Summary: Mr X complained about the Council’s handling of a child protection case and its refusal to consider his complaint at stage 2 of its complaint process. The Council was not at fault. The Council provided Mr X with its reports 48 hours in advance of the child protection conferences and was not responsible for the actions of education and health professionals. The Council responded appropriately to the concerns Mr X raised.

The complaint

1. Mr X complained about the Council’s handling of a child protection case. He said the Council did not explain what its concerns were, did not challenge the information it received from health professionals, and did not explain why it considered the case met the threshold for child protection. Mr X said this caused significant distress and negatively affected his relationship with health professionals involved with his child. He also complained the Council refused to consider his complaint at stage 2 of its complaints process.

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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. 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)
3. 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)

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How I considered this complaint

4. I have considered:
• all the information Mr X provided and discussed the complaint with him;
• the Council's comments about the complaint and the supporting documents; and
• the Council's policies, relevant law and guidance.
5. Mr X and the Council had the opportunity to comment on two draft decisions. We considered their comments before making a final decision.

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What I found

Relevant law and guidance

Child protection

6. Under Section 47 of the Children Act 1989, where a council has reasonable cause to suspect that a child in their area is suffering or is likely to suffer significant harm, it has a duty to make such enquiries as it considers necessary to decide whether to take any action to safeguard or promote the child’s welfare.
7. The council should make early enquiries of agencies involved with the child and family, for example, health visitor, GP, schools and nurseries. The information gathering at this stage enables the council to assess the nature and level of any harm the child may be facing. The assessment may result in:
• no further action;
• a decision to carry out a more detailed assessment of the child’s needs; or
• a decision to call a strategy meeting.
8. If the information gathered under Section 47 supports concerns and the child may remain at risk of significant harm the social worker will arrange an initial child protection conference (ICPC). The ICPC decides what action is needed to safeguard the child. This may include a recommendation that the child should be supported by a child protection plan (CPP).
9. After the ICPC, there will be one or more review child protection conferences (RCPC) to consider progress on action taken to safeguard the child and whether the CPP should be maintained, amended, or discontinued.
10. Working Together to Safeguard Children (2015) updated in 2018, sets out the way in which councils should carry out the necessary steps to support children under Child in Need processes and how they should investigate safeguarding concerns. It also places a duty on health organisations to cooperate under section 27 of the Children Act 1989 by assisting the local authority in carrying out its children’s social care functions.
11. The Council is the lead organisation in matters of safeguarding.

Fabricated Induced Illness

12. Fabricated Induced Illness (FII) is where a child is, or is very likely to be, harmed due to parental behaviour and action seeking to convince doctors that the child’s state of physical and/or mental health or development is impaired or more impaired than is actually the case.  FII can result in emotional and physical abuse and neglect of the child. 
13. The Greater Manchester Safeguarding Children Procedure Manual has a procedure for Fabricated and Induced Illness. This follows the National Working Together Framework. The process requires:
• all professionals involved with the child to work together;
• the Council to have lead responsibility for undertaking an assessment along with the doctor who had lead responsibility for the child’s healthcare and other relevant agencies following receipt of the referral;
• parents not to be informed at the referral stage;
• the Council to coordinate information gathering to build up a medical, psychiatric and social history and an understanding of the child's needs and the parents' capacity to meet the child's developmental needs. A comprehensive chronology of the child's history must be compiled;
• the Council to organise strategy meetings and when appropriate, Initial and Review Child Protection Conferences. In cases of FII, the strategy meeting will always take the form of a face-to-face meeting; and
• at all stages discussions to decide what information will be shared with parents and by whom. Clear decisions need to be made about who will monitor the child’s health and development.

What happened

Initial response to safeguarding referral

14. In mid-December 2021 the Council received a referral from a health professional about Mr X’s son, Child A. The referral raised concerns about fabricated or induced illness, on the grounds of multiple visits to the G.P, and hospital, and requests for multiple assessments. The Council noted there had been a previous safeguarding concern about Child A in April 2021, relating to the number of times he had been taken to hospital.
15. In mid-January 2022 a multi-agency strategy meeting was held, at which it was agreed the Council would make enquiries under section 47 (see paragraph 7).
16. Between early January and late February 2022, Mr X spoke to the Council on the telephone seven times to discuss the safeguarding concerns. Mr X said he did not believe there was a safeguarding issue. The Council tried to arrange a meeting to discuss its concerns. Mr X initially said he could not attend a meeting until late February 2022. Mr X then told the Council he would not attend the meeting until he had spoken to a team manager about the concerns. He said the Council had not asked for his consent to complete an assessment and he did not agree to it visiting Child A. He asked the Council to set out its concerns in writing, which it refused to do as that was not in line with its process. Mr X then complained the Council had not followed the correct process.
17. In its response to the complaint at stage 1, the Council said:
• it accepted Mr X did not consent to an assessment or support for Child A under section 17;
• Council officers and Health professionals had tried to meet with Mr X to discuss and share information and answer any questions he had;
• it had asked the doctor who made the initial referral to put their concerns in writing in a format that could be shared with Mr X and it would follow it up in early March 2022; and
• it would like to discuss the matter further with Mr X and agree the next steps.
18. In early March 2022 a second multi-agency strategy meeting was held at which it was agreed the Council would arrange an initial child protection conference (ICPC).
19. The same day Mr X made a further complaint about the hospital’s refusal to send him information about a hospital meeting on the grounds that he had not attended the meeting. The Council said it could not investigate complaints about the hospital and suggested he use the hospital’s complaints process. Mr X clarified that the hospital had refused to send him information because he had refused to meet with the Council.

Child protection plan

20. In mid-March 2022 the Council emailed Mr X the child and family assessment and ICPC information pack. Child A’s nursery and health professionals did not send Mr X the ICPC reports 48 hours in advance of the meeting.
21. In late March 2022 an ICPC was held. The Council, Mr X, Child A’s mother Ms Y, and relevant professionals attended. The ICPC discussed the safeguarding concerns:
• Child A’s multiple attendances to out of hours A&E and at a doctors surgery, including over 40 presentations to A&E in a short period of time;
• Mr X changing the reasons Child A was unwell and why Child A needed multiple assessments;
• Mr X becoming aggressive when assessments were refused;
• Mr X’s comments about Child A being developmentally behind but no health professional concerns of this nature; and
• Mr X getting private health care for Child A in addition to NHS care.
22. It was unanimously agreed at the ICPC that Child A needed a child protection plan (CPP). Mr X did not agree with the conference decision. The chair gave Mr X information about the appeal process. Mr X appealed but his appeal was not successful.
23. In late March 2022 a core group meeting was held at which the Council went through the CPP and explained what Mr X needed to do if Child A was unwell.
24. In late April 2022 the Council responded to Mr X’s complaint from early March 2022. It said the information Mr X sought related to a health meeting the Council did not attend so it could not share the information.
25. Mr X replied to the Council in early May 2022. He said:
• he asked several times about the meeting he did not attend in late February 2022. First the Council said it was informal, then said it was a section 17 discussion and later told him it had been a section 47 discussion;
• the decision for the child protection plan was unsound and biased;
• the Council failed to say what health is being fabricated;
• he was concerned about the content of the CPP, and was worried about seeking medical advice for Child A; and
• not everyone attending the conference attended the core group meeting in late March 2022.
26. The Council confirmed it would investigate the parts of the complaint that related to Council services, but Mr X would need to make a separate complaint about the health aspects.
27. The Council responded three weeks later in late May 2022. In its response, the Council:
• explained both the Council and Health had tried to meet with Mr X to discuss and share information and answer any questions;
• explained that decisions to make section 47 enquiries, arrange an ICPC and that Child A needed a CPP were multi-agency decisions;
• due to the CPP the Council had a statutory duty to work with and visit Child A, and that Mr X should work with the NHS only in relation to Child A’s health;
• confirmed information regarding about prescriptions from late December 2021 should have been made available at the ICPC but concerns about those prescriptions were not the reason a CPP was agreed; and
• accepted some relevant health professionals had not attended core group meetings and said it would speak to them about that.
28. Mr X said the Council had not answered all his questions and asked it to escalate the complaint to stage 2. The Council responded that the complaints process was not the correct route to seek an amendment to its records and he should report his concerns to its Information Governance Team.
29. In mid May 2022 a Council officer made a home visit to see Child A. Mr X said he did not agree with Child A’s CPP and he was scared to seek medical advice.
30. In mid-June 2022 a review child protection conference (RCPC) was held. It was attended by the Council, Mr X, Ms Y, health professionals and the nursery. Mr X and Ms Y said they had not received reports from health professionals before the conference and they found it difficult to engage with professionals. They also said they had different plans, from the NHS, the Council and the doctor and did not know which one to use. It was recorded that the Council had not yet received the health chronology required as part of the FII process. The records confirmed there was a majority decision the CPP would continue for Child A for six months because professionals felt Child A remained at risk of harm.
31. In late June 2022 Mr X complained again. He said the Council had not explained why it considered Child A was at risk of significant harm or what evidence it had to support FII.
32. The Council said it would not accept Mr X’s new complaint because it had responded to similar issues already and the complaint process could not be used to overturn a CPP decision. Mr X responded that his concerns related to the RCPC, that the Council had not shared information with him, and that a Council officer was loud in front of Child A. The Council agreed to investigate.
33. The Council responded in late June 2022. It said:
• it had received a referral from a G.P, raising concerns about FII. It set out the history, including the number of NHS visits and concerns about private consultations;
• the Council officer complained about did not intend to upset Child A and were willing to discuss this further with Mr X and to listen to his recording of their meeting; and
• had fed back to health professionals Mr X’s concerns about the information they provided to the Council.
34. Mr X remained unhappy and Mr X complained to the Ombudsman in late June 2022.
35. In July 2022 Mr X chased the Council multiple times about the delay in health professionals providing a chronology to set out the basis for deciding harm was caused to Child A.
36. Mr X appealed the stage 2 response. In its response, the Council accepted that Mr X was not sent all the papers for the conferences in line with the timescales set out in its process, and therefore, it would resume the ICPC in September 2022.
37. Mr X made further requests for information and raised further questions about the process. He refused to engage with the assessment process because he said the Council should have all the information it needed already. And he specifically refused to provide information about his or Ms Y's health.
38. In early September 2022 the Council asked Mr X to attend a meeting with Council officers and health professionals to discuss the health chronology. Mr X said he wanted to see the chronology before agreeing to a meeting so the Council sent a copy by email.
39. In mid-September 2022, the Council reconvened the ICPC on the grounds that the previous two conferences had not seen the health chronology. The reconvened ICPC confirmed the need for a CPP to continue.
40. In late September 2022 Mr X sent the Council a new complaint about discrimination, including that officers were inappropriately seeking information, racism and confirmation of information from Ms Y.
41. In response to the draft decision, the Council provided evidence to show it sent Mr X the child and family assessment and conference information four days before the ICPC and it sent Mr X core group minutes six days before the RCPC in line with its statutory duty. The documents not sent 48 hours before the ICPC and RCPC were the responsibility of education and health professionals.

My findings

42. The Council’s focus is to safeguard and promote Child A’s welfare. On receiving the referral, it had a duty to make enquiries to establish if Child A was at risk of harm. It followed the correct process in arranging strategy meetings and an ICPC. Following the ICPC, the Council arranged core group meetings and an RCPC, as appropriate. Throughout the process it considered the view of the health professionals, but the key decisions were not made by the Council alone, they were multi-agency decisions.
43. Although the health chronology was not available at the ICPC or RCPC, the records show the Council chased health professionals appropriately to obtain this, and that, having obtained it, the reconvened ICPC confirmed the need for a CPP.
44. The Council did try to discuss its safeguarding concerns with Mr X by telephone and tried to arrange meetings with him to discuss those concerns, and also to address Mr X’s concerns about the process. Mr X attended the ICPC, RCPC and reconvened ICPC so he was aware of the concerns about Child A. Although not all documents were shared with Mr X before the ICC and RCPC, which affected Mr X’s ability to prepare for those meetings, the missing documents were not the responsibility of the Council. In view of this, the Council decided to reconvene the ICPC.
45. Having reviewed extensive records, I have not found evidence of discrimination. In relation to Mr X’s concerns about contact with Ms Y, the Council was seeking to involve her in its assessment, which was appropriate.
46. The Council has addressed all the issues Mr X raised without undue delay. It appropriately signposted Mr X to relevant health bodies to consider his complaints about health professionals and in relation to disclosing information provided by them. It referred him to its Information Governance Team to consider data protection issues. On occasion, the Council was unclear what Mr X was complaining about, but when he clarified, it investigated the concerns he raised. I have therefore not found fault with the complaints process.

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Final decision

47. I have completed my investigation finding no fault by the Council.

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Investigator's decision on behalf of the Ombudsman