Summary: We will not investigate Miss X’s complaint that the Council offered and then retracted to pay for a sensory Occupational Therapy assessment of her child, Y. This is because there is insufficient evidence of fault to warrant our involvement.

The complaint

1. Miss X complains the Council agreed to fund a private Occupational Therapy (OT) assessment of her child, Y, but later changed its decision and refused the request, saying the NHS can provide the service. Miss X said the NHS told her it does not provide the service she is seeking.
2. Miss X said the matter caused her frustration and uncertainty.
3. Miss X wants the Council to fund the assessment and provide additional OT for Y.

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The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start an investigation if we decide the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I considered information provided by the complainant and the Council.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

7. Miss X has a child, Y. Y has an Education, Health and Care Plan.
8. Miss X asked the Council to conduct a sensory OT assessment of Y. The Council told Miss X it would commission an assessment. However, it later wrote to Miss X and told her it would not conduct the assessment because it was available on the NHS.
9. Miss X complained to the Council. She told the Council the specific sensory OT assessment she wanted was not available on the NHS.
10. In its complaint response, the Council told Miss X the NHS Community Paediatric OT sensory team, as part of the “new Pathway” can provide an assessment and provision of techniques and strategies.
11. The Council considered Miss X’s request but, upon considering all the information, decided not to commission the assessment.

Analysis

12. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong.
13. The Council considered Miss X’s request and decided it would not commission an OT assessment. This is a merits decision the Council is entitled to reach. There is insufficient evidence of fault in that process to warrant an investigation by the Ombudsman, and so we will not investigate this complaint.

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Final decision

14. We will not investigate Miss X’s complaint because there is insufficient evidence of fault to warrant our involvement.

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Investigator's decision on behalf of the Ombudsman