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Southend-on-Sea Borough Council (20 008 399)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 15 Jun 2021

The Ombudsman's final decision:

Summary: Mr and Mrs W complain about the Council’s actions regarding the care planning and hospital discharge of their late mother, Mrs Y. They also complain about the conduct and professionalism of a social worker. We cannot determine what the social worker said during the meeting in question, but the Council has already provided an apology from the social worker. This is a suitable remedy. There is no evidence the Council persuaded Mr and Mrs W to provide informal care to Mrs Y after her discharge. However, there is some fault in the Council’s handling of the complaint which it will apologise for and pay £100 to remedy the time and trouble caused.

The complaint

  1. The complainants, Mr and Mrs W, are unhappy with how the Council treated their late mother, Mrs Y, following her discharge from hospital. They say the Council was at times unprofessional, failed to arrange the appropriate support and delayed in arranging reablement care.
  2. Mr and Mrs W say the Council failed to give them adequate information about the support options for Mrs Y before she was discharged from hospital. They are also dissatisfied with the Council’s complaint response.
  3. Mr and Mrs W say the Council’s actions caused Mrs Y and her family significant and avoidable distress at an already difficult time.

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The Ombudsman’s role and powers

  1. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by their personal representative (if they have one), or someone we consider to be suitable. (Local Government Act 1974, section 26A(2), as amended)
  2. 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)
  3. 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

  1. During my investigation I discussed the complaint with Mrs W and considered any information she and Mr W provided.
  2. We made enquiries of the Council and considered its response. I also consulted the relevant law and guidance, cited where necessary in this statement.
  3. We issued a draft decision statement and considered any comments received before making a final decision.

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What I found

What happened

  1. At the time of the matters complained about Mrs Y lived alone and without professional care or support. In September 2019 Mrs Y was admitted to hospital with several medical concerns, including an infected ulcer on her lower leg and a pressure sore. Mrs Y reported that she had sat in her armchair for five days. Both Mrs Y and her family expressed that she would need some formal care upon her discharge from hospital.
  2. The Council assessed Mrs Y whilst in hospital and agreed she would be eligible for a period of reablement care. Reablement support services are for people after they have left hospital or when they are at risk of having to go into hospital. They are time limited and aim to help a person to preserve or regain the ability to live independently. Regulations say local authorities must not charge for the first six weeks of reablement services. They may make a charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits.
  3. On 30 September 2019 Mrs Y’s family met with a social worker on the hospital ward. The social worker made notes of the meeting as follows:

“We could refer for reablement however if they did not have capacity a mainstream provider would be required which may be chargeable, [Mrs Y] was not happy with this information and her son advised that they (himself and his sister) would support [Mrs Y] at home”

“[Mrs Y] again declined and her son was in agreement that at this time they would support [Mrs Y] at home. I explained that at this time [Mrs Y] was only able to transfer however they both remained adamant that they did not wish for an assessment”.

  1. The Council referred Mrs Y’s case for reablement services on 1 October 2019. This was following an assessment which concluded that Mrs Y required the use of a walking frame and the help of two people when transferring. The hospital physiotherapist also said that Mrs Y needed the use of some specialist equipment to assist during transfers.
  2. The physiotherapist called the social worker on 3 October 2019 to express some concerns. The social worker made notes of the call:

“She has spoken with [Mrs W] who remained adamant they would provide care… however was concerned she was not aware of the impact this could have on [Mrs Y] as well as her safety”.

  1. Later that day, the social worker called Mrs W to discuss Mrs Y’s physical needs “[Mrs W] advised that they managed to transfer [Mrs Y] before and would do it again if needed.”
  2. Mrs Y’s family met with the social worker on 4 October 2019 on the hospital ward to discuss Mrs Y’s future care needs. Mr and Mrs W say the social worker failed to introduce herself, was dismissive and did not take a person-centered approach. The social worker and her manager explained that reablement care was not currently available and that Mrs Y was on the waiting list as a ‘priority’.
  3. Mrs W says the social worker told her the hospital had the power to evict Mrs Y if necessary.
  4. The social worker entered a note on Mrs Y’s records: “She [Mrs W] agreed to take [Mrs Y] home and would support her until reablement was ready I explained that I could not give them a date and she could be supporting her mother for a couple of weeks at least she said that was fine. So I confirmed again with her that she would support and being willing to wait until reablement was ready ad she was able to do this as I could not give a date. She agreed. Discharge to be arranged for family support”.
  5. The hospital discharged Mrs Y on 5 October 2019. The records show the social worker called Mrs W two days later to see how the family were managing, and to again discuss mainstream care. Mrs W explained that things had been hard, but that she refused mainstream care and would continue to support her mother until reablement services commenced.
  6. Mrs Y received reablement services at home from 11 October 2019.

Was there fault in the Council’s actions causing injustice?

  1. Mr and Mrs W complained to the Council because they were dissatisfied with the conduct of the social worker; namely her lack of professionalism and her poor communication. Mr and Mrs W also complained the Council allowed Mrs Y to be discharged without the necessary care and support in place, which in turn meant that family members were forced to step in and provide support until reablement services started. They say this caused injustice both to the family and Mrs Y.
  2. When responding to the complaint, the Council expressed an apology from the social worker and agreed social workers should be clear from the outset around the timescales of reablement care. The Council also apologised for the comments about hospital eviction and confirmed that social workers should not have discussions of this nature with families. The Council said this would be relayed to the relevant staff in a team meeting. This is an appropriate remedy for this part of Mr and Mrs W’s complaint.
  3. While the Council has already apologised for the actions of the social worker, Mr and Mrs W remain dissatisfied because they consider the Council has not acknowledged that Mrs Y was discharged from hospital without the necessary support. The family dispute the Council’s assertion that they agreed to provide informal support for Mrs Y between 5 and 11 October 2019.
  4. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened. Although we cannot say for certain what the family agreed upon Mrs Y’s discharge, there are several contemporaneous notes made by the social worker which reiterate the family’s agreement to support Mrs Y on a temporary basis. This was after the social worker had explained the difficulties family members may face in assisting Mrs Y with transfers. Despite this, the records indicate the family declined mainstream support.
  5. After considering the available information, and on the balance of probabilities, I cannot find fault in this part of Mr and Mrs W’s complaint. The family were able to make an informed decision after having several discussions with the social worker who gave them the option to do the necessary assessments for mainstream care.

Complaint handling

  1. Councils should have clear procedures for dealing with social care complaints. Regulations and guidance say they should investigate a complaint in a way which will resolve it speedily and efficiently. A single stage procedure should be enough.
  2. Regulations do not say how long a complaint investigation should take but expect this will be determined at the start of the procedure, usually in discussion with the complainant. During the investigation, the body must keep the complainant informed of progress ‘as far as reasonably practicable’.
  3. The Council’s response to Mr and Mrs W’s complaint was late. The Council received their complaint on 28 October 2019 and promptly acknowledged it, stating it expected to respond by 12 November. However, Mr and Mrs W did not receive the response until 28 November.
  4. Furthermore, Mr and Mrs W complain about gaps in the Council’s complaint response; particularly about its failure to provide a response to the complaint about a lack of training for Mrs Y’s specialist equipment. The Council said: “Unfortunately, I am unable to respond to this part of the complaint; this will need to be answered by [hospital name] as the organisation responsible for providing Therapy and the necessary equipment”.
  5. Where a complaint concerns more than one responsible body, those bodies must co-operate in handling the complaint. This includes settling who will lead the process, share relevant information and provide the complainant with a coordinated response (Reg 9, Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)
  6. The Council did not provide a coordinated response, and its response was delayed. This fault caused Mr and Mrs W some injustice, which the Council has agreed to remedy with the actions listed below.

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Agreed action

  1. Within four weeks of my final decision, the Council will:
    • Apologise to Mr and Mrs W and pay £100 in acknowledgement of the injustice caused by errors in the Council’s handling of their complaint;
    • Speak with Mr and Mrs W about the outstanding health element of their complaint. If they still wish for this to be pursued, the Council should arrange for Mr and Mrs W to receive a response; and
    • Remind the relevant staff about the requirement to coordinate complaints which concern more than one responsible body.

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Final decision

  1. We have completed our investigation with a finding of fault causing injustice. The actions listed above are a suitable remedy for the injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman

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