Summary: Mr X complained the Council failed to consider his concerns that his child (Y) is a victim of Fabricated or Induced Illness (FII) by Proxy and prevented them from being assessed for it despite providing supporting evidence. He says his child is at risk of harm which has caused him distress, frustration and uncertainty. The Council consulted medical professionals and considered Mr X’s concerns in line with the relevant policies without fault.

The complaint

1. Mr X complained the Council failed to consider his concerns that his child (Y) is a victim of Fabricated or Induced Illness (FII) by Proxy and prevented them from being assessed for it despite providing evidence to support this. He says his child is at risk of harm which has caused him distress, frustration and uncertainty.

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The Ombudsman’s role and powers

2. 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 how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
3. 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

4. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
5. Mr X and the Council had an opportunity to comment on a draft decision. I considered comments before making a final decision.

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What I have and have not investigated

6. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended). While Mr X was aware of the concerns from 2022, this is an on-going issue, so I have exercised my discretion to investigate.

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What I found

Relevant law and guidance

The Council’s Fabricated or Induced Illness Policy

7. Fabricated or Induced Illness (FII) is a clinical situation where a child is, or is very likely to be, harmed due to parents'/carers' behaviour and action, carried out in order to convince doctors that the child's state of physical and/or mental health or neurodevelopment is impaired (or more impaired than is actually the case).
8. If a General Practitioner (GP) has concerns about a child’s welfare and FII is a consideration, the GP has a duty to share any relevant and proportionate information that may impact on the welfare of a child.
9. If there are concerns about FII and the child does not have a known consultant, the GP should refer the child to a Paediatrician, Consultant Child Psychiatrist or Consultant Clinical Psychologist (dependent upon the presenting issues) with expertise in symptoms and signs the child presents. The GP should make it clear about their concerns regarding possible FII in the referral letter. The GP should not share this letter with parent/carers. Timeliness of the referral will depend on presentation.
10. When a possible explanation for the signs and symptoms is that a carer has fabricated or induced these and as a consequence the child's health or development is or is likely to be impaired and there are concerns of significant harm to the child, the GP should make a referral to Children's Social Care Services. For urgent referrals, the Council encourages GPs to call the customer service centre (or the police if necessary) without delay and follow up the referral in writing. There is a safeguarding referral form for GPs to fill out.
11. Children's Social Care should decide within one working day how to respond and what action it needs to take. The referrer and the recipient of the referral should agree what the parents will be told, by whom and when.
12. If there is reasonable cause to suspect that the child is suffering, or likely to suffer significant harm, then Children's Social Care should convene a Strategy Discussion/Meeting involving all key professionals. From this, the Council will decide whether there are grounds to initiate a section 47 enquiry.

What happened

13. The information below is not a comprehensive overview of everything that happened. It is a summary of key information.
14. Mr X has a child (Y). Y’s mother (Mrs Z) commissioned a private assessment which concluded Y has a neurodevelopmental condition.
15. Mr X is of the view this is a deliberate misdiagnosis and Mrs Z’s actions match the description of FII by proxy. Records show he raised concerns with the GP in Mid 2022 and advised he thought Mrs Z was fabricating illness. The GP raised this with the Council who told the GP to look at its FII policy. It explained the first step was for a paediatrician to assess Y. If the paediatrician has evidence of possible FII then the relevant health professional should make a referral to the Council.
16. Records show Mr X then contacted the Council again a few months later. He said following advice the Council had given the GP, Y had an appointment booked with a paediatrician. However, the paediatrician cancelled the appointment as they were of the view this was a welfare issue and told Mr X to go back to the Council. The Council advised Mr X any diagnosis for FII needs to come from a medical professional.
17. The GP requested a consultation with the Council in early 2023. It shared its FII policy with the GP again. Records show it advised the GP to discuss the concerns and relevant information with other health professionals as so far, it was only Mr X raising the concerns. It said following this the health professionals should decide whether there is information to substantiate FII and if there is to make a safeguarding referral. It advised if not, there was no role for the Council.
18. Mr X contacted the Council again in 2023 reporting he remained concern Y is a victim of FII by proxy. He said he followed up with the clinician who completed the private assessment. The clinician confirmed Y has had no formal diagnosis but it is their professional opinion Y has a neurodevelopment condition. Records show the Council explained whilst Mrs Z has told others Y has a neurodevelopmental condition with no formal diagnosis, this does not evidence she is fabricating an illness, given the professional opinion of the clinician. It advised it would be concerned if Mrs Z was medicating Y without a medical reason but there is no evidence to suggest this is the case.
19. Records show there was a further consultation with the GP in the summer of 2024 who said Mr Y had reported further concerns around FII by proxy and the GP agreed to share these with the Council on behalf of him. It advised the Council the GP sees Y infrequently and has appropriate medical attendances for routine needs. The GP had no evidence to support FII by proxy perpetrated by Mrs Z.
20. Mr X complained to the Council saying despite providing evidence of Y being a victim of FII, a health professional has still not assessed Y for this. The Council issued a complaint response the following month saying it had directed his GP to its FII policy after Mr X raised concerns. It explained the policy includes a referral to paediatrics to undertake further assessment or observation of Y. Should the paediatrician have concerns for Fabricated and Induced Illness then the relevant professional should make a safeguarding referral. The Council says no paediatric or GP referral has ever been made to the Council identifying concerns for Fabricated or Induced Illness for Y.
21. Mr X remained dissatisfied with the Council’s handling of the matter and complained to us. Since then, Mr X has continued to raise concerns about FII by proxy to the Council.

Council’s response to our enquiries

22. The Council says Mr X has contacted the Council nine times since December 2022 raising concerns Y was a victim of FII by proxy. It says the GP has consulted the Council on two occasions regarding Mr X’s concerns. The Council has not received a referral from health or any other professionals raising concerns of FII as per the policy. It says during the consultation with the GP, it shared Y’s attendance at the doctors is infrequent.

My findings

23. Mr X says the Council has not considered his concerns of FII by proxy and prevented Y from being assessed for this. The Council’s policy says if a professional has concerns about FII and as a consequence the child's health or development is or is likely to be impaired and there are concerns of significant harm to the child, the relevant health professional should make a referral to Children's Social Care Services. The Council has advised Mr X that it has never received a safeguarding referral from the GP, paediatrician or any other professional despite the Council explaining and sharing its policy twice. The records show the GP has shared Mr X’s concerns with the Council on his behalf but the GP has not advised it is of the same view. The Council has considered the concerns in line with its FII policy, recorded it’s decision-making and advised Mr X it has no evidence Y is a victim of FII by proxy or that Mrs Z is medicating Y without medical reason to do so. Whilst I appreciate Mr X disagrees with the Council on the matter, there is no fault in how the Council reached its decision to take no further action.

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Decision

24. I have completed this investigation and found no fault with the Council’s actions.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman