Summary: We uphold a complaint about the Council’s failure to act when Ms X asked for assistance with childcare and other support when she was receiving cancer treatment. The Council will apologise, make a symbolic payment and take action set out in this statement to minimise the chance of recurrence.

The complaint

1. Ms X, a representative, complained for Ms Y that the Council failed to carry out a social care assessment in August 2022 or January 2023 when Ms Y requested care and support as she was struggling to look after herself and her child T due to illness. Ms X said the assessment completed by adult social care in January 2023 was a contact assessment (not a full needs assessment) and did not consider Ms Y’s caring responsibilities.
2. As a consequence, Ms Y was without support when she was unwell and this caused avoidable distress and a declined in her mental health.

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The Ombudsman’s role and powers

3. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with an organisation’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

5. I considered the complaint to the Council and its response, the complaint to us and documents described in this statement.
6. Ms Y, her representative and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

Children’s social care

7. Councils must safeguard and promote the welfare of children within their area who are in need. A child is in need if, without council support:
• They are unlikely to achieve or maintain a reasonable standard of health or development or
• Their health or development is likely to be significantly impaired.

(Children Act 1989, section 17)

8. Where a referral is accepted under section 17, the council should lead a multi-agency assessment and compete it within 45 working days. (Working Together)
9. When a council assesses a child as being in need, it supports them through a child in need plan. This should set clear, measurable outcomes for the child and expectations for their parent. Councils should review child in need plans regularly.

Adult social care (ASC)

10. A council must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). There is a power to meet urgent needs for care and support without carrying out an assessment. (Care Act 2014, section 19)
11. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2(1) and (2))

12. An adult cannot achieve an outcome if it causes them significant pain, distress or anxiety (Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2(3))
13. A council must make arrangements for ensuring co-operation between officers in adult social care and children’s services (Care Act 2014, section 6(4))

What happened

2022

14. Ms Y was diagnosed with a recurrence of cancer. She started treatment in August.
15. Ms X said in a legal letter before claim to the Council and in her complaint that Ms Y had contacted the ASC team in August 2022 and again in December 2022 or January 2023 to advise she needed care and support because of cancer treatment. Ms Y said she was told there was nothing ASC could do to help and she should contact the district nurse and health visitor.
16. The Council provided me with its case records for the ASC team. These begin in January 2023 after Ms X had sent the letter of claim. There is no record of any calls from Ms X in August 2022.
17. The Council’s Children and Families assessment (completed in 2023) said a social prescriber at Ms Y’s GP had referred her to children’s services in October 2022 because of concerns about social isolation and her ability to cope with day-to-day tasks caring for her child. The assessment said “recommend progression of case for early help.” (early help is preventative support for families which aims to stop problems from escalating.)
18. The Council has not provided evidence that the case was “progressed for early help” in October 2022.

2023

19. Ms X’s letter of claim in January asked the Council to complete a social care assessment for Ms Y. Ms X also alleged the Council was failing to meet its duty to Ms Y’s daughter T as a child in need. The letter of claim went on to say Ms Y’s treatment was aggressive and was causing her pain and fatigue. It said she needed care and support to manage and maintain nutrition, to make use of services in the community, to carry out caring responsibilities and to maintain her home.
20. The ASC case records indicate there was phone and email contact between staff in the children’s and ASC teams in January and February and that Ms Y was on a waiting list for an ASC assessment.
21. An officer from the ASC team completed a contact assessment with Ms Y over the phone at the end of January. The record of the assessment said:
• She was having aggressive treatment and was struggling to care for her two year old
• She had no support in Coventry
• She was exhausted. She only went out for shopping or appointments
• She could manage to dress and take care of her personal needs
• She ordered takeaway food and cooked when able to
• She could manage her medication
• She did the domestic chores in her home
• She could do a little shopping when feeling ok. Or a neighbour would help or she did on-line shopping
• There were no care needs or adaptations identified. She said she was exhausted and was finding it difficult to care for her child.
22. The Council’s response to the letter of claim said:
• The assessor concluded Ms Y had no care needs and when asked, she said she was exhausted after treatment and was finding it difficult to care for her daughter. The Council would recommend she sought support from her family who lived in the area where she was having treatment.
• Children’s services confirmed there would be a child and family assessment completed within 35 days.
23. I have summarised entries in the Council’s case records kept by the children’s social care team:

January 2023 Ms Y was having cancer treatment and T couldn’t go to nursery because of Ms Y’s low immune system. The family required an assessment to ensure support and services were in place.

End of January The adult social care team (ASC team) received a referral. The case had not been looked at. A social worker from the children’s team visited Ms Y. After, the social worker spoke to the ASC team who said an assessment could take six weeks.

February Ms Y said she needed 20 to 25 hours of support a week while undergoing treatment – to help with caring for her daughter T. The children’s social worker noted no concerns about T other than Ms Y couldn’t meet her needs during her illness.

March Children and Families assessment was completed. A manager agreed 25 hours funding for care for T for two weeks. At a home visit, Ms Y told the children’s social worker she was pleased with the carer’s support. The social worker advised Y would be on a child in need plan.

April A case note said the C&F social worker’s view was there was a need for support from ASC focussing on Ms Y’s needs.

May Ms Y took an overdose. Emergency services attended. The children’s social worker visited for a welfare check. Ms Y’s relative agreed Ms Y could stay with her. There was a child in need meeting.

June There was another child in need meeting. Ms Y was staying with a relative in a neighbouring area and was arranging for T’s nursery placement in the new area. The Council referred the case on to the neighbouring local authority.

24. Ms X complained to the Council. The Council’s response said:
• Its adult social care team received a referral in January 2023 and completed a contact assessment. The legal team sent Ms X a letter detailing the actions taken.
• Ms Y should have been referred to Children’s services at the time to support her in her parenting role. The Council was sorry for this.

Information from the Council

25. I asked the Council to provide its procedures for joint working and liaison between social work staff in adults and children’s services. The Council didn’t disclose a procedure. Instead, the Council told me:
• Adult social care should have made a referral to children’s services.
• The Principal Social Worker would develop practice guidance around a whole family approach and would train staff in the adult initial contact team in recognising when parents may need support.

Findings

26. There is fault by the Council.
27. There was no procedure in place to ensure effective co-operation between officers in children’s and adult’s services, as acknowledged by the Council (see paragraph 25). This was a failure to act in line with Section 6 of the Care Act 2014 and was fault.
28. Ms Y said she contacted the Council by phone in August 2022. Although there is no written record of this in the Council’s case notes, it is more likely than not that Ms Y phoned and no record was made of her phone call. I have taken into account the medical evidence that Ms Y was starting cancer treatment and so it is credible that she would have contacted the Council for support as she knew she may be unwell and unable to care for T. It was fault by the Council (a) not to make a record of the call including what Ms Y said and any advice given to her and (b) not to record its consideration of whether Ms Y should have an adult social care assessment and/or whether there should be a multi-agency assessment of the family under the Working Together guidance and/or ‘early help’-type support.
29. The Council’s children’s services records indicate there was a referral from a social prescriber at Ms Y’s GP surgery in October 2022. The response to this referral was flawed as there was a failure to consider whether further assessment under Care Act or Children Act duties was appropriate. In particular:
• There was no action by the Council despite the recommendation that the case needed to progress to ‘early help.’
• The information indicated Ms Y might be an adult appearing to need care and support. So the Council should have considered whether it needed to carry out an assessment of need under the duty in Section 9 of the Care Act. The threshold for a social care assessment is a low one – appearance of need. The failure to consider the duty in Section 9 in October 2022 was fault.
30. The contact assessment by the ASC team didn’t consider the impact of Ms Y’s cancer treatment (which she said caused pain and fatigue) and how this potentially affected her ability to achieve any of the eligibility outcomes. This was not in line with Regulation 2 of the 2014 Regulations described in paragraph 12. There was also a failure to consider exercising discretion under Section 19 to meet any urgent care and support needs around parenting while Ms Y was incapacitated during treatment.

Injustice

31. The failings above caused Ms Y avoidable distress. The failure to take any action following the contacts in August and October 2022 was a missed opportunity for the Council to properly consider Ms Y’s and T’s entitlement to support services during a period of ill-health that was already placing the family under stress.

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Agreed action

32. The Council has already apologised, but this apology did not recognise the full fault or injustice. So, within one month of the final decision, the Council will make:
• A written apology, in line with the advice on apologies in our Guidance on Remedies and
• A symbolic payment of £250 to reflect the avoidable distress and to recognise the avoidable uncertainty around entitlement to support caused by the failures set out in paragraphs 27 to 30.
33. Within three months, the Council will provide us with:
• A copy of the practice guidance it is developing around the whole family approach and
• Written evidence it has delivered training to staff in the initial contact team around recognising when parents need support.
34. The Council should provide us with evidence it has complied with the above actions.

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Final decision

35. I uphold a complaint about the Council’s failure to act when Ms X asked for assistance with childcare and other support when she was receiving cancer treatment. The Council will apologise, make a symbolic payment and take action set out in this statement to minimise the chance of recurrence.
36. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman