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City of York Council (19 019 589)

Category : Adult care services > Transition from childrens services

Decision : Upheld

Decision date : 24 Sep 2020

The Ombudsman's final decision:

Summary: Mrs C complains about the way in which the Council managed her son’s transition from children’s social care services into adult social care services. Mrs C says the Council’s fault left her son without any support between January and July 2019. The Ombudsman found fault with regards to the Council’s actions. The Council has agreed to pay Mr X for the temporary loss of his support services and pay him and his mother for the distress this caused them

The complaint

  1. The complainant, whom I shalll call Mrs C, complains on behalf of herself and her son, whom I shall call Mr X. Mrs C complains:
    • There were failings by the Council in the process through which it had to transition her son into adult social services. As a result, there was a gap between January 2019 and June 2019, where her son no longer received the care support he needed and had received before.
    • There was a failure by the Council to effectively respond to the concerns and safeguarding alerts raised by the family and professionals between February and June 2019.
    • Her son did not have any short breaks between January and July 2019.

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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)

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How I considered this complaint

  1. I considered the information I received from Mrs C and the Council. I shared a copy of my draft decision statement with Mrs C and the Council and considered any comments I received, before I made my final decision.

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What I found

Legislation

  1. The Statutory Care and Support Act Guidance states:
    • 16.1 Effective person-centred transition planning is essential to help young people and their families prepare for adulthood.
    • 16.3 Early conversations provide an opportunity for young people and their families to reflect on their strengths, needs and desired outcomes, and to plan ahead for how they will achieve their goals.
    • 16.42 Councils must cooperate with relevant partners. This includes an explicit requirement that children and adult services must cooperate for the purposes of transition to adult care and support. As young people and carers prepare for adulthood, children’s services and adults’ services should work together to pass on their knowledge and build new relationships in advance of transition.
    • 16.43 Councils should have a clear understanding of their responsibilities for young people who are moving from children’s to adult services. Disputes between different departments within a council about who is responsible can be time consuming and can sometimes result in disruption to the young person.
    • 16.47 Agencies should agree how to organise processes so that all the relevant professionals are able to contribute.
    • 16.53 It is critical that families are able to understand what support they are likely to receive when the young person is in the adult system. The transition period should be planned and managed as far in advance as practical and useful, to ensure there is not a sudden gap in meeting the young person’s needs.
    • 16.67 Young people and their carers have sometimes faced a gap in provision of care and support when they turn 18, and this can be distressing and disruptive to their lives. Councils must not allow a gap in care and support when young people and carers move from children’s to adult services.
    • 16.68 If transition assessment and planning is carried out as it should be, there should not be any gap in provision of care and support. However, if adult care and support is not in place on a young person’s 18th birthday, and they have been receiving services under children’s legislation, the council must continue providing services until the relevant steps have been taken, so that there is no gap in provision.

What happened

  1. Mr X became 18 years old in January 2019 and lived with his parents. Before he became an adult, he received four hours of support per week and had a very good relationship with his allocated Child in Need Practitioner (CNP).
  2. The CNP completed Mr X’s transitional protocol document in July 2018, seven months before Mr X would turn 18 years old. He sent this to the manager of the adults learning disability (LD) team. This gave the team more than enough time to allocate his case and plan Mr X’s transition to receiving support via adult social care. However, the Council failed to progress Mr X’s case until January 2019, despite of the CNP’s regular efforts to chase it.
  3. The Council arranged an independent investigation in response to Mrs C’s complaint. Mr X’s CNP told the investigator that it was especially important for the Council to ensure that his transition would go smooth, because he is autistic and struggles with change and communication. He explained that:
    • The adult’s team should have allocated a social worker and have carried out an assessment to decide which team Mr X would move to.
    • The team should have carried out this assessment at least 6 months before Mr X’s 18th birthday.
  4. Mr X’s CNP also told the investigator that, in the interim, he tried to find overnight respite support for Mr X. However, provision was limited, and Mr X did not like what was available to him. The CNP said he subsequently found Mr X a “short-breaks worker” who could take him out 4 hours on a Sunday. He said he hoped the adult social care team would be able to continue this provision after January 2019. The CNP received assurance early January 2019 from the LD team that: “We will continue to meet the cost of Mr X’s current support until the assessment is complete.”
  5. A health transition meeting took place in January 2019, with the aim of transferring Mr X to the new professionals within adult services. However, shortly after the meeting, the Council checked Mr X’s GP records which led to a lack of clarity if Mr X had Learning Difficulties or a Learning Disability. The Council said this would determine what adult social care team Mr X would be referred to.
  6. The Council allocated Mr X’s case to a social worker (officer A) on an interim basis, to carry out an assessment of his needs. The social worker completed the assessment at the end of January 2019. However, she did not complete a support plan. The assessment said that:
    • Mr X is struggling with his mental health and had suicidal feelings.
    • Mr X is being supported by a Community Short Breaks worker to go out and develop his friendships and social circle. This is promoting his emotional wellbeing and he would like this to continue.
  7. However, despite assurances that this would continue, it stopped.
  8. Mrs C says this, and the uncertainty around his transition, had a negative impact on her son’s mental wellbeing. She told me that, even though safeguarding concerns were raised by those involved with Mr X, the Council failed to effectively act and respond to them:
    • In mid-February 2019, his College emailed officer A, to inform her that Mr C felt suicidal. The Council says the College staff member agreed there was no longer an imminent risk. The Council also advised to call 101 if they felt there would again be an immediate risk.
    • The following day a different staff member from the College called. They said Mr X had been feeling suicidal for a few days and had had walked into traffic that morning. The Council told me it provided the same advice and the College decided to take Mr X to A&E where he could be seen by the Mental Health Crisis Team.
    • In early March 2019, Mr X’s college told the Council by email that Mr X had threatened to jump of a balcony. The college was very keen to get an update about any support the Council was providing to him. Officer A explained that Mr X’s case was being transferred to the Long-Term Team (LTT), because he did not have a learning disability. As such, officer A said the College should contact them instead. The LTT duty worker who subsequently spoke to the College said: “it was unfair to provide the College with the LTT duty number on the same day as the LTT received the transfer”. The Council has told me it agrees that this call was not handled properly.
    • The Council received a safeguarding referral the following day from the Ambulance Service, due to Mr X expressing suicidal thoughts. The ambulance had brought Mr X to A&E as a place of safety. The Council says its safeguarding team would not normally deal with someone expressing suicidal intent.
    • The “York mental health crisis team” called mid-March 2019 to ask if Mr X had been allocated a social worker. The duty worker reported that he had not. The crisis team advised there were increasing concerns for Mr X’s mental health AND for the increased carers’ stress at home.
  9. On 8 March 2019, officer A chased the allocation of a social worker with the manager of the LD team, asking for a meeting to discuss who would be overseeing his care. The mental health team service manager also contacted the LD team, to propose a joint assessment due to Mr X’s history of mental health issues. This was discussed at the Mental Health allocations meeting a few days later, without a decision being made.
  10. At a multi-disciplinary meeting on 19 March 2019:
    • The Mental Health Service said Mr X’s behaviour was because he has troubles expressing his frustration appropriately, due to his autism.
    • The LD Health manager agreed to ask a Psychologist to do a formal assessment of Mr X.
    • It was identified there was a gap within adult services, in identifying what team a young person with autism and learning difficulties should be allocated to. At the meeting, the LD team manager advised it should be for the LTT and mental health team managers to decide, as Mr X did not have a learning disability.
  11. Due to the deterioration in Mr X’s mental wellbeing, the College had to inform the Council later that day, that Mr X would not be able to attend college as they could not keep him safe there. Mrs C has told me that when her son stopped College in March 2019, without an assessment and support in place, it left the family in crisis.
  12. Mrs C called the Council on 22 March 2019 to ask for an update. The Council said it would need to quickly determine what would be the most suitable team in adult social care for Mr X. The officer said they hoped this could be done early next week.
  13. Mr X received an extended assessment by the mental health crisis team in mid-April 2019. The advanced nurse practitioner described him as: “profoundly learning disabled and has anxiety. (…). He notes there are significant tensions at home. He wondered if short break options could help and asked this to be looked into”.
  14. The independent investigator reported that case notes from visits in March and April 2019 by the Community Psychiatric Nurse, showed that Mr X was overwhelmed with all the recent changes, including: the College breaking down, not having short break / support provision, no social worker. As a result, he had started to self-harm (no injuries noted).
  15. The LD team accepted Mr X’s case mid-May 2019, but there was no social worker available for another two months to allocate his case. However, the team would start to look at providing short breaks. It took until early June 2019 before his homecare support of three hours a week was in place again.
  16. Mr X was eventually formally classed as having a learning disability in July 2019, six months after this issue was first raised. The Council says it is unable to comment why it took the NHS Team from March until July 2019 to establish this.
  17. Mr X has had an allocated social worker since July 2019. She completed an assessment, which concluded that Mr X would need four hours of community support per week.
  18. In response to Mrs C’s complaint, the Council has told her that:
    • Mr X’s transition was handled poorly, and it made serious mistakes. Its Adult Social Care Department should have planned how to support Mr X and meet his needs well in advance of his 18th birthday.
    • There was too much emphasis by the department on seeking a diagnosis rather than practically meeting his needs.
    • The department did not allocate a social worker between mid-January 2019 and July 2019. Continuity of support at this time of change was important and Mr X should have had a permanent allocated social worker.
    • Mr X has not had any short breaks between January and August 2019.
    • As a result of the above, Mr X and his family were left without the support needed, which impacted on Mr X’s mental health, as well as the family. The Council offered an apology for the distress this caused in addition to a £500, as a remedy.
  19. The independent investigation concluded it identified concerning failings. It said the Council should ensure they are equipped to manage ongoing cases without similar failings. As such, it recommended the Council should: “immediately review the current arrangements and processes / policies in respect of transitions. (…) The Council should include in their revision of services of transitions, the importance of early and comprehensive identification.
  20. The Council told me it has since established a “Preparing for Adulthood Panel” to ensure that Adult Services become aware of young people (from the age of 16 years) who may have additional needs requiring support into adulthood. It has also established a “Preparing for Adulthood multi-agency Steering Group” who are developing a PfA Strategy and Protocols/practice guidance to ensure best practice for all young people who may need to transition from Children’s to Adult Services.

Analysis

  1. The Care Act 2014 stipulates the need to ensure smooth transitions by early identification of need and communication with partner agencies. I agree with the independent investigation report’s conclusion that the Council should engage with a young person much sooner. Adult social care should have carried out an assessment much earlier, which would have enabled an accurate understanding of his disabilities and care support needs by the time he reached his 18th birthday. The Council has acknowledged this and has put steps in place (see paragraph 25) to address this.
  2. As a result, Mr X did not have an allocated support worker when he turned 18 and his support package stopped. This was fault and went against the Care Act 2014 which says that: “if adult care and support is not in place on a young person’s 18th birthday, and they have been receiving services under children’s legislation, the council must continue providing services until the relevant steps have been taken, so that there is no gap in provision”. Records show the Council was aware of this duty in January 2019 but failed to act on it.
  3. It became quickly clear that this had a very negative impact on Mr X’s mental wellbeing, leaving the family in crisis. Despite these concerns being regularly raised by external stakeholders during this time, the Council failed to urgently put an interim support package in place. Mr X only started to receive some support in June 2019 and only got an allocated social worker in July 2019. This was fault.
  4. During this time, the Council appeared mainly interested in the question whether Mr X had a learning disability or learning difficulty. Even though this had been identified in January 2019 as an issue that needed to be solved, it took until March 2019 before the Council identified actions to resolve this; the NHS would organise an assessment. This is fault. While this issue may have been relevant for his long-term support, the Care Act clearly states the Council should have continued to meet his support needs in the interim.
  5. Mr X has suffered low mood and anxiety and displayed some concerning behaviour, which people involved in his care have linked to the lack of support and his experiences of his transition.

Agreed action

  1. I have noted that the Council has already apologised to Mr X and his family for the impact its failings had on them.
  2. I recommended that the Council should, within four weeks of my decision:
    • Pay Mr X £600 to remedy that he did not receive the support he should have received and was therefore unable to engage in the activities he wanted, for six months.
    • Pay Mr X £600 for the distress and frustration this has caused him.
    • Pay Mrs C £600 for the distress the above has caused her.
    • Share the case and lessons learned with all adult social care staff involved in transition.
  3. The Council has told me that it accepted my recommendations.

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Final decision

  1. For reasons explained above, I have upheld Mrs C’s complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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What I have not investigated

  1. Mrs C told me in August 2020 that, even though the Council allocated a social worker to her son in July 2019, it has not reinstated the short breaks yet (two nights a month) that he is entitled to. My investigation has been into Mr X’s transition into adult social care, in which I have found fault for not providing Mr X and his family with the support they needed until July 2019.
  2. If Mrs C wants to make a complaint about the Council’s failure to organise respite care for her son since a social worker was allocated in July 2019, she needs to make a complaint about this to the Council first.

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Investigator's decision on behalf of the Ombudsman

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