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London Borough of Merton (19 013 859)

Category : Adult care services > Transition from childrens services

Decision : Upheld

Decision date : 22 Jul 2020

The Ombudsman's final decision:

Summary: Mrs X complained the Council failed to properly plan for her son, F’s transition from children into adult care services. The Council was at fault. It failed to forward plan for F’s transition to adult care services in line with statutory guidance. This did not cause F a significant injustice as the services were in place before his 18th birthday. The failure to plan did however cause Mrs X distress, uncertainty and time and trouble. The Council agreed to pay Mrs X £150 to recognise this. It also agreed to review its procedures to prevent recurrence of the fault.

The complaint

  1. Mrs X complained the Council failed to properly plan for her son, F’s, transition from children into adult care services. Mrs X also complained the Council planned to cut F’s overnight respite provision from 52 to 45 nights per year. Mrs X said the Council’s failure means F will not have care services in place when he turns 18. Mrs X wants the Council to agree the same level of services for F as an adult as he received from children’s services.

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The Ombudsman’s role and powers

  1. 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)
  2. 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)
  3. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Office for Standards in Education, Children’s Services and Skills (Ofsted), we will share this decision with Ofsted.

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How I considered this complaint

  1. I considered the Council’s response to our initial enquiry letter.
  2. I considered the complaint correspondence.
  3. I considered the Care Act and the Care and Support Statutory Guidance.
  4. Mrs X and the Council had an opportunity to comment on my draft decision. I considered comments before I made a final decision.

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What I found

Moving from children’s social care to adult social care

  1. Until the age of 18, services for children and young people with long term health conditions are provided by child health and social care services. From the age of 18 they are usually provided by adult services. Between the ages of 16 and 18, the child will start a transition to adult services. For children with an education, health and care plan, transition planning should begin when a child is in year 9 at school.

Transition assessments

  1. A transition assessment must be conducted for all those who have likely needs, however the timing of this assessment will depend on when it is of significant benefit to the young person or carer. When a child or young person approaches their 18th birthday, they may ask the Council for a transition assessment. A parent or carer may also ask for an assessment on behalf of the child or young person. The Council has a duty to carry out this assessment.
  2. The transition assessment should support the young person and their family to plan for the future by providing them with information about what they can expect. All transition assessments must include an assessment of:
    • Current needs for care and support;
    • Whether the child or young person is likely to have needs for care and support after they turn 18;
    • If so, what those needs are likely to be and which are likely to be eligible needs.
    • The outcomes the young person or carer wishes to achieve in day-to-day life.
  3. Statutory guidance says transition and planning should be carried out so there is no gap in provision or care and support.
  4. Where the child or young person is also transferring from children’s to adult NHS continuing healthcare, the national framework sets out best practice for the timing of transition steps as follows:
    • Children’s services should identify young people with likely needs for NHS Continuing Health Care (CHC) and notify the relevant Clinical Commissioning Groups (CCG) when the young person turns 14
    • There should be formal referral for adult NHS CHC screening at 16
    • There should be a decision in principle at 17 so that a package of care can be in place once the person turns 18.

What happened

  1. Mrs X has a son, F who has autism and severe learning difficulties and received care and support from the Council’s children’s services. This included care and support during weekends, evenings and school holidays. F was due to turn 18 in January 2020 and therefore was due to transition to adult social care services.
  2. In May 2019 Mrs X complained to the Council. Mrs X said F was turning 18 in January 2020, but the Council’s transition team had not seen him, nor had they scheduled a meeting to start the process for F’s transition to adult care services. Therefore, Mrs X was uncertain what care services and respite F would receive when he turned 18.
  3. The Council responded to Mrs X in June 2019. It said its adult social care team was notified in February 2019 that F would turn 18 in January 2020. It noted that a planned visit by social workers to F, in April 2019 did not take place. The Council apologised that the transition team had not delivered the service it should have. The Council said it intended to take remedial action which would involve a lessons learnt process with the staff involved. The Council said F’s social worker was already working on his care and support plan to see how the Council could meet his eligible needs.
  4. Records show the Council completed F’s needs assessment in June 2019 and submitted F’s CHC referral in July 2019.
  5. The Council requested funding for F’s adult social care at an outcomes forum in September 2019. An outcomes forum is where cases are presented to senior social care professionals. The forum concluded F should receive a staged transition to adult respite services however the other elements of his care such as daytime support at weekends, evenings and school holidays were declined pending the outcome of the CHC referral and assessment from the CCG.
  6. The CCG rejected the referral on the basis F was not yet 18. Records show the Council successfully challenged the CCG’s decision in October 2019 when the CCG said F was eligible for free nursing care but not full CNC funding. Records show however that F’s allocated social worker was off sick at the time and therefore this was not promptly actioned.
  7. In November 2019 Mrs X complained to the Ombudsman as the Council had still not agreed F’s services for when he turned 18.

The Council’s response to Ombudsman enquiries

  1. Following Mrs X’s complaint to us we made enquiries of the Council to ask why F’s services were not in place and why it had reduced his respite care.
  2. Between November and early December 2019, the Council identified appropriate services for F which Mrs X agreed to. The Council made a further funding request at an outcomes forum in December which agreed provision for F at weekends, evenings, and school holidays. The forum agreed a total of 45 nights respite. It agreed to submit a funding application to the CCG for the additional nights respite. The Council confirmed arrangements were in place for F’s services to start on his 18th birthday at the start of January 2020, and the respite care to start the following week. F’s school holiday provision would start during the February half term.
  3. Mrs X made a further complaint to the Council in January 2020 about F’s respite care. Mrs X said the Council had reduced F’s respite from 52 to 45 nights. Mrs X referred the Council to her other son who has similar needs to F. She said he received 52 nights which was increased to 104 nights at the same respite home.
  4. The Council said it agreed to fund F’s respite provision for 45 nights per year. It said it made an application for joint funding to the CCG which was agreed at the start of January 2020. As a result, F was awarded an additional 59 nights which brought his total overnight respite to 104 nights per year, the same as his brother’s.

My findings

  1. The evidence shows the Council did not start planning for F’s transition to adult services until Mrs X complained in May 2019. That was not in line with statutory guidance and was fault. The Council has already apologised and accepted this and said it would carry out a lesson learnt process with the staff involved.
  2. The guidance says the transition to adult services should be carried out so there is no gap in provision or care and support. The evidence shows F’s provision was in place in time for his 18th birthday and the issues around the respite care were also resolved in time. Therefore, I have seen no evidence that the delay in commencing the transition process caused F a significant injustice.
  3. However, the evidence does show it caused Mrs X distress, uncertainty and time and trouble. Mrs X should not have needed to complain to the Council for it to start F’s transition assessment. The delay meant the Council carried out the process in a hurry. It meant the CHC referral was not submitted in good time which caused uncertainty when it originally rejected the referral. This had a knock-on effect and meant the package of care and services were only agreed in December 2019 which was just a few weeks before F turned 18. It also meant the issues around the respite care were not resolved until January 2020. Had the Council started the transition process in line with statutory guidance, the issues which arose would not have caused the distress and uncertainty that they did.

Agreed action

  1. Within one month of the final decision the Council agreed to:
    • pay Mrs X £150 to recognise the distress, uncertainty and time and trouble caused to her by the Council’s delay in planning for F’s transition to adult care services.
    • provide the Ombudsman with an update of the lessons learnt process it carried out with the staff involved.

Within three months of the final decision the Council agreed to:

    • review its internal procedures regarding planning for young person’s transition to adult services to ensure it prevents recurrence of the fault.

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Final decision

  1. I have completed my investigation. I found fault and the Council agreed to my recommendations to remedy the injustice caused by the fault.

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Investigator's decision on behalf of the Ombudsman

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