Summary: Miss X complains the Council hindered Child Y being referred for a diagnosis and failed to provide support. Miss Y says instead the Council focused on fabricated mental health concerns. This meant Child Y was unnecessarily without support and medication, and caused significant distress to Miss X. The Ombudsman finds fault with the Council for its handling of some areas of the child and family assessment, however the Council has identified and remedied the fault through the statutory complaints process.

The complaint

1. Miss X complains the Council hindered neurological and health referrals for her daughter because the referrals were sent to the social worker instead of health services.
2. Miss X complains this delayed her child being assessed, which in turn delayed her accessing services, a diagnosis and medication.
3. Miss X complains this caused significant distress and prolonged a stressful situation for her family.
4. Miss X complains the Council fabricated mental health issues/concerns about her to blame her daughter's presentation and health on her. 
5. Miss X also complains about the Councils handling of her complaint which delayed resolving the issues and did not fully address her complaint.

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The Ombudsman’s role and powers

6. 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)
7. 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

8. I considered Miss X’s complaint and information she provided. I also considered information from the Council.
9. I considered comments from Miss X and the Council on a draft of my decision.
10. 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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What I found

Legislation and guidance

Children’s services

Duty to Investigate

11. Councils have a duty to investigate if there is reasonable cause to suspect that a child in their area is suffering, or is likely to suffer, significant harm. They must decide whether they should take any action to safeguard or promote the child’s welfare. (Children Act 1989, section 47)

Acting on a referral

12. Anyone who has concerns about a child’s welfare should make a referral to children’s social care and should do so immediately if there is a concern the child is suffering significant harm or is likely to do so.
13. The council should make initial 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 convene a strategy meeting.

Child in Need

Section 17 duties

14. Section 17 of the Children Act 1989 says councils must safeguard and promote the welfare of children within their area who are in need.
15. 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;
• their health or development is likely to be significantly impaired unless the council provides support; or
• they are disabled.

Duty to provide services

16. Under the Children Act 1989, councils are required to provide services for children in need for the purposes of safeguarding and promoting their welfare. Where a referral is accepted under section 17 the council should lead a multi-agency assessment and compete it within 45 working days. Where the council’s children’s social care decides to provide services, it should develop a multiagency child in need plan which sets out which organisations and agencies will provide which services to the child and family. The plan must be reviewed within three months of the start of the child in need plan and further reviews should take place at least every six months thereafter. (Working Together to Safeguard Children) 

Low level needs/Individual and universal services

17. Where a child’s need is relatively low level, individual services and universal services may be able to take swift action. Where there are more complex needs, the council may offer a service under section 17 (child in need) or section 47 (child protection) of the Children Act 1989.  

Statutory complaints procedures

The three-stage process

18. The law sets out a three-stage procedure for councils to follow when looking at complaints about children’s social care services. The accompanying statutory guidance, ‘Getting the Best from Complaints’, explains councils’ responsibilities in more detail.
19. The first stage of the procedure is local resolution. Councils have up to 20 working days to respond.
20. If a complainant is not happy with a council’s stage one response, they can ask that it is considered at stage two. At this stage of the procedure, councils appoint an investigator and an independent person who is responsible for overseeing the investigation. Councils have up to 13 weeks to complete stage two of the process from the date of request.
21. If a complainant is unhappy with the outcome of the stage two investigation, they can ask for a stage three review by an independent panel. The council must hold the panel within 30 days of the date of request, and then issue a final response within 20 days of the panel hearing.

No reinvestigation if process complete and not flawed

22. If a council has investigated something under the statutory children’s complaint process, the Ombudsman would not normally re-investigate it unless we consider the investigation was flawed. However, we may look at whether a council properly considered the findings and recommendations of the independent investigation.

SEN

23. 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. The EHC plan is set out in sections. We cannot direct changes to the sections about education, or name a different school. Only the tribunal can do this.

Council services

Children and Young People’s Services (CYPS)

24. Services delivering mental health and disability support services to children and young people are sometimes referred to as CYPS. They are also sometimes known as Child and Adolescent Mental Health Services (CAMHS).
25. These services are NHS services and can be referred to by professionals who are concerned that a child may have additional needs or disabilities, as well as mental health support.

The Hub

26. Councils often have a multiagency team that assesses referrals that are submitted for children’s services. These can sometimes be called the “Multi Agency Safeguarding Hub”.
27. It is the job of this team to assess referrals and determine whether children require further support. Children and families can be directed to universal services, or where there are significant safeguarding concerns, the referral will be passed to children’s social care for a section 17 or section 47 investigation.
28. Universal services sometimes include targeted early intervention support. This this case, the Council provided early intervention services via its “Hub”.

What happened

29. Miss X has a child, Child Y. In 2018, the Council received a referral with concerns about Miss X’s parenting of Child Y. The Council carried out a child and family assessment but closed the case with no further action.
30. The Council received two further referrals in 2019 with similar concerns about Miss X’s parenting of Child Y. This included a referral from Child Y’s school to the early intervention team for support. The Council reviewed the referrals, and contacted Miss X. The Council told Miss X it wanted to carry out a child and family assessment to assess the family for further support. This would be under the Councils section 17 duties.
31. A social worker carried out a home visit shortly after beginning the assessment. The social worker also visited Child Y at school.
32. Miss X had several discussions with professionals, including the social worker, that she felt Child Y was struggling with undiagnosed additional needs, and this was causing Miss X to struggle with parenting her. Miss X told professionals she was seeking support from them with this issue.
33. Shortly after carrying out the observations, the social worker took sick leave from work. The Council reallocated the case 2 weeks later and a new social worker took over the case. The new social worker carried out a further visit to Child Y.
34. In December 2019, Miss X’s GP made a referral to the Hub for further support. The GP outlined that Miss X felt Child Y had undiagnosed needs and may benefit from an assessment for further support. In this referral, the GP did not refer to the CYPS or set out that he believed Child Y needed an assessment for undiagnosed needs. As the case was already open to a social worker, the hub passed the referral to the social worker to review as part of the ongoing assessment.
35. At the same time, a nurse at the GP surgery also referred Child Y to CYPS for assessment of undiagnosed needs. The CYPS rejected the referral as there had been no assessments or front-line intervention.
36. The CYPS closed the case but passed the referral to the Council’s Hub to assess whether Child Y would benefit from being referred to universal services. The Council screened the referral and decided that as the case was already open to social worker, the social worker could review whether further support services were needed.
37. Miss X was unhappy with the handling of the case and discussed her concerns with a manager. Miss X advised the manager she wished to withdraw her consent for the assessment. Miss X said she felt the assessment process had been unnecessary and lengthy, and had focused on fabricated mental health issues of Miss X instead of the health needs of Child Y.
38. In December 2019, the Council closed the case as Miss X had withdrawn consent, and it did not feel the concerns warranted a section 47 investigation.
39. Miss X contacted the Council in June 2020 to ask whether it had received a referral for Child Y and an assessment for their undiagnosed needs. The Councils early intervention team contacted the CYPS to find out whether Child Y the CYPS would be assessing Child Y or offering an appointment.
40. The CYPS confirmed it had closed the case. It had later received further referrals and offered Miss X an appointment which was declined.
41. Miss X complained to the Council in August 2020. In her complaint she said
42. She was unhappy how the Council had handled the safeguarding referrals for Child Y

• The Council did not seek full information about health needs for Child Y during its assessment
• The Council did not need to carry out an assessment and the outcomes were flawed
• The Council did not confirm ending the assessment or provide her with a copy of the assessment.
• The assessment took too long, and the Council often did not contact her for long periods of time.
• The Council delayed the referral to CYPS which impacted Child Y getting a diagnosis
• The Council criticised Miss X’s parenting instead of focusing on Child Y’s needs.
• The Council made unnecessary comments about parental relationships.
• The Council should have been more proactive in addressing the health concerns for Child Y.

43. The Councils stage 1 response in September 2020 said

• It could have sought more information from health professionals.
• It could not complete a full assessment as Miss X withdrew her consent.
• It should have provided a copy of the assessment, even if it was a reduced assessment because Miss X withdrew her consent.
• The assessment was completed within timeframe but accepted that staff sickness had impacted contact.
• The Council had received a referral from CYPS who advised Child Y did not meet criteria for an assessment with CYPS but may benefit from universal services. As the case was open, the referral was passed to the social worker. As Miss X withdrew consent, the Council could not determine whether further support was to be given.
• The Council did not intend to criticise Miss X and tried to work with her in a multi-agency environment to achieve the best for Child Y.
• The Council had no records of inappropriate comments about parental relationships.
• The Council had signposted the school to begin further work with Child Y.

44. Miss X asked to escalate her complaint to stage two
45. At stage two, the Council appointed an independent officer and an independent person. The Independent officer upheld four points of Miss X’s complaint. They partially upheld two points of complaint and did not uphold nine points of complaint. They could not reach a finding on three parts of the complaint.
46. The independent person reviewed the independent officers report and agreed with the findings. Recommendations were made to the Council to address the injustice from the upheld parts of complaint.
47. The Council reviewed the IO and IP reports. It agreed with the findings and recommendations. The upheld and partially upheld findings were

• There was delay in completing the assessment.
• Unhelpful and incorrect language was used in the assessment.
• It had not included full health information in the assessment.
• The Council did not provide a copy of the assessment.
• Further information could have been sought from the health visiting service.

48. The Council also recognised there was significant delay in addressing the complaint through the complaints process and apologised for this. It also offered Miss X £300 in recognition of the distress and injustice caused.
49. Miss X remained unhappy and asked the Council to escalate her concerns to a stage three review by an independent panel.
50. The stage three review panel agreed with most of the findings by the IO and IP. It however changed one finding from not upheld to upheld as it identified the stage had wrongly calculated the dates of the assessment, which meant it had not been completed within the timeframe. It agreed with the recommendations from the stage two and made a further recommendation for the Council to ensure it includes both parents views in assessments.
51. Miss X remained unhappy and bought her complaint to the Ombudsman.

Additional information

52. After the Council had completed the complaints procedure, a further referral was made to the CYPS. CYPS later diagnosed Child Y with a disability, and an application to the Council for an EHCP was made.
53. The Council assessed Child Y for an EHCP and found that it had a duty to deliver education provision to Child Y.
54. Miss X feels the Council prevented the diagnosis being given sooner, which in turn prevented the EHCP and provision being agreed sooner.

Analysis

55. When a case has been considered via the statutory complaints procedure, we do not reinvestigate the substantive issues. The statutory procedure is designed to provide an independent, detailed investigation and analysis of each the concerns raised.
56. This means it is not necessary for us to carry out any further investigation of the complaint issues, unless we find there were serious and fundamental flaws in the way they were investigated and considered.
57. Our role is usually limited to looking at whether the complaint issues were properly considered, and suitable remedies recommended and implemented. Therefore, I have considered whether the Council suitably conducted the stage two investigation and stage three review panel.
58. Miss X’s complaint centres around the Councils involvement in assessing Child Y, both in a safeguarding capacity, and further assessment in an SEN capacity. Most importantly, Miss X feels strongly the Council poorly handled the child and family assessment, which in turn impacted her daughter being diagnosed with a disability.
59. As part of my investigation, I asked the Council to clarify its role with the CYPS and how referrals were managed.
60. The Council clarified the CYPS does provide services for assessment or diagnosis, but that it is an NHS service, not a Council service. With Child Y, the CYPS first received a referral in 2019 from Miss X’s GP. The CYPS did not feel the referral met its criteria and passed the referral to the Council to see if Child Y would benefit from universal services. As Child Y was already open to Children’s services, the social worker would consider whether further support was needed. The NHS remained responsible in deciding whether Child Y met the criteria for an assessment for diagnosis.
61. During my investigation, I explained to Miss X the process for referrals. I told Miss X the GP had not referred Child Y to the Council for a diagnosis, but for support from the early intervention team. Miss X said she was not aware of this and had believed the GP had referred to the Council for a diagnosis. This had caused confusion over the Councils actions and its responsibilities to referrals.

Consideration of the stage two and stage three

62. The stage two sets out clearly how it has considered the points that Miss X has raised and has been able to evidence how it reached its conclusion.
63. It is the role of the stage three panel to consider whether the stage two has been carried out properly. The stage three panel identified where there had been a miscalculation with dates, and the findings of the stage three panel reflect this by changing the finding from not upheld to upheld. It agreed with all the other findings.
64. The Council has carried out a detailed investigation and review into Miss X’s complaint. I have not identified any serious or fundamental flaws to how the process was carried out. Therefore, I do not find fault with the Council for how it carried out the statutory complaints process and I do not propose to reinvestigate the complaint.
65. I have therefore reviewed the Councils recommendations and remedies. The Council recognised there had been delay in progressing the complaint, which caused distress and recommended £300. The Council also apologised to Miss X for the fault identified and agreed to the service improvements recommended by the stage three review panel. This is in line with the Ombudsman’s guidance on remedies.

Did the Council fully consider Miss X’s complaint?

66. Part of Miss X’s complaint is the Council didn’t fully address her complaint via the complaints process, and therefore didn’t properly investigate the issues.
67. Miss X had the opportunity to agree the scope of her complaint with the Council at both Stage 1 and stage two. She also had the opportunity at Stage two and Stage three to voice her views. The Council communicated with her clearly about the scope of the complaint, and thus, I do not find fault with the Council for failing to consider parts of Miss X’s complaint. If Miss X was unhappy with the scope of the investigation, she had the opportunities to raise this as part of the process.
68. However, I think Miss X could mean she feels the Council should have taken more action about Child Y’s needs which were later diagnosed. Miss X says she told the Council on many occasions her child had an undiagnosed need and asked for help.
69. I agree with the Councils comments in the stage three which set out the Council can only rely on the information it has available. This would also include the information available at point of referral. I have considered the referrals submitted, which were for concerns about Miss X’s parenting methods, and a rejection from the CYPS. It is unlikely the Ombudsman would find fault with how the Council considered the information at point of referral.
70. However, I also considered the upheld finding that the assessment did not suitably include information about Child Y’s health needs.
71. The stage two sets out that although Miss X consented to professionals being contacted, there was little in the assessment to reflect Child Y’s needs. Additionally, case records reflect professional discussions which the Council should have included in the assessment. The IO found fault with this, and the Council accepted this in its adjudication letter to Miss X where it apologised and said it would take learning forward.
72. It would be speculative to say that failing to include a full account of Child Y’s needs in the assessment had a later impact on a diagnosis. I cannot say what information the Council may have included. Additionally, because Miss X withdrew her consent, the Council could not fully assess the situation and conclude whether more information could have been collected to determine if Child Y needed further support. The Ombudsman would not be able to add to this part of the investigation as the injustice is speculative. I am satisfied the apology and service recommendations are in line with the Ombudsman’s guidance.

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Final decision

73. I have now completed my investigation. I find fault for how it managed some aspects of the child and family assessment, however the Council has carried out the statutory complaints process without flaw and has remedied the faults identified. There is no further role for the Ombudsman.

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Investigator's decision on behalf of the Ombudsman