3. Pay £500 to Mr X in recognition of the failure to properly prepare for his transition to adulthood and additional anxiety caused by the disruption to his short break provision.
4. Make arrangements to ensure an additional five days respite care are booked to replace the lost respite case.
5. Amend the minutes of the meeting referred to above to reflect the fact Mrs Y did not agree to Mr X attending Placement B without 1:1 supervision.
6. Clarify and review its policy on transport provision to short break services. It should provide the Ombudsman with a summary of the outcome of this exercise.
7. Remind all relevant social work personnel of the need to make sure transitional arrangements are put in place before the young person’s 18th birthday.
64. These actions should be completed within four weeks from the date of my final decision.

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Final decision

65. I have found fault in the way the Council handled Mr X’s transition to adult care services. This caused injustice to both Mr X and Mrs Y. The Council has agreed to make a suitable remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman