South Western Ambulance Service NHS Foundation Trust (18 000 685b)

Category : Health > Ambulance services

Decision : Not upheld

Decision date : 12 Jun 2019

The Ombudsman's final decision:

Summary: The Ombudsmen found no fault with the way safeguarding concerns were dealt with by a Council, an Ambulance Trust and an NHS Trust. The Ombudsmen also found no fault by the Council in relation to it following child protection procedures.

The complaint

  1. Miss F complains about Wiltshire Council (the Council), Salisbury NHS Foundation Trust (the Trust) and South West Ambulance Service NHS Foundation Trust (the Ambulance Service). In particular she complains that:
      1. The Council failed to provide her with support after she requested it in early 2017, despite her diagnosis of Myalgic Encephalomyelitis (ME) and her children’s complex needs.
      2. A paramedic from the Ambulance Service made assumptions about her and reported her to social services unnecessarily when he attended her property in October 2017 to treat her son, H.
      3. Staff from the Trust failed to treat H when he attended the Emergency Department (ED) later that day and instead focused on interrogating her about the circumstances leading to his injury. Miss F says H was only treated at her insistence.
      4. Staff at the Trust discriminated against her and H as they believed they were travellers.
      5. The Trust’s staff lied to social services and the police about the events leading to her taking H home following his treatment.
      6. The Council escalated the matter to police unnecessarily.
      7. The Council convened a Child Protection Conference even though it knew she could not attend.
      8. The Council placed H on a Child Protection Plan (CPP). Miss F says this decision was based on unfounded allegations that she had abused H and that the Council did not meet with her to substantiate these claims or explain its decision.
      9. A Council social worker failed to visit the family regularly as required by the CPP and kept inaccurate records of what took place.
  2. Miss F says the Council’s failure to support her meant she was left struggling, physically and mentally, to look after her children.
  3. Miss F says the actions of the Ambulance Trust, Acute Trust and Council when she attended the ED with her son resulted in the police becoming involved unnecessarily. She says police took her son from his bed in the middle of the night and arrested her. Miss F says this was very frightening and is now on her record.
  4. Miss F says the child protection process, and the Council’s failure to provide her with information about what was happening and why, was distressing and confusing for her.
  5. Miss F says these events exacerbated her existing health conditions and made her unwell.
  6. Miss F would like the Council, the Trust and Ambulance Service to acknowledge and apologise for their mistakes. She would also like them to pay her financial recompense in recognition of the distress these events caused her.

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The Ombudsmen’s role and powers

  1. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
  2. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
  3. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

  1. In reaching this decision, I took account of the information Miss F provided to the Ombudsmen. I made enquiries of the Council, the Trust and the Ambulance Service and took account of the documents and comments they provided, including relevant medical and care records.

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What I found

Legal and administrative context

Safeguarding

  1. Anyone who is concerned that a child is suffering or at risk of harm should inform the Council.  Health bodies should be alert to the possibility that children may be at risk of harm and refer their concerns to the local authority for assessment.
  2. Under section 47 of the Children Act 1989, 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. This may involve assessment to analyse a child’s needs and the risk of harm to the child. Councils may also convene a Child Protection Conference (CPC). The CPC will decide whether any action is necessary to protect the child from harm.
  3. The government has issued guidance to Councils managing cases where there are concerns about a child’s safety or welfare.  (Working Together to Safeguard Children)
  4. For children in need of immediate protection and removal, the social worker, police or NSPCC must take action as soon as possible after the referral has been made to local authority children’s social care (sections 44 and 46 of the Children Act 1989).

Child in Need

  1. Section 17 (10) and (11) Children Act 1989 defines a child in need as a child who is unlikely to achieve or maintain a reasonable level of health or development, or whose health and development is likely to be significantly or further impaired, without the provision of services; or a child who is disabled.

Background

  1. At the time of the events complained about Miss F lived with her three-year-old son, H. Miss F’s older child has learning difficulties and was in residential care.
  2. In early 2017 Miss F told the Council she was finding it difficult to cope with looking after H. She said this was due to her ME and she raised concerns about causing H harm.
  3. Miss F’s social worker completed an assessment on 11 April 2017. The social worker did not think Miss F’s comments about harming H were a true reflection of the situation and did not feel H was at high risk of coming to harm. The Council started child in need planning for H and referred Miss F to the Community Mental Health Team (CMHT).
  4. The records show continued contact between Council staff and Miss F over the next few weeks. The Council continued to have concerns about H’s safety and a safeguarding strategy meeting on 6 June decided these met the threshold for significant harm. A Section 47 enquiry was completed.
  5. The Council visited Miss F on 12 June, at which point Miss F’s mother was staying with her to help out. The safeguarding records show Miss F said she wanted respite from looking after H, but the Council explained this was not available through child safeguarding. Miss F’s mother said she planned to take H to live with her for a year once the current school term ended.
  6. H went to stay with Miss F’s mother in July 2017 and the Council closed its case. However, this arrangement broke down and H returned to live with Miss F after a few weeks.
  7. In October 2017, Miss F was staying in her campervan with H.
  8. On 25 October H burnt his hand on a log burner in the campervan. Miss F contacted NHS 111 for advice and they decided to send an ambulance. As the location where Miss F was staying did not have a postcode, the paramedic had some difficulty finding Miss F’s campervan. The Ambulance Service tried to pin point Miss F’s location with limited success. However, after a short time, the paramedic managed to find the campervan parked near a bridleway.
  9. The paramedic reported the lighting in the campervan was poor so it was not possible to properly assess the extent of H’s burns. The paramedic also recorded concerns about H’s safety living in the campervan. The paramedic took H and Miss F to hospital for treatment.
  10. The Ambulance Service sent a safeguarding referral to children’s social care due to the concerns the paramedic reported.
  11. Records show the ED assessed H’s hand at 9:52pm. The notes state a cling film dressing was in place and H had already taken paracetamol and ibuprofen. The ED cleaned and dressed H’s burn.
  12. The records show ED staff discussed concerns about H’s safety, in particular Miss F’s reported concerns about her ability to cope and providing a safe environment for a child. The records show ED staff asked Miss F to wait while they spoke to a paediatrician and duty social worker.
  13. It is recorded that Miss F telephoned a friend to give her a lift back to her campervan. The records show nurses asked Miss F to stay at the hospital. She left the ED with H at 11:35pm.
  14. The Trust told the duty social worker at the Council that H was no longer at the hospital. The Council started a Section 47 enquiry because H was taken from the ED against medical advice and against a history of Miss F not coping with H’s care.
  15. The police visited Miss F’s campervan later that night to remove H to a place of safety.
  16. The Council arranged for a CPC to be held on 16 November 2018. Miss F was unable to attend. The outcome of this was to place H on the Child Protection register.
  17. In December 2018 Miss F went to stay at her mother’s address (out of area). The Council alerted social workers in that area to continue the Child Protection visits.
  18. Miss F returned to her home with H at the end of January 2018. The Council continued with the CPP visits until 22 March after which the case transferred to another local authority area because Miss F had moved home.

Analysis

Support for Miss F

  1. Miss F complains the Council failed to provide her with support when she requested it in early 2017, despite her diagnosis of ME and her children’s complex needs.
  2. The Council’s records show it visited Miss F and completed an assessment after Miss F reported she was finding it difficult to cope. This is in line with the child protection procedures. The Council started child in need planning and arranged a referral to the CMHT for Miss F to receive help and support with her mental health.
  3. The records show several further contacts between Council staff and Miss F over the next few weeks. Support and encouragement to engage with services was provided. However, the records show health and social care professionals were becoming increasingly concerned that Miss F’s behaviours may be having a negative effect on H’s development.
  4. When the Council visited Miss F after the safeguarding strategy meeting, Miss F’s mother was staying to help out and look after H. The safeguarding records show Miss F did ask for respite care, but the Council explained this was not available through safeguarding procedures and encouraged Miss F to engage with mental health services. At this time Miss F’s mother said she planned to take H to live with her for a year once the current school term ended in July. The Council considered this plan mitigated the risk of harm to H and would give Miss F the respite she needed and time to address her mental health needs.
  5. The records do not indicate the Council failed to support Miss F when she asked for help in early 2017. The Council encouraged her to engage with services to help meet her needs and help her cope with caring for H. Ultimately Miss F decided to send H to live with her mother. The Council felt this was a safe and appropriate move given Miss F and her mother suggested this was going to be a long-term arrangement. Although this arrangement quickly broke down, this was not a failing by the Council. I have not found fault by the Council in relation to its actions when Miss F said she could not look after H due to her ME.

Ambulance service

  1. Miss F complains the paramedic made assumptions about her and reported her to social services unnecessarily.
  2. The records show the paramedic had difficulty assessing H’s burn due to the poor lighting in the campervan. The records also show the paramedic also had concerns about the safety of the environment for H and with Miss F’s responses to some questions about their situation. These were not shared with Miss F at the time because the paramedic did not want to unnecessarily escalate the situation given that H was going to hospital anyway.
  3. The records show the paramedic asked Miss F and H questions about the events and their social situation. The paramedic recorded that H made some comments about “nasty people” living at their home and Miss F said they had come away in the campervan to escape from the stress she was under. The paramedic also recorded H said some “nasty men” were staying nearby and they had been in the campervan with Miss F. The paramedic noted Miss F was uncooperative with answering any further questions.
  4. I believe this shows the paramedic did not make assumptions about Miss F or her situation and he attempted to gather as much information as he could. As he did not find information forthcoming he had unresolved concerns about H’s safety. While Miss F disagrees there was anything for the paramedic to be concerned about, under the Children’s Act, he was dutybound to refer any concerns he had about H’s safety. Meanwhile, he took H to hospital to get his burn assessed and treated. I therefore consider the paramedic acted in accordance with the Children’s Act and I find no fault.

Medical treatment at the Trust

  1. Miss F complains staff at the Trust failed to treat her son when he attended the ED and instead focused on interrogating her about the circumstances leading to his injury. Miss F says her son was only treated at her insistence.
  2. The records show an ED nurse assessed H shortly after arrival and noted he had a cling film dressing in place and he had received pain relief. A statement from the nurse stated Miss F was reluctant to disclose any information about home, but notes a discussion about Miss F’s ability to cope. She noted Miss F said H had just returned from staying with his grandmother because of an argument Miss F had with her.
  3. An Emergency Nurse Practitioner then saw H about 90 minutes later. The cling film dressing was still in place. A statement from the Emergency Nurse Practitioner noted H was active and did not appear to be in pain. The Emergency Nurse Practitioner said he questioned Miss F about the reasons for their attendance but she was vague with her answers. He said either H or Miss F then removed the cling film and therefore he cleaned and dressed the wound before continuing to ask more questions about the circumstances of H’s attendance.
  4. I appreciate that Miss F may have been worried at this time and her recorded responses to questions indicate she wanted to return to her campervan and get H to bed. Given it seems Miss F or H removed the cling film dressing before the wound was redressed, I can understand why Miss F may have considered she had to ask medical staff to treat H. However, it was valid for the Emergency Nurse Practitioner to establish what had happened, especially because of concerns raised by the paramedic and ED nurse about H’s safety.
  5. There is no suggestion H needed more urgent treatment or that the ED staff neglected his injury. Neither is there any evidence that shows Miss F had to insist H was treated. I therefore find no fault in relation to this aspect of Miss F’s complaint.

The Trust’s role in child protection reporting

  1. Miss F complains the Trust’s staff discriminated against her and her son as they believed they were travellers. She says the Trust’s staff lied to social services and the police about the events leading to her taking her son home after his treatment.
  2. The records show an ED nurse discussed the need for a social worker and paediatrician review. The reasons recorded for this included H’s ED attendance five days earlier with a head injury, the safeguarding concerns reported by the paramedic, Miss F was being vague with responses to questions and she had expressed concerns about her ability to cope with H.
  3. It is also recorded that an ED nurse asked Miss F to stay in the department but she ‘left rushing out of department and ran down ramp (ED)’. Miss F says the reason she rushed out of the department was because her friend was parked in a disabled bay. Miss F’s complaint to the Trust acknowledges a nurse told her she should not leave, but she told the nurse they could telephone her if they needed to speak.
  4. Given the history, the safeguarding referral from the paramedic and concerns the ED staff noted during their discussions with Miss F, it was appropriate to ask for a paediatric review. Hospital staff have a duty under the Children’s Act to inform the Council about any concerns that a child is suffering or at risk of harm. The Trust therefore acted without fault in contacting social services after Miss F appeared to leave the ED abruptly and against the medical staff’s advice. It was then the Council’s decision how to use this information. I have seen no evidence the Trust’s actions were discriminatory in any way.

The Council’s actions

  1. Miss F complains the Council escalated the matter to police unnecessarily. She says this meant H was woken up unnecessarily in the early hours to be taken to the hospital.
  2. This issue was not specifically raised with the Council during local resolution of her complaint.
  3. A Section 47 enquiry started after Miss F left hospital against medical advice. Records show medical professionals reported this was after Miss F was informed of a referral to social care. The records also note Miss F’s history of not coping with H’s care, H’s injury, and medical professionals’ concerns about Miss F’s emotional presentation.
  4. Due to concerns about H’s safety, the Council considered an urgent response was needed and the police became involved. Given the urgency of the concerns, which are clearly documented, the decision to involve the police was appropriate and in line with Working Together Guidance. I therefore find no fault by the Council.

Child Protection Conference

  1. Miss F complains the Council convened a CPC even though it knew she was unable to attend. Miss F said she told the Council she did not have child care and she did not consider a CPC was an appropriate environment for a child. Miss F says she was told she should bring H to the meeting.
  2. The records show on 1 November 2017 Miss F told her social worker she would probably be unable to attend. Her other child had a medical review the day before the CPC was scheduled for and Miss F said she would be too tired due to her having chronic fatigue syndrome. The social worker agreed to look into whether the meeting could be moved.
  3. The Council did offer an alternative date, but Miss F could not make this date either. The social worker emailed Miss F on 7 November to confirm the meeting would take place on the original date. However, they offered to make arrangements to make attending easier for Miss F, such as her joining via telephone from home. It does not appear Miss F accepted this offer.
  4. I have seen nothing in the records to indicate the Council told Miss F she needed to take H to the meeting. While Miss F’s recollection is that she understood H should be taken to the meeting, without evidence of this I am unable to corroborate this. The records show the Council did attempt to rearrange the meeting. When this was still not suitable for Miss F, it offered to make reasonable adjustments to accommodate her attendance. Given the number of individuals involved in the CPC, I consider the Council’s actions were proportionate and appropriate. I therefore find no fault in this regard.

Child Protection Plan

  1. Miss F complains the Council placed her son on a CPP. She says this decision was based on unfounded allegations that she had abused her son and that the Council did not meet with her to substantiate these claims or explain its decision.
  2. The records show the Council met with Miss F regularly before the CPC through social work and Child in Need visits. There is also evidence of telephone contacts with Miss F and other family members. The reason for the CPC was based on documented concerns from health and social care professionals. I appreciate Miss F may not agree with these views but I have seen no reason to question that these concerns were unfounded or properly considered.
  3. The Council’s records show the social worker telephoned Miss F after the CPC and explained the outcome and the reasons for this in detail. It is recorded Miss F did not agree with this but indicated she understood what she had been told. I therefore do not consider the Council was at fault in this regard.

CPP visits

  1. Miss F complains that a social worker failed to visit the family regularly as required by the CPP and kept inaccurate records of what took place.
  2. The social worker’s record of visits is their professional view on the situation at the time. The records are comprehensive and I have seen no reason to question the accuracy of the social worker’s record. It is clear Miss F has a different recollection to what is recorded. I have no reason to dispute either account and without evidence, I it is difficult to reach a view about the accuracy of what was recorded.
  3. The Council’s Practice Standards state children subject to a CPP should be seen at least every 14 days. The CPP started on 16 November 2017. Records show the Council attempted to visit on 7 December but there was no answer. The social worker left a note asking Miss F to telephone urgently. There is no record of Miss F making a telephone call. It is however noted the Health Visitor confirmed to the social worker that she had visited Miss F the previous day. The social worker visited again on 15 December.
  4. Miss F confirmed she was visiting her mother the following week (out of area) for a few weeks. The Council informed social services in the area Miss F’s mother lived so they could continue to visit Miss F and H. They saw Miss F and H on 4 January 2018.
  5. The Council telephoned Miss F’s mother on 23 January to enquire when Miss F was planning on returning to her home. It is recorded Miss F’s mother was uncooperative.
  6. The out of area social worker visited again on 31 January, but Miss F had already returned to her home. The Council then visited Miss F on 2, 14 and 27 February and on 22 March, before her case was transferred to a different area.
  7. There was a gap slightly outside the timescales set out in the Council’s Practice Standards (between the visit on 27 February and 22 March). However, the records show there was a telephone call between Miss F and the social worker on 14 March. The record states Miss F ‘would not allow’ the social worker to visit the following day as she would be busy, but they arranged a visit for 22 March. The records indicate the social worker did not have any immediate concerns about H’s safety to necessitate an earlier visit and there is no indication this delay caused any injustice to Miss F or H. I consider the frequency of visits was appropriate in the circumstances set out above. I therefore find no fault by the Council.

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Decision

  1. I found no fault by the Council, the Trust or the Ambulance Trust in the way these organisations reported and handled safeguarding concerns about H. I also found no fault with the Trust’s care of H in the ED.
  2. There was no fault by the Council in relation to arranging child protection conferences and communicating this information with Miss F. I did not find fault with the visits after the child protection plan was started. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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