Summary: Mr B says the provider commissioned by the Council failed to provide the care it agreed to provide, harassed and bullied him and acknowledged his concerns but made no changes. There is no evidence of harassment or that the provider made no changes following his complaint. The evidence shows Mr B received significant support but the care plan failed to set out the support he could expect which raised his expectations. An apology and changes to the information recorded in care plans is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Mr B, complained a provider commissioned by the Council:
• failed to provide the care it agreed to provide;
• failed to ensure he was seen by the person he had an appointment with;
• failed to arrange for him to see a doctor;
• gave him little or no notice of cancelled appointments;
• failed to ensure prescriptions were ready for collection from the pharmacy;
• cancelled three consecutive foundations for change sessions;
• harassed and bullied him during the complaint process; and
• acknowledged his concerns and apologised but then made no changes.

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The Ombudsman’s role and powers

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

4. As part of the investigation, I have:
• considered the complaint and Mr B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
5. Mr B 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

Background – provision in place

6. in November 2018 Mr B began receiving services from Change Grow Live (CGL) which was a service commissioned by the Council. The intention of the service was to provide support and interventions to change Mr B’s lifestyle to one which was free from drugs. At the beginning of its service CGL offered an alternative to methadone, which Mr B declined. CGL also provided Mr B with contact numbers for various support organisations.
7. Mr B attended a nurse appointment on 19 November 2018 and the recovery pod on 20 November 2018. CGL then allocated Mr B a key worker. The first appointment with a key worker took place on 27 November.
8. Mr B was due to attend an appointment on 17 December but did not attend at the scheduled time. When he attended later in the day CGL advised him his prescription was available at the pharmacy.
9. Mr B did not attend the scheduled appointment on 31 December. Mr B telephoned CGL the following day to apologise.
10. CGL invited Mr B to a meeting to discuss peer mentoring on 3 January 2019. Mr B attended that meeting on 21 January and said he was keen to progress with the peer mentoring course.
11. Mr B had an appointment with his key worker on 11 February. The next appointment on 4 March was cancelled as the key worker was dealing with an urgent situation. Mr B did not attend the next appointment on 2 May as he said he had not received notification of it. CGL made a further appointment for him on 17 May, which Mr B did not attend.
12. On 3 June CGL provided Mr B with a prescription when the pharmacy advised him it had not received a prescription for him.
13. Mr B attended an appointment with his key worker on 6 June. CGL asked Mr B to complete a GP consent form so the service could continue to prescribe. Mr B declined and said he wanted to reduce out of treatment so was happy for the service to continue with a rapid reduction from the next prescription. Mr B raised concerns about the provision he had received from CGL.
14. On 10 June the key worker cancelled the appointment for that day and rebooked it for 12 June.
15. CGL changed Mr B’s key worker and he met with the new key worker on 12 June 2019. At that meeting Mr B agreed to join the foundations of change group and the key worker agreed to refer him to the CBT group when it was arranged.
16. Mr B met with his key worker on 14 June.
17. CGL invited Mr B to the CBT group and that took place on 8 July. Mr B then attended the foundations of change group on 10 July. Mr B was due to attend another CBT group session on 15 July but told CGL he could not stay for it. He saw his recovery worker instead.
18. On 17 July Mr B told CGL he did not want to attend the foundations of change group as he did not feel in the right headspace. CGL provided him with telephone numbers for the local mental health and crisis teams.
19. Mr B attended the CBT group on 22 July but left halfway through and asked for one-to-one CBT. CGL placed him on a waiting list.
20. Mr B attended the foundations of change group on 24 July.
21. On 31 July Mr B raised concerns about the support he was receiving.
22. Mr B did not attend the foundations of change group on 7 August or his appointment with his key worker on 9 August. CGL cancelled the next foundations of change group on 12 August.
23. Mr B attended his appointment with his key worker on 23 August. He raised concerns about the foundations of change group being cancelled for the previous three weeks. He also raised concerns about how people were dealing with him. Mr B’s key worker passed that information onto a more senior officer who telephoned him.
24. CGL completed a care plan review on 9 September.
25. On 18 September Mr B attended his appointment with his key worker and completed a referral form for inpatient detox. Mr B again raised concerns about cancellation of the foundations of change group which was required for him to prepare for detox.
26. Mr B attended a scheduled appointment with his key worker on 3 October. Following that meeting the key worker discussed with the lead nurse the detox process. CGL then arranged for Mr B to see the lead nurse for blood tests and for him to attend the pre-detox group. Mr B attended that group later in October. When he met with his key worker on 21 October Mr B raised concerns the pre-detox group was heavily focused on alcohol.
27. Mr B attended a further appointment with his key worker on 30 October.
28. The lead nurse completed a referral for Mr B for detox at the beginning of November and CGL arranged for him to visit the placement. Mr B thanked CGL for its help.
29. Mr B attended an appointment with his key worker on 18 November to complete his contingency plan and after-care plan for detox. Mr B again raised concerns about the service he had received.
30. A team leader contacted Mr B at the beginning of December to suggest a meeting to complete the outstanding paperwork for detox. Mr B told the team leader he was not comfortable speaking to anyone on his own as he felt he had been made out to be a liar. The team leader contacted the detox placement to check on the progress of Mr B’s application. The detox placement raised concerns about Mr B’s mental health and requested a report from his GP or psychiatrist before it could progress the application. CGL told Mr B that and provided him with a copy of the email from the detox placement. CGL suggested Mr B could visit one of its doctors to complete the mental health assessment or he could use his GP or psychiatrist.
31. On 24 January 2020 CGL asked Mr B whether he needed any help with his mental health assessment. Later that month CGL told Mr B it had arranged a medical review to discuss changing his prescription for early in February. CGL also asked Mr B to provide a urine sample. Mr B raised concerns about why CGL needed that and CGL confirmed the urine sample was a requirement.
32. Mr B attended a medical appointment arranged by CGL on 7 February. Mr B said he would arrange his own GP appointment for the mental health assessment.
33. From March 2020 CGL cancelled face-to-face appointments due to COVID-19. I also understand this has affected the detox placement. Since then CGL has provided telephone appointments for Mr B and suggested alternative support through Narcotics Anonymous. CGL has also completed a medical review and provided details to Mr B about a planned community reduction plan. Mr B was not happy with those options as he wanted to pursue the detox inpatient provision which is currently not available.

Complaint chronology

34. CGL formally notified the Council of Mr B’s concern about the service he had received on 1 November 2019. CGL suggested a meeting with Mr B, which took place on 25 November 2019. Following the meeting CGL wrote to Mr B, agreeing he had not always received a level of service he expected in terms of cancelled appointments, prescriptions not being available for collection and cancellation of a foundations for change session. CGL told Mr B as part of the learning from the complaint it would:
• ensure staff followed CGL’s procedure when cancelling appointments at short notice with every effort made to ensure notification to service users promptly with an alternative date and time offered;
• ensure service users receive their prescriptions promptly;
• carry out training for more staff to deliver group sessions to reduce the need for those to be cancelled; and
• information provided to those who sign up for group sessions to make them aware sessions could be subject to cancellations due to unforeseen circumstances.

Analysis

35. Mr B says the Council, through its provider CGL, failed to provide the care it agreed to provide. In contrast the Council has provided a list of support CGL put in place for Mr B which included:
• six medical appointments with a nurse-medical prescriber;
• one nursing assessment;
• offer of a mental health assessment which was declined;
• one-to-one appointments with either a recovery worker or team leader;
• frequent telephone, text and email exchanges;
• welcome to recovery group;
• foundations of change group;
• CBT group;
• liaison with the detox facility about a place for him;
• pre-detox group; and
• provision of information about other support organisations.
36. It is clear from that list CGL provided Mr B with a lot of support. My concern though is the care plan produced for Mr B does not provide any detail about what type of support CGL would provide, on behalf of the Council. It is possible in those circumstances Mr B believed he would get a different type of support than that he received. I would expect the care plan to set out the level of support CGL would provide on behalf of the Council. Not only would that enable Mr B to understand what intervention he would receive but also it would have managed his expectations about what he could expect. Failure to specify that in the care plan is fault. Taking into account the amount of support CGL provided to Mr B on behalf of the Council I do not consider he is likely to have missed out on any support as a result of that failure. However, I consider it has caused Mr B some uncertainty about what he could expect from the service and his expectations were not managed. I recommended the Council liaise with CGL to ensure in future care plans set out the type of support CGL intends to offer, with those care plans updated as circumstances change. I also recommended the Council apologise to Mr B for failing to ensure CGL set out the level of support it would provide to him. The Council has agreed to my recommendations. I consider that a satisfactory outcome for this part of the complaint given the level of support put in place for Mr B.
37. Mr B says there were regular occasions when he was not seen by the person he had an appointment with. Having considered the documentary records I have found no evidence to support Mr B’s allegation. The only occasion when I can identify Mr B saw a different officer was in June 2019 when CGL changed his team leader. As I understand it though, CGL did that as Mr B had concerns about the team leader allocated to him. In those circumstances I have no grounds to criticise the Council.
38. Mr B says during his time receiving support from CGL he did not see the doctor. I have seen nothing in the documentary records though to suggest CGL identified the need for Mr B to see the doctor. Nor have I found any evidence to suggest access to CGL’s doctor on a regular basis was part of Mr B’s plan. In those circumstances I have no grounds on which to criticise the Council. As I said earlier though, the care plan does not provide any details about provision and this should be amended in future so service users know what to expect.
39. Mr B says he was provided with little or no notice of cancelled appointments. I understand Mr B’s frustration when appointments were cancelled with little notice. However, having considered the documentary evidence I can only identify three occasions when the CGL cancelled the appointment at short notice. I am satisfied on one of those occasions CGL cancelled the appointment as the officer due to meet with Mr B was dealing with a safeguarding incident. On one of the other occasions CGL changed the appointment time for the following day and on the third occasion an appointment was cancelled and rebooked with a new team leader. While I understand Mr B’s frustration I am not convinced cancelling or changing three appointments in a 14 month period warrants a finding of fault.
40. Mr B says there were regular occasions when his prescriptions were not ready for him to collect. Unfortunately the documentary records show only when Mr B attended the service to collect a prescription. The documentary records do not record whether the prescription was ready at the point at which Mr B visited. Normally that would mean I could not reach a safe conclusion about this part of the complaint. However, CGL has already investigated this issue and accepts Mr B had, on occasion, to collect his prescription from the service rather than the pharmacy. On that basis CGL upheld that part of his complaint. In the absence of any documentary records I see no reason to disagree with those conclusions.
41. Mr B says CGL cancelled three consecutive foundations of change sessions. The documentary evidence though only shows one session of foundations of change cancelled. That was the session due to take place on 12 August 2019. I am satisfied that session was cancelled because the officer taking the session was off sick and there was nobody else available to run the session. While I understand Mr B’s concern I do not consider cancelling one session warrants a finding of fault, particularly when it was due to staff sickness which was beyond the Council’s control. I am, however, satisfied CGL has acted to prevent such situations occurring again by ensuring more officers are trained to carry out the sessions. I welcome that.
42. Mr B says the provider commissioned by the Council harassed and bullied him during the complaint process. I have considered the documentary records showing contact between Mr B and CGL officers during the complaints process. It is clear from those records Mr B continued to raise concerns about how he was being dealt with. I have seen nothing in the documentary records though to suggest officers dealt with him inappropriately during that period. Nor have I found any evidence of harassment or bullying. I therefore have no grounds to criticise the Council.
43. Mr B says CGL acknowledged his concerns and apologised but then made no changes to its procedures. As I said earlier, I am satisfied CGL has put in place training for additional members of staff on running courses so when a member of staff is unable to attend at short notice another member of staff can take over the course. I am also satisfied the Council monitors the progress of CGL at quarterly meetings. As part of those meetings the Council considers the complaints upheld and the actions identified following those complaints to ensure CGL takes action when issues are identified. I therefore have no grounds to criticise the Council.

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Agreed action

44. Within one month of my decision the Council should:
• apologise to Mr B for failing to ensure CGL completed a detailed care plan outlining the support he could expect to receive; and
• advise CGL it should ensure care plans set out the type and level of support the person can expect to receive, with that care plan adjusted as progression is made.
45. The Council should then ensure it inspects a sample of anonymised care plans during its quality monitoring to ensure the changes outlined above have been introduced.

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Final decision

46. I have completed my investigation and found fault by the Council in part of the complaint which caused Mr B an injustice. I am satisfied the action the Council will take is sufficient to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman