Summary: Mr X complains the Council neglected his daughter B’s teeth for five months while she was on a child protection plan. We found fault because the Council did not properly update or record decisions about B’s teeth before removing the matter from the child protection plan, so Mr X was not kept updated. We have recommended a suitable remedy in this case so have completed our investigation.

The complaint

1. I have called the complainant Mr X. He complains the Council neglected his daughter B’s dental health for five months. Mr X says B had missing teeth, some rotten beyond repair and she could not eat in a normal way. Mr X says he was distressed to see her in pain and suffering and was concerned about B’s health, safety, and welfare. Mr X says the Council’s failure to act has caused them both distress.

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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. 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)
3. 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)
4. Under our information sharing agreement, we will share this decision with the Office for Standards in Education, Children's Services and Skills (Ofsted).

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How I considered this complaint

5. I have read the papers submitted by Mr X and spoken to him about the complaint. I considered the Council’s comments about the complaint and the supporting documents it provided.
6. Mr X 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

Relevant law and guidance

Child in need

7. Section 17 of the Children Act 1989 says councils must safeguard and promote the welfare of children within their area who are in need.
8. A child is in need if:
• they are unlikely to achieve or maintain a reasonable standard of health or development unless the council provides support; or
• their health or development is likely to be significantly impaired unless the council provides support; or
• they are disabled.

Child protection

9. Section 47 of the Children Act 1989 says where a council has reasonable cause to suspect a child is suffering, or is likely to suffer, significant harm, it should make enquiries to enable it to decide whether it should take any action to safeguard and promote the child’s welfare.
10. After making enquiries, where the council considers a child is at risk of significant harm, the council may hold a strategy meeting. At the meeting it discusses with relevant professionals whether to hold an initial child protection conference (ICPC).
11. The ICPC is a multi-disciplinary meeting whose attendees decide what action is needed to safeguard the child. The ICPC may decide to make the child the subject of a child protection plan which details what action is necessary to reduce the risk of harm.
12. The Council is part of the Manchester Safeguarding Partnership (the Partnership), which brings together key bodies involved in ensuring the safety of children such as the Police and local hospital trusts. The purpose of the Partnership is to monitor and control the safeguarding practice of the bodies in the Partnership. It does not make decisions in its own right. The Partnership uses the safeguarding policies of the Greater Manchester Safeguarding Partnership (Greater Partnership).

Events leading to the complaint

13. This section sets out the key events in this case and is not intended to be a detailed chronology.
14. Mr X’s daughter, B, lives with his ex-partner, Ms Y, and her other children. In 2018 and 2019 the Council provided some low-level services to B. In March 2020, the Council decided B was a child in need and it updated Mr X on B’s case in early April 2020.

15. In June 2020 Mr X raised the issue of B’s teeth and decay with a social worker. Council documents noted that B was not registered with a dentist although it would be in her best interest once the Covid-19 restrictions were removed and if/when surgeries were accepting patients. It was also noted that it would be best for Mr X as B’s father to address such issues with Ms Y directly.
16. In late June 2020, the Council decided to put B and the other children on a child protection plan ( plan).

17. The Council held the first core group meeting in July 2020 to discuss B and the plan. In the health part of the plan one task was for a development check to be carried out on B including support and advice on dental hygiene and progression of dentist for the children in Ms Y’s care. The plan included B learning skills such as how to hold a toothbrush and brush teeth with supervision and support. The meeting noted a health visitor carried out a development check on B and raised no concerns. The Council continued to hold monthly core group meetings.
18. In August 2020 the core meeting listed the same task but there were no reports or updates listed on this issue. In September 2020 the core meeting minutes, the health visitor reported no concerns about B. It listed the same task for the dentist but recorded no updates.
19. In October 2020 a social worker emailed Mr X about the core groups meetings. The social worker advised Mr X he was not invited to attend the meetings but received updates and minutes from meetings. The social worker told Mr X he could also provide information to the meeting. The social worker told Mr X he could telephone the GP, dentist, health visitor, Early Help worker or social worker if he needed further updates.
20. The October 2020 minutes recorded no concerns raised about B and Ms Y was attending to the children’s needs. The minutes made no reference to the previous task about the dentist or support to help B with a toothbrush.
21. The core group meeting in November 2020 noted no reported safeguarding issues about B or concerns about her development and care. It was noted she was clean and well presented with Ms Y attending to her needs. The minutes made no reference to the task about the dentist.
22. In December 2020 the core group meeting minutes noted Mr X was no longer having contact with B and the contact arrangements being dealt with in private court proceedings. A health visitor reported seeing B and having no concerns about her or that she was being neglected. The health visitor said B was ’developing well and cheerful and chatty’. There was no reference to the task about the dentist. The January 2020 core group meeting noted B was safe in Ms Y’s care and there were no concerns. The minutes did not refer to the task about the dentist. The minutes noted the Council was considering closing the child protection case.
23. Mr X and Ms Y were in contact in February 2021 to discuss arrangements for Mr X to see B again. Mr X says Ms Y advised him that B’s teeth had worsened, and she had been unable to register B with a dentist because of COVID-19. Mr X said he would arrange for B to be registered. Mr X found a dentist who would accept B. But was subsequently told it could not accept a referral form from him but needed to be from a health professional or similar. Mr X emailed the health visitor and GP asking them for a referral request. Mr X believed the social worker had made a referral but found later the health visitor had responded and sent a referral request.
24. Mr X reports the dentist telephoned Ms Y about B’s teeth. Ms Y said B was not in pain but had dental decay and she had been unable to find a dentist. The dentist told Ms Y they were not seeing patients for routine work unless in pain but would assess the teeth from photographs. If work needed doing the dentist would arrange a visit to the clinic to examine B. The notes record Ms Y was happy with this.
25. Mr X and Ms Y’s private court proceedings ended in March 2021 and Mr X saw B for first time since September 2020. Mr X says he was shocked by state of B’s teeth, and they had deteriorated since September 2020. Mr X raised concerns with the social worker saying B should have been a referred to a dentist before now and considered the Council had neglected her dental health for over five months. Mr X expressed concern B may lose her baby teeth due to decay. So, he arranged an emergency dental appointment with a different dentist for her which Ms Y took her to.
26. Council documents for a Child in Need meeting in March 2021 record the health visitor reported no concerns about B. But Mr X raised concerns about her dental health and the health visitor referred her for an emergency dental appointment. The health visitor reported B ‘is not in pain and the dentist will not be able to do much as B has baby teeth but may be able to give some advise( sic) to Ms Y’.
27. Mr X emailed the social worker with details of B’s dental decay. Mr X alleged the social worker should have acted sooner and failed to address the dental neglect. Mr X raised concerns the social worker reported seeing B in February 2021 and noted she was ‘always smiling and happy’. But Mr X disputed this and considered B was in pain because of dental neglect.
28. The social worker responded and sent Mr X records of meetings held about B. The social worker considered B’s dental care had been resolved and she had seen a dentist. The social worker told Mr X that as he was B’s father it was reasonable for him to arrange a dental appointment for her if he considered she needed it.
29. In April 2021 the social worker told Mr X children’s services were closing B’s case as there were no further safeguarding concerns. The Council considered B safe in care of Ms Y with her needs being met. Mr X was unhappy about the decision to remove B from a child protection plan and appealed to the Council against the decision.
30. An independent reviewing officer considered Mr X’s appeal in May 2021 about the decision to remove of B from a child protection plan. The reviewing officer looked at Mr X’s concerns about B’s teeth and that no dental treatment was sought for her. The officer acknowledged that B’s teeth were not discussed at a Child Protection Review Case Conference which Mr X attended. The officer noted Mr X had no contact with B for some months and because of this he was not aware of extent of the issue so did not raise it at the meeting.
31. The officer read the review minutes and agreed the only recording about B’s teeth was advice about giving sugary drinks. The officer agreed it was not ideal and it did appear that B needed dental treatment. The officer agreed it would have been helpful to discuss it at the review meetings and for it to be included in a subsequent child in need plan.
32. But the officer said for a child to step down from a child protection plan the Multi Agency group needed evidence and to agree the risk to the young person was reduced to the extent they are no longer deemed to be at risk of significant risk. The officer said the core groups, statutory home visits and review case conferences all indicated that the risk to B was reduced.
33. The officer said tooth decay on its own did not constitute significant harm to necessitate a child protection plan and should be dealt with as part of the child in need plan. The officer noted that even though the information was not discussed at the Child Protection Review Conference B had now had dental treatment as Mr X sourced a dentist and made an appointment. The officer noted the social worker considered the dental issues were addressed and B’s case closed to Children’s services.

Mr X’s complaint to the Council

34. Mr X complained to the Council in May 2021 he reported the neglect to B’s teeth in March 2021 and it was left unresolved for some time. Mr X said he was unhappy with the social worker’s response. This was because B was in pain, her teeth in bad condition and having to adapt how she ate to avoid further pain. Mr X complained B needed to be registered with a dentist for some time after an issue in September 2020, but it was now severe due to neglect.
35. Mr X alleged the social worker was visiting B during those five months and should have seen she was in pain due to problems with her teeth. Mr X had to arrange an emergency dental appointment. Mr X expressed concerns about Ms Y’s parenting and the Council’s role in this.

The Council’s response to Mr X’s complaint

36. The Council says B was subject to a child protection plan when a lead social worker was allocated to her. B was not subject to an interim care order and so the Council did not have parental responsibility for her. So, it was not the role of the social worker to register B with a dentist but the mother’s responsibility. The social worker confirmed she did not tell Mr X she would register B with a dentist at any time.
37. The Council says part of the initial child protection plan from July 2020 was for a health development check to be undertaken on B including support and advice on dental hygiene and progression of dentist for the children in Ms Y’s care.
38. This was tasked to the health visitor to support Ms Y. The health visitor visited and did not raise any immediate concerns about B’s teeth. The Council says the plan was actioned as far as the health visitor (and therefore social worker) had the power to do so as dentists were not accepting new patients or non-emergencies during the COVID-19 pandemic lockdown in March 2020 and the period afterwards.
39. The Council says any other abuse or neglect under different categories was always considered in the ongoing assessment, but B’s tooth decay did not constitute significant harm under neglect as she was not in pain. It states Ms Y said B was not in pain due to her teeth and the lead social worker did not observe B in pain. When a dentist did see B, they did not recommend treatment as the issue concerned B’s baby teeth and she was not in pain. So, there was therefore no treatment the social worker could recommend or offer.

Mr X’s comments on the draft decision

40. In commenting on the draft decision Mr X provided a copy of the emergency dentist’s report on B’s visit in March 2021. Mr X says the report refers to B’s teeth being decayed; gums are red and bleeding on brushing. Mr X believes the report shows B was in pain with her teeth and outlines the treatment provided. The report concludes that the dentist advised B should keep regular visits with her own dentist.
41. Mr X says B’s own dentist recorded that B did not require any urgent appointment and was due to be seen in six months’ time as Ms Y reported she was not in pain. Following discussion with Mr X the dentist agreed to bring forward the appointment. Mr X provided copies of notes from the dentist referring to B not being in pain as reported by Ms Y, the emergency dentist dressed a tooth ‘with white stuff’ and on examining photographs of the teeth noted there was decay but the teeth ‘appear clean’. Mr X disagrees with some of the dentist’s comments. When the dentist saw B, she had developed an abscess after the emergency appointment. B has now been referred by the dentist to a dental hospital and due to have some teeth extracted.

My assessment

42. The documents provided show that the issue of dental health had been raised and included in the child protection plan for B and the children in Ms Y’s care to progress seeing a dentist. The plan noted B was to receive support using a toothbrush. The task about the dentist was referred to until October 2020 without any updates and then removed from the plan.
43. Mr X was relying on the information from the core group meetings while he was not in contact with B as he could not attend the meetings. As the independent reviewing officer acknowledged the issue about the dentist and B’s teeth were not discussed at the Child Review case conference which Mr X did attend. So, he was not aware of the situation with B’s teeth.
44. The Council’s documents show B was being seen by the health visitor and social worker during the time Mr X was not in contact with her. They reported she was developing well with no concerns about B or issues she was being neglected. The Council confirmed dentists were not accepting new patients or carrying out non-emergency treatments during this time in 2020 due to the COVID-19 pandemic. This has been confirmed by evidence I have seen. So, the social worker could not have recommended any treatments for B and did not hold parental responsibility for B. In any event the officers did not considered B was not in pain.
45. The evidence shows the Council was taking action to check B’s development and welfare through the health visitor and social worker which was according to the child protection plan. But it did not properly update the progress on this task or record a decision on B’s dental health before removing it as a task from the plan. I consider this fault by the Council as it is good administrative practice for the Council to update and record reasons for its decisions. In addition, Mr X was relying on the information from the core group meetings and child protection plan for updates on B.
46. I consider the fault has caused an injustice to Mr X as he was caused avoidable distress when seeing B’s and the state of her teeth in March 2021. However, I consider the injustice to Mr X is limited by the Council’s actions in ensuring B was being regularly seen by the health visitor and social worker and she was not reported to be in any pain. Although Mr X maintains B was in pain, others including professionals do not consider she was.
47. I do not consider on the balance of probabilities even taking into account the emergency dental treatment record, I can reach a view on who is right about whether B was in pain or not. It would not be unusual for some discomfort following a visit to the dentist due to checking teeth and gums. So even if B was in discomfort or pain following this, it does not mean this was generally the case. B’s abscess and need for extractions is very unfortunate. But given the history of dental issues and decay I do not consider I can say this could have been avoided had the Council acted differently.
48. In addition, B required minimal treatment when she saw the emergency dentist in March 2021 and was not referred for any further immediate treatment. Because of this I consider the Council should apologise to Mr X for the avoidable distress it caused him by not updating the child protection plan task about the ‘progression of a dentist’ for B.
49. I consider the Council should remind officers to ensure they update and record any decisions made about a task and its progress or otherwise before removing it from a child protection plan. This is to ensure that all those receiving the minutes of core groups or copies of the child protection plan are kept updated.

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Agreed action

50. To remedy the injustice I have identified in this case to Mr X , the Council will within one month of the date of my decision;
• apologise to Mr X for any distress caused by the failure to ensure it updated and recorded any decision on B seeing a dentist before it removed the task from the child protection plan, so he was aware of the situation.
• remind officers to ensure they update and record any decision made about a task and its progress or otherwise before removing it from a child protection plan.

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Final decision

51. I am completing my investigation. I have found fault by the Council because it did not properly update or record decisions about B’s teeth before removing the matter from a child protection plan so Mr X was not kept updated. I have recommended a suitable remedy in this case.

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Investigator's decision on behalf of the Ombudsman