Nottinghamshire County Council (22 005 749)

Category : Adult care services > Transition from childrens services

Decision : Not upheld

Decision date : 14 Dec 2022

The Ombudsman's final decision:

Summary: There is no fault by the Council in relation to its planning for the complainant’s son’s transition from children’s to adult social care. Whilst only limited services have been provided since the complainant’s son became 18, there is no fault by the Council as it offered suitable provision that the complainant would not accept until recently.

The complaint

  1. The complainant, whom I shall refer to as Mr D, complains that Nottinghamshire County Council has failed to properly manage his son’s transition from children services to adult services. Specifically he says:
  1. the Council failed to properly plan for his son, E, to transition from children to adult services when he became 18 in March 2022;
  2. as a result of this poor planning X has not received respite care since March 2022 and has not received any day care services since leaving school in July 2022.
  1. Mr D says this has caused significant injustice to E, him and his wife. E has been, and continues to be, very distressed and this has led him to be physically violent towards both his parents and cause damage to the family’s home. Mr D says he has become unwell and unable to work as a result of having to provide additional care to his son and this is causing the family financial difficulty. In addition the family has been left with little option but to place E into residential care later this year as they cannot access support to enable E to remain living with them.

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The Ombudsman’s role and powers

  1. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
  2. 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

  1. I discussed the complaint with Mr D and considered the written information he provided with is complaint. I made written enquiries of the Council and considered all the information before reaching a draft decision.
  2. Mr D 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

What should have happened

  1. The Children Act 1989, section 17, requires councils to safeguard and promote the welfare of ‘children in need’ in their area, including disabled children, by providing appropriate services for them. All disabled children are regarded as ‘children in need’ and entitled to an assessment under section 17.
  2. When a child in need is provided with overnight respite care they become a looked after child under section 20 of the Children Act 1989. Councils are required to arrange regular reviews of children who are looked after. These are called Looked After Child (LAC) reviews.
  3. A child with special educational needs may have an Education, Health and Care (EHC) plan. This sets out the child’s needs and what arrangements should be made to meet them.
  4. When a child reaches 18 years of age, they are legally an adult and responsibility for meeting their needs moves from the council’s children services to its adult services.
  5. Statutory guidance says transition assessments should begin when the council can be reasonably confident about what the young person’s needs for care and support will look like when they turn 18. The purpose of the assessment is to provide the young person and their family with information so they know what to expect in future and can prepare for adulthood.
  6. The assessment must identify all the young person’s needs for care and support and identify the outcomes the young person wishes to achieve. The assessment should also consider whether the carer is able to continue in their caring role after the young person turns 18.
  7. After completing the transition assessment, the council must give an indication of which of their needs are likely to be “eligible needs” under the Care Act 2014, and which are not. This is so young people and their carers can understand the care and support they are likely to receive and can plan accordingly. For those needs that are not eligible the council must provide information and advice on how those needs can be met.
  8. Nottinghamshire County Council uses a system called Dynamic Purchasing System (DPS). As I understand it this is a digital system which allows health and social care providers to access providers of services including providers of care services.
  9. Nottinghamshire County Council’s adult care services department operates a short breaks service. These are planned short breaks from caring and may be provided in residential care homes or council-run short breaks units or a Shared Lives Scheme. Short breaks are usually managed using the direct payments process.
  10. The Council has three of its own short-breaks providers. These are small units that provide short breaks/respite care to adults with care needs.
  11. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning.
  12. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.

Relevant background

  1. E is 18 years old. He has an autistic spectrum disorder, is almost entirely non-verbal, has epilepsy, a learning disability and Tourette’s syndrome. He is also extremely anxious and has a history of being physically aggressive towards family members and carers. The Council’s children’s services team began providing the family with services to support E in 2018 when E was 14 years old. E was a child in need under section 17 of the Children Act 1989 and was provided with overnight respite care under section 20 of the Children Act 1989.
  2. The Council says that in June 2020 its children’s services team agreed to provide E with 208 nights respite care a year. This is the equivalent of four nights respite a week. E was 16 years old when this was agreed. His care plan dated March 2022 confirms the respite provision in a children’s home that was planned to continue until he was 18 years old. It also states he was receiving 156 nights overnight respite a year. The Council has confirmed 208 nights respite a year had been agreed though the evidence appears to suggest that whilst this amount was agreed the family continued to access 156 which amounted to three overnight stays a week. Mr D has told me that athough the Council agreed to pay for 208 nights a year it was only able to find provision for 156 nights.
  3. E had an EHC Plan until September 2022.

What happened

  1. The Council confirms that a referral for E from children’s to adult services was received in May 2019. The adult services team agreed in June 2019 that it would be allocated to a member of staff in adult services in March 2020.
  2. The Council confirms E was allocated to an adult services member of staff (Social Worker 1) in March 2020 as planned but says that due to the Covid-19 pandemic and the fact that E was still only 16 years old at that time, its involvement at that point was minimal.
  3. In April 2021 Social Worker 1 appears to have started the process of assessing E’s needs and considering what support adult services would be able to provide to E and his family. She attended E’s EHC Plan review meeting in April 2021. At that meeting E’s mother said she wanted the same support the family was currently receiving from children’s services. Social Worker 1 told the meeting that the adult service could offer up to 42 nights a year respite care but this would need to be agreed by a funding panel. During a further meeting that included E’s mother, the headteacher of E’s school and Social Worker 1 in July 2021, Social Worker 1 said the maximum number of overnight respite care offered by adult social care was 42 a year. The notes of that meeting seem to indicate that Social Worker 1 said that E could stay at home a couple of nights a week if he became resident in an adult care provision. But E’s mother said she did not feel the family was ready for that and could manage with 156 nights respite plus 5 days a week daytime activities/provision. This was essentially what the family was receiving for E as a child: three nights respite care a week and daytime in school.
  4. A care needs assessment was started in July 2021. That assessment included a discussion with E’s mother that the amount of short breaks for an adult at the level provided to E as a child would be “unusual” but that in a residential care placement E could still stay overnight at home every week. E’s mother said the family was not ready for this and that they wanted to keep 156 overnight respite and five days a week day care they currently had. Social Worker 1 discussed day care services and social worker 3 agreed to discuss capacity at two local day care services to see if they could provide this support. The conclusion of that assessment was that E clearly had care needs and the family wanted support so they could continue caring for E at home. She agreed to make a referral to a Council panel regarding short breaks and to speak to a day care service. Social Worker 1 concluded that further assessment was needed.
  5. Concerns about the number of short breaks (156 a year) that the family wanted for E from adult services was put to the adult services accommodation panel for consideration in July 2021. In August the panel decided this provision should be explored using the Direct Purchasing System process.
  6. In September 2021 a newly allocated adult social worker (Social worker 2) attended E’s looked after child review. At that meeting it appears Social Worker 2 advised it was likely to be difficult to find overnight care providers who would be able to meet the 156 nights a year provision requested within the county and said he did not know if there was any out-of-county provision.
  7. Due to the difficulties adult services were having in trying to identify sufficient overnight respite the social worker spoke to the family again in September 2021 about the possibility of E moving into residential care and having “a few” nights a week at home. Again the family said they did not want to pursue that as an option given E’s young age but said this was likely to be an option they would be interested in when he was older.
  8. In October 2021 the social worker submitted an application for joint health funding of respite care. This was refused by health providers in November. Social Worker 2 also completed a Carer’s Assessment in relation to E’s mother concluding that her caring role for E had a serious impact on her wellbeing and that she was eligible for NHS short breaks and that direct payments were not suitable to achieve the support she needed.
  9. In November Social Worker 2 assessed E as needing between 7.5 to 8 hours a day of support provided by two carers and that he also required a carer to be available overnight. It also assessed him as needing support in the community between five and six times a week. It assessed an indicative personal budget of around £500 a week.
  10. Also in October social worker 2 started the process of seeking agreement to use the Dynamic Purchasing System (DPS) to try to identify alternative care providers for E.
  11. In November a new adult services social worker (Social worker 3) began working with the family. Social Worker 3 spoke to Mr D in December 2021. She reiterated what previous social workers had told Mr D about the maximum number of overnight care in adult services being 42 nights a year but said she would request that this was increased for E given the “exceptional circumstances” in E’s situation. Mr D was concerned as E was going to be 18 in March the following year and he was worried time was running out to get arrangements in place.
  12. Access to DPS was agreed again in late December 2021 but by mid-January 2022 no provision had been identified using that system. Social Worker 3 called a number of providers directly to see if they could offer short breaks for E but none were able. The DPS request was resubmitted.
  13. At the beginning of February Social Worker 3 tried the local short breaks providers again but they were either not accepting new referrals or had closed due to lack of staffing.
  14. In early February Social Worker 3 offered the family residential provision for E on four nights a week and for him to be at home for three nights a week. The family rejected this offer and said that E needed three consecutive nights in short breaks provision - I assume this means the family did not want four. Social Worker 3 advised that this quantity of short breaks was proving difficult to identify.
  15. In mid-February the DPS again resulted in no offers. The Council submitted the request again. Social Worker 3 continued to contact providers directly asking for three nights a week and four days of day care provision.
  16. In late February Social Worker 3 attended a LAC review. She explained the problem she was having and said that adult care services were offering a residential placement which the service would fund as a full-time placement but would agree that E could return home for three nights a week. Again Mr D and his wife said this was too much and that they only wanted overnight provision elsewhere for three nights a week. The Council’s chronology also notes that “Parents concerned about losing mobility car if E accommodated. Mr D and his wife also refused support with E at home”.
  17. Shortly after E’s mother contacted Social Worker 3 about a new short breaks service that was due to open in June 2022. Social Worker 3 said she had already been in touch with this service and agreed to make a referral to them. Social Worker 3 also continued to call other providers to see if they could offer the provision that Mr D and his wife wanted for E. The parents wanted E to remain at the children’s short breaks provider that E was already attending whilst alternative adult based care was still being sought. Social Worker 3 advised she could not agree this as it was a children’s services provision. She reiterated to Mr D that she would support the family retaining their mobility car if E was to move into residential care with some nights a week at home. Mr D agreed to Social Worker 3 discussing this option with his wife the following day. He told social worker 3 he may have to give up work if no short breaks could be found. Social Worker 3 said she could explore direct payments as an interim measure in exceptional circumstances.
  18. In late February a service manager in the children’s services team told Mr D that E could not continue to attend the children’s respite provision beyond his 18th birthday. In response to my enquiries on this point the Council has said that it could no longer offer E respite in it’s children’s respite provision as it had other under 18s who needed to access the service. A senior officer in the children’s social care service also stated that children’s social care also understood that the adult social care team had offered provision for E but that Mr D and his wife had declined this.
  19. On the same day Social Worker 3 contacted E’s mother to offer an adult residential care provider where E would only stay for three days a week although the placement would be full time. E’s mother said she would discuss this with Mr D.

Provision since March 2022

  1. The Council says that Social Worker 3 has remained in close contact with the family. The Council confirms that health provision for E has been provided in the home in the form of providing weekly community care/mental health support for E at home since July 2022 which is when E stopped attending school.
  2. The Council says it has been unable to make the provision the family would prefer in the form of day provision and three nights short breaks a week as it has been unable to identify providers who can make this provision. The provision the family asked for in June 2022 and which the Council agreed to refer E to has yet to open but it is intended it will open in January 2023.
  3. The Council confirms it has repeatedly and regularly offered a residential placement for E. The Council confirms that having rejected this on many occasions the family has now accepted this offer. I understand from Mr D and the Council that E will start a residential placement around December 2022.
  4. The Council confirms E’s transition to this residential placement is underway. It confirms E will be able to visit and spend time overnight in his family home.
  5. The Council “ceased to maintain” E’s EHC Plan in early September 2022. The notes of the annual review of the EHC Plan in April 2022 seem to indicate that the decision reached was that E would not continue with education and support would be dealt with by social care.

Mr D’s complaint to the Council

  1. Mr D complained to the Council in April 2022. He complained that the Council had failed to sort out respite care for E despite having a period of nine months to do so before E turned 18.
  2. The Council provided its response in May 2022. The Council’s response to was outline the action it had taken and to outline what it had offered for E. As part of this response the Council confirmed that the respite provision opening in June 2022 had agreed to complete an assessment of E with a view to it providing a service to him depending on the outcome of that assessment.
  3. Mr D responded promptly stating he was dissatisfied with the outcome of his complaint. It appears a meeting took place in July 2022 to discuss this. During this meeting the Council confirmed that the new respite care provider that was due to open in June 2022 hoped to offer a service to E on two days a week but had not yet opened and was still recruiting staff. Mr D and his wife explained how difficult they were finding managing E without the respite provision. The Council offered direct payments for Mr D to act as E’s personal assistant (he had said he would need to stop working to help look after E) but Mr D refused this as it would not provide the family with the break they needed. Residential care was offered again. Mr D said the problem was that they could not be offered day care on the days E was not staying overnight in the residential placement as they had been told this could not be funded. A senior council officer at the meeting agreed this could be considered further. The offer of support at home was to be considered again as was a further request for health funding which Social Worker 3 would look into again.
  4. The senior Council officer who had attended the meeting then provided a further written response to Mr D’s complaint. In her letter she confirmed that her understanding from the meeting was that Mr D was happy to proceed with ”shared care” meaning that E would stay at a residential provision for three or four nights a week and then be at home for the other nights and days. She described this as “Enhanced Supported Living Service”. She also confirmed that the previously offered support at home was now in place.

Was the Council at fault and did this cause injustice?

  1. There is no evidence that the Council failed to plan for E’s transition from children to adult services. The original referral was made in 2019 (when E was 14), the Council allocated a Social Worker in 2020 but that social worker did not start working with the family until April 2021 which was still around 10 months before E turned 18. So, it is the case the Council could have started planning for E’s transfer to adult services in 2019, two years before it actually started to properly look into this. However, I am not persuaded the evidence suggests that the kind of provision the family wanted would have been achievable even with a longer period of time to try to find that. I consider all three social workers allocated to the family since April 2021 attempted to find the support the family preferred for E and took account of this in the assessments they undertook. There has been no question that E has eligible needs or that the Council would not support services to meet those needs. The three social workers have approached numerous short breaks providers to try to find one that will provide 156 a year even though they have all said that the usual amount of overnight respite is a maximum of 42 a year. These searches included its own providers, other local providers as well as looking more widely. Unfortunately none has been able to meet the need. The Council also struggled to find day care provision despite, again, approaching a number of providers. Given the difficulty it has had I am not persuaded that it would have been able to find this provision even it had started the transfer process, and started searching for providers earlier.
  2. The Council accepts that provision of respite care/overnight breaks did not continue after E’s 18th birthday in March 2022. And when E left school in July there has been limited day time provision. However, the Council essentially argues that it had offered an alternative to the three nights respite care and daytime provision that Mr D wanted in the form of residential care with overnight visits home every week. It offered this option many times before E’s turned 18 and I have no reason to believe this could not have been in place by the time of his 18th birthday if Mr D had accepted this. But Mr D chose not to take this up. I consider that, whilst it was not what Mr D wanted at that time, the offer of residential care could meet the needs identified in the assessment which was for overnight care several nights a week and day care provision: the residential care provider would have been able to meet both these needs. The Council went to some lengths to try to find the provision that Mr D wanted for E as I have detailed but was unable to and I do not consider there are grounds for me to criticise the Council for being unable to source this. The Council has agreed to pay for full time respite even though E will not be using the placement on a full-time basis and this is clear indication that it is focussing on E’s needs. There are therefore no grounds for me to conclude there was fault by the Council in how it sought to find provision for E and in its offer of residential care.

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Final decision

  1. There is no fault by the Council in relation to its planning around the transition from children to adult social care or in the service it offered from when E turned 18 in March 2022.

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Investigator's decision on behalf of the Ombudsman

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