Summary: Mr X complains about the Council’s handling of concerns relating to his grandchild, Child Y, following a Social Worker visit to his home. There was no fault in the way the Council completed its Child in Need assessment of Child Y. The Council has also given Mr X a fair opportunity to present his case to the stage three complaint Review Panel. There was however substantial delay in the Council completing stages two and three of the statutory complaints process. This delay was avoidable and caused significant distress and uncertainty for Mr X and his family. The Council has agreed to apologise and make an increased remedy payment to Mr X.

The complaint

1. Mr X complains about the Council’s handling of concerns relating to his grandchild, Child Y, following a Social Worker visit to his home in September 2018. Mr X says the Council has failed to properly address concerns he raised about the following areas:
1. Nepotism between professionals working for the Council and other organisations, which created biased handling of his grandchild’s case;
2. Delay in progressing his complaints through the statutory complaints process for Children Social Care;
3. Flawed handling of his complaints by the Council, especially at stage three where Mr X complains he was not given a fair chance to present his case and provide information to the Review Panel.

Mr X says the Council’s handling of these concerns has caused additional distress to him and his family following the death of Child Y.

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The Ombudsman’s role and powers

2. 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)
3. We cannot investigate a complaint if it is about a personnel issue. (Local Government Act 1974, Schedule 5/5a, paragraph 4, as amended)
4. 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)
5. 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

6. I have spoken to Mr X and considered the information he has provided in support of his concerns. I have also considered the information the Council has provided in response to my enquiries.
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Office for Standards in Education, Children’s Services and Skills (Ofsted), we will share this decision with Ofsted.
8. 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 guidance

Child in Need

9. The Children Act 1989 sets out a council’s responsibilities to safeguard children. The government published guidance, Working Together to Safeguard Children, in 2010 and updated it in 2013, 2015 and 2018. The guidance sets out the legal requirements and expectations on individual services to safeguard and promote the welfare of children.
10. Section 17 says a child is in need if they are unlikely to achieve or maintain a reasonable standard of health or development without services provided by the council. Councils can provide services for the whole family or for any individual member of the family if it is provided to safeguard or promote the child’s welfare.
11. Every assessment should draw together relevant information gathered from the child and their family and from relevant practitioners including teachers and school staff, early years workers, health practitioners, the police and adult social care.

Statutory complaints

12. The government sets out a three-stage procedure for councils to follow when looking at complaints about statutory social services functions. The accompanying statutory guidance, ‘Getting the Best from Complaints’, explains councils’ responsibilities in more detail. The handling and consideration of complaints consists of three stages: Stage 1 - Local Resolution, Stage 2 - Investigation and Stage 3 - Review Panel.
13. The timescales in working days for the procedure are:

• 10 days at stage 1 (with a further 10 days for more complex complaints or additional time if an advocate is required);
• 25 days at stage 2 (with maximum extension to 65 days);
• 20 days for the complainant to request a Review Panel;
• 30 days to meet and hold the Review Panel at stage 3;
• 5 days for the Panel to issue its findings; and
• 15 days for the council to respond to the findings.

What happened

14. This is a chronology of key events and does not cover everything that happened.
15. Child Y was born in March 2018. They had several significant health conditions which meant they spent the first few months of their life in hospital. Child Y was discharged from hospital in August 2018 and required 24-hour care from their parents. Child Y and their parents lived with Mr X and his wife, who are Child Y’s maternal grandparents.
16. Shortly after hospital discharge, Child Y’s mother and a nurse working with the family made requests to the Council to ask for additional help with caring for Child Y. The Council agreed to complete a Child in Need assessment and arranged to visit Child Y at home on 13 September 2018.
17. The allocated Social Worker made their arranged visit to assess Child Y with two nurses on 13 September 2018. The Social Worker and nurses wanted to speak to Child Y’s parents alone to establish how they were coping with the intense level of constant care Child Y needed. Other members of Child Y’s family were at home during the visit, including Mr X’s wife.
18. During the visit, Child Y stopped breathing and the two nurses present helped resuscitate them while an ambulance was called. Child Y was admitted to hospital and sadly died a month later.

Mr X’s complaints

19. On 14 September 2018, Mr X first raised concerns with the Council about the Social Worker’s visit to his home. He complained about the Social Worker preventing his wife (Mrs X) from accessing the room where Child Y and their parents were and not allowing Child Y’s mother to speak to Mr X on the telephone.
20. The Council responded to Mr X’s concerns on 1 October 2018. It explained the Social Worker’s intention had not been to cause distress or to block Mrs X’s access. The Council explained the Social Worker had mentioned speaking to Child Y’s parents alone when they arranged the visit with Child Y’s mother. The Council also confirmed there was no conflict of interest due to Mrs X being an employee of the Council and being managed by the same person as the allocated Social Worker.
21. The Council wrote to Child Y’s parents on 3 October 2018 to confirm it had closed its case for Child Y because it concluded their needs were being met by health services. The Council shared a copy of its assessment with Child Y’s parents and offered to meet with them to discuss the content of the assessment.
22. Mr X continued to have concerns about the Council’s handling. On 11 October 2018, the Council explained Mr X could not access the formal complaints process because he did not hold parental responsibility for Child Y.
23. Child Y’s mother, Miss Z, made a complaint to the Council on 3 November 2018. She complained about the Social Worker’s visit and gave permission for her father, Mr X, to act on her behalf. Miss Z also raised concerns about the accuracy of the Council’s assessment of Child Y.
24. The Council responded to Miss Z’s complaint on 22 November 2018 under stage one of the statutory complaint process. It reiterated its position that the Social Worker’s conduct during the visit to Child Y had been appropriate. The Council invited Miss Z to provide further details about the elements of the assessment she disagreed with or wished to correct for it to consider these further.
25. On 16 December 2018, Mr X and Miss Z raised concerns about the appropriateness of the manager that responded to their stage one complaint. They also provided some comments about the content of the assessment. The Council responded on 18 December to explain how Mr X and Miss Z could escalate their concerns to stage two. The Council also arranged for a manager independent of the team involved to work with Miss Z and Mr X on the issues they had with the content of Child Y’s assessment.
26. In January and April 2019, Mr X’s MP contacted the Council about Mr X’s continued concerns. The Council explained what it needed from Mr X to escalate his complaint to stage two. On 4 June 2019, Mr and Mrs X had a telephone meeting with the independent manager to discuss the content of Child Y’s assessment.
27. On 12 July 2021, the Council appointed an independent Investigating Officer (IO) and Independent Person (IP) to complete the stage two complaint investigation of Mr X’s complaints. The IO and IP met with Mr X and agreed a statement of complaint with him on 2 August 2021, which set out the Council had failed to:
1. produce a factually accurate assessment, despite being alerted to incorrect and misleading facts/opinions;
2. investigate the conduct of the allocated Social Worker and to adequately address the concerns raised;
3. comply with a request for a specific manager not to be involved in the stage one complaint following concerns raised by a judge in an earlier (unrelated) matter, or acknowledge the nepotism risk identified by Child Y’s family;
4. adequately and fully communicate the complaints process and to follow procedure to ensure an impartial investigation; and,
5. comply with an information request made by Child Y’s family and Information Commissioner’s Office (ICO) in relation to the case.
28. The IO and IP completed their respective investigation reports into Mr X’s complaints in December 2021. They examined Council case records and interviewed relevant staff as part of their investigation. The IO and IP concluded that complaints a, b, c and e listed above should not be upheld and that complaint d should be partially upheld. The IO and IP found the Council should have provided Mr X and his family clearer information about the complaints process and that it had taken too long to progress their concerns through the process, which added to the distress the family was already experiencing following Child Y’s death.
29. The Council’s Adjudicating Officer (AO) provided its response to the stage two investigation reports to Mr X on 24 January 2022. The Council apologised for the delay in progressing Mr X and his family’s complaints. Mr X remained dissatisfied and on 1 February 2022, he asked the Council how long he had to request a stage three panel review of his complaint.
30. The Council emailed Mr X on 20 September 2022 to confirm it had arranged the stage three Review Panel meeting for 25 October 2022. The Council provided details of who would be attending the meeting, which included the Senior Manager (Officer B) who had responded to Miss Z’s stage one complaint and that Mr X and his family had raised concerns about. The Council explained Officer B would be acting as the Council’s representative at the meeting and would provide advice and guidance to the Review Panel on Council procedures and policies.
31. Mr X raised concerns with the Council’s Complaints Team about Officer B’s attendance. The Complaints Team explained Officer B would have no decision-making role at the meeting. Mr X continued to voice his objections at Officer B attending and said he did not give permission for his written submission to the Review Panel to be shared with Officer B. The Council explained it had consulted the Chair of the Review Panel, who confirmed it was entirely the Council’s decision who it chose to send to the meeting as its representative. The Council’s Complaints Manager confirmed Mr X’s written submission had only been shared with the Chair of the Review Panel before the meeting as requested by Mr X.
32. The Review Panel met as arranged on 25 October 2023. Mr and Mrs X attended on behalf of Child Y’s parents and other family. The report showed Mr and Mrs X had participated in the meeting and been able to freely provide their comments to the Review Panel.
33. The Review Panel concluded the outcomes reached for complaints a, c and d (in paragraph 27 above) at stage two were correct. The Review Panel decided an outcome of no finding for complaint b as it concluded there was a lack of independent evidence to corroborate what had happened during the Social Worker’s visit to Mr X’s home to assess Child Y. The Review Panel felt complaint e fell outside the scope of the statutory complaints process for children services because it related to data protection matters that fall under the remit of the ICO.
34. The Council shared the Review Panel’s report with Mr X on 15 November 2022. It apologised for the delay in progressing his complaints and for the additional distress this had caused at an already difficult time for Child Y’s family. The Council offered Mr X a payment of £200 in recognition of the time and trouble he and his family had experienced in making their complaints.
35. Mr X brought his complaints about the Council back to us as he remained dissatisfied with its handling and responses.

Analysis

36. When a case has been considered via the statutory complaints procedure, we generally would not reinvestigate the substantive issues simply because the complainant was unhappy with the outcome. The statutory procedure is designed to provide significant independence and detailed analysis of concerns raised. This means reinvestigation is neither necessary nor warranted unless a complainant can point to and evidence serious and fundamental flaws in the way the case was investigated.
37. That said, I understand Mr X has had some significant concerns about the way in which the Council completed its assessment of his grandchild and his subsequent complaints about this. I hope my independent review of the Council’s handling can help to provide some reassurance to Mr X and his family.
38. I have carefully examined the case records provided by the Council which show how the assessment of Child Y came about. I can see the Council’s involvement was prompted by requests for help from Miss Z and a health professional working with Child Y and their family. I understand Miss Z has had concerns that the aim of the Social Worker’s visit to assess Child Y in September 2018 had been with a view to instigating child protection action and removing Child Y from their parents’ care.
39. There is no evidence of this within the Council’s case records. The case records show the Social Worker was allocated to assess Child Y as a Child in Need given their significant health conditions. The Council appears to have sought relevant information about Child Y from those involved in their care and treatment, together with legal advice on next steps. The Council has then quickly concluded their involvement was not required as Child Y’s needs were being appropriately met by their family and the health services involved.
40. I have also seen no evidence within the case records to suggest bias in the way the allocated Social Worker approached the assessment of Child Y or their interaction with the family. Like the Stage Three Review Panel, I agree that it is not possible to now determine whether the Social Worker’s conduct was appropriate during the visit to Mr X’s home, due to the lack of independent evidence of what happened.
41. In any event, our role is to investigate the Council’s actions as a corporate body, rather than to investigate an individual. I understand Mr X had already reported his concerns about the individual Social Worker to their professional body (Social Work England), which is the appropriate organisation to consider such matters.
42. The completion of the statutory complaint process has confirmed it took the Council far too long to progress Mr X’s concerns about its handling through the last two stages of the complaint process. The stage two complaint investigation also highlighted issues around the lack of clarity in the Council’s communication with Mr X about which stage his and Miss Z’s complaints were at, which created unnecessary confusion and barriers to them accessing the formal complaints process.
43. It appears the first time Mr X indicated to the Council that he wanted to escalate his concerns to stage two of the complaints process was 3 October 2018. The Council did not complete stage two of the complaint process in this case until 24 January 2022, which is a total of 842 working days, rather than the maximum 65 working days allowed under statutory guidance.
44. In response to my draft decision, the Council has provided information about its interaction with Mr X and Miss Z during the intervening years. This shows some of the time taken to progress through the last two stages of the complaint procedure was not attributable to the actions of the Council. I am however aware Mr X and Miss Z both approached us over this time about progression of their complaints, where we appear to have directed the Council to complete the statutory complaint process.
45. The IO’s stage two investigation report highlights the delay in progressing Mr X’s complaint. It states the Council had trouble appointing IOs and IPs for a backlog of stage two complaints, which it said was caused by the COVID-19 pandemic and that it has since worked on to reduce.
46. The Council’s delay in progressing Mr X’s complaint, considerably beyond the statutory timescales was fault, which no doubt caused significant distress and frustration to Mr X and his family. This was further compounded by the grief the family was already experiencing following the loss of such a young family member, when Child Y died.
47. There was then further delay in the progression of Mr X’s complaint at stage three, which took a total of 191 working days to complete. In response to enquiries, the Council has said it delayed the Review Panel meeting at the request of Mr X and his family because the original date proposed was close to the anniversary of Child Y’s death in mid-October.
48. This does not however explain what caused the delay from February 2022, when Mr X first indicated he wanted to escalate his concerns to stage three. The Council’s offer of a £200 payment to Mr X for the impact of its delay in progressing his complaints through stages two and three, is not in my view sufficient to recognise the significant injustice caused. To address this, I have recommended an increased amount at the end of this statement in line with our Guidance on Remedies. I do however appreciate the increased remedy payment will not alleviate the pain and grief Mr X and his family have experienced from losing Child Y.
49. I have removed the recommended service improvements made in my draft decision as the Council has provided me with evidence of the action it has taken to address the avoidable delays highlighted by Mr X’s case.
50. Mr X complained he was not given a fair chance to present his case to the stage three Review Panel. He says he was unaware his written submission had not been shared with all Review Panel members prior to the meeting and as a result he did not highlight significant parts of the information within his report to the Panel.
51. The Council has shared email chains between it and Mr X prior to the Review Panel meeting, which showed it informed him it had only shared his written submission with the Review Panel Chair as Mr X had requested. Mr X had indicated to the Council that he did not give it permission to share his written submission with Officer B, which is why it was not shared further.
52. Considering the evidence provided by the Council, there appears no evidence of fault in respect of this element of Mr X’s complaint.

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Agreed action

53. Within one month of my final decision, the Council as agreed to:

• issue a written apology to Mr X and his family for the distress and frustration caused by its significant delay in progressing their complaints through stages two and three of the statutory process; and,
• make a payment of £1,000 in recognition of the significant injustice caused to Mr X and his family by its delay in complaint handling.

54. The Council should provide us with evidence that it has completed the recommendations above.

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Final decision

55. I have completed my investigation and uphold Mr X’s complaint. Mr X and his family were caused injustice by the actions of the Council. The Council has agreed to provide the enhanced remedy we have recommended to address the injustice.

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Investigator's decision on behalf of the Ombudsman