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NHS Sheffield Clinical Commissioning Group (19 015 370a)

Category : Health > Community hospital services

Decision : Not upheld

Decision date : 08 Mar 2021

The Ombudsman's final decision:

Summary: The Ombudsmen find there was an extensive avoidable delay in the Council assessing two young adults’ needs and producing a support plan for their care at home. This situation caused their mother significant avoidable stress which is an injustice. The Council has agreed to apologise, make a payment to recognise the injustice and to take steps to learn from the case and prevent recurrences.

The complaint

  1. Mrs A complains about Sheffield City Council's (the Council's) and Sheffield Clinical Commissioning Group's (the CCG's) actions in relation to arranging and funding care for two of her children, Mr Y and Ms Z. Specifically, Mrs A complains:
      1. About an unreasonable and avoidable delay in agreeing home-based support plans for Mr Y and Ms Z; from 2016 to 2019 for Mr Y and from 2018 to 2019 for Ms Z.
      2. An unreasonable delay in responding to her complaints about these matters.
  2. Mrs A said the delays in the case led to a significant impact on her resilience and well-being. Further, she said the process had caused avoidable work and inconvenience.

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The Ombudsmen’s role and powers

  1. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen (Local Government Act 1974, section 33ZA, and Health Service Commissioners Act 1993, section 18ZA).
  2. 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)).
  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. I read the correspondence Mrs A sent to the Ombudsmen, spoke to her on the telephone and corresponded with her via email. I wrote to the organisations to explain what I intended to investigate and to ask for comments and copies of relevant records. I considered all the comments and records they provided. I also considered relevant legislation and guidance.
  2. I shared a confidential copy of my draft decision with Mrs A and the organisations under investigation to explain my provisional findings. I invited their comments and considered the responses I received.

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What I found

What happened

  1. Mr Y and Ms Z both turned 20 years old in early 2016.
  2. Mr Y has diagnoses of learning disabilities and an autistic spectrum disorder, along with other medical conditions. In 2016 he lived in a 52-week residential placement (where he had been for around five years) and attended college there. Joint funding came from social care, education and the CCG.
  3. Ms Z has diagnoses of a learning disability, an autistic spectrum disorder and some medical conditions. In 2016 Ms Z lived at home where her family provided the great majority of her care and support. She attended a local college five days a week.
  4. In June 2016 Mrs A said she wanted Mr Y to return to live at home with an appropriate package of care. The college advised the Council of this.
  5. In February 2017 there was a Best Interest meeting to consider this request. Those present agreed the time was right for Mr Y to return home. A Social Worker noted an aim for the transition to take place toward the end of Easter (mid-April). However, the college raised concerns this did not allow enough time to recruit, train and embed carers. The meeting recorded an agreement to formulate a transition plan for Easter but noted this may be extended up to the spring break. The notes said “All members of the meeting agreed to Mr Y returning home and that all parties needed to work together to achieve this outcome”.
  6. The Council completed a Care Plan Review of Mr Y’s needs in the middle of March 2017. It noted an expectation that the family would largely support Mr Y when he returned home but he would need help from personal assistants to help him attend college. It also noted a need to consider supporting him outside college. The review also said it may be beneficial to make some adaptations to the family home to allow better support.
  7. The Council allocated Mr Y’s case to an Occupational Therapist (OT) in late April 2017 to undertake an assessment of the need for adaptations. Also, over the following months a Social Worker spoke to possible providers about providing personal assistant support for Mr Y.
  8. The OT completed their assessment in mid-August 2017. They concluded that there was a need for an additional bathroom and for a garden room, to support both Mr Y’s and Ms Z’s combined needs when they would be at home together.
  9. By April 2018 there had not been a decision about how much support Mr Y and Ms Z would need to meet their needs at home when they were living together. A meeting that month noted that Ms Z was due to leave college in July 2018 and would need alternative activities after that time. A Social Worker suggested Mrs A provide a visual timetable of the activities and support Mr Y and Ms Z needed.
  10. Mrs A provided the requested timetables at the end of the month. In the middle of May 2018 Social Workers said they still had some questions about Mr Y’s and Ms Z’s needs. Mrs A replied to their questions the next day.
  11. In early July 2018 a Social Worker contacted Mrs A and noted areas where she felt they would be able to put a compelling case to a funding panel to request support. However, she said there were other areas where she did not feel they had enough detailed information and asked Mrs A to provide it. Mrs A provided information the same day.
  12. Around a month-and-a-half later, at the end of August 2018, a Social Worker contacted Mrs A again and said the information she had provided was too anecdotal. She attached 24-hour support grids and said it would be useful if Mrs A would complete them for a few days. Mrs A did so and submitted completed sheets in September.
  13. Mrs A chased for a response to these sheets close to a month later, in late October 2018, having not heard anything in response. The following day a Social Worker replied and said there was still too much generalised information. They suggested a meeting to discuss what they needed. A meeting took place in November 2018.
  14. In March 2019 Mrs A wrote to the Secretary of State for Health and Social Care. She copied other agencies in, including the Council. Mrs A complained about an extensive and avoidable delay in arranging for Mr Y to return home. Mrs A asked for someone to intervene and asked for packages of support to be in place by the end of July 2019.
  15. A multi-disciplinary meeting took place in early July 2019. Those attending discussed possible support but did not form a definite plan. Mr Y left the residential placement and returned home toward the end of July 2019.
  16. The Council agreed support plans for Mr Y and Ms Z in principle in September 2019. The plans were for 65 hours of support per week for each sibling (at different hourly rates) along with some additional money for three activities a week each.
  17. While Mrs A was satisfied with the content of the proposed support plans she did not feel able to accept them due to the financial implications. A prolonged dialogue with the Council about funding and charging began, but this is outside the scope of this investigation.
  18. At the end of October 2019 Mrs A made a further complaint about the delays her family had experienced. The Council replied in January 2020 and apologised that it had not put in place acceptable packages before the end of July 2019.

Relevant legislation and guidance

  1. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult who appears to need care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
  2. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
  3. There is no set definition of an assessment. The Care and Support Statutory Guidance (the CSSG) notes that: ‘The nature of the assessment will not always be the same for all people, and depending on the circumstances, it could range from an initial contact or triage process which helps a person with lower needs to access support in their local community, to a more intensive, ongoing process which requires the input of a number of professionals over a longer period of time’ (Section 6.4 of the CSSG).
  4. The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. This should then inform the council’s response to any identified needs. The response ‘might range from offering guidance and information to arranging for services to meet those needs’ (Section 6.5 of the CSSG).
  5. Councils are encouraged to take a holistic approach to assessment in order to ‘prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing’ (Paragraphs 6.75 to 6.78 of the CSSG).
  6. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider: what needs the person has; what they want to achieve; what they can do by themselves or with existing support; and, what care and support may be available in the local area. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.


Delays in assessment

  1. The Council has accepted there was an inappropriate and avoidable delay between June 2016 and February 2017. It would be reasonable to expect that it could take around a month to arrange a Best Interest meeting. Therefore, there was an avoidable delay of around six-and-a-half months here.
  2. At the meeting there was a unanimous, clear agreement about the need for Mr Y to return home. The Social Worker stated an intention to come up with a transition plan over the next six to eight weeks. It was appropriate for the college to caution that recruiting, training and embedding support workers would take longer. However, the aim to review Mr Y’s needs and form a plan of how to meet them at home in two months was reasonable and achievable. Further, there is evidence to show professionals recognised the importance of this planned move. A Care Plan Review completed in the middle of March 2017 said “It is so important to [Mr Y] that he returns to live with family, that any failure to make this transition would be a disaster for [his] mental wellbeing”.
  3. The aim to complete a plan in two months appears to have been achievable because the Council was not starting from a blank canvas. Mr Y had a comprehensive Education Health and Care Plan (EHCP). This is a document designed to set out a full picture of all a person’s needs in one place. The EHCP included input from Mr Y’s parents, a Council Reviewing Officer, a Council Social Worker, college staff, two Clinical Psychologists, an Educational Psychologist, and a Speech and Language practitioner. Mr Y had also been subject to detailed assessments of his eligibility for Continuing Healthcare funding (CHC) – assessments which explored his needs across a wide range of areas. Further, Mr Y had been in a residential placement since 2011. As such, there was a comprehensive baseline of information about Mr Y’s needs. The family were available to give their views about Mr Y’s needs. Further, the Council could have obtained more views and documentary evidence about Mr Y’s needs from a host of other areas.
  4. As detailed above, the review of March 2017 identified the possible need for home adaptations to ensure carers could support both Mr Y and Ms Z safely and appropriately at home. The Council assigned the case to a relevant professional about a month-and-a-half later. From this point it would have been possible and appropriate for the Council to do this assessment alongside the Social Worker’s, as far as possible, to ensure a holistic assessment. By July 2017 the OT had established that Mr Y’s and Ms Z’s needs were combined and needed to be considered together.
  5. From the Best Interest meeting in February 2017 there is very little detail in the notes to show what proactive steps Council staff were taking to assess Mr Y’s or Ms Z’s needs. There is little evidence of requests for documents from the college or other professionals. Further, there is very little to show that the Council were hampered by obstacles and delays which were outside of its own control.
  6. The evidence I have seen so far shows that, while the Council was in touch with Mrs A at a variety of points, it was not until April 2018 that a Social Worker asked Mrs A to complete a visual timetable of the activities Mr Y and Ms Z did each day, and the support they needed. Mrs A supplied the requested material about two weeks later. I have not seen anything to explain why the Council did not request this information from Mrs A and the college in the days and weeks after the Best Interest meeting.
  7. When a Social Worker raised further questions of Mrs A, she replied the next day. Another month-and-a-half then went by before a Social Worker asked Mrs A for more information. Again, Mrs A responded very quickly. Almost two months then passed before the Social Worker asked Mrs A to complete 24-hour grids. Mrs A provided the completed grids within the next month, but a further month passed before the Council said it needed more detail (and this was after Mrs A had chased for an update).
  8. At this point, in late October 2018 – 20 months after the Best Interest meeting – the Social Worker suggested a meeting with Mrs A as a better way of getting the information the Council needed. As with the initial email requests for information, there is no clear evidence to show that the Council could not have arranged such a meeting much sooner.
  9. As detailed above, the Council did not put a clear support plan forward until September 2019. This was 31 months since the Best Interest decision. It was 26 months since an OT had noted the combined nature of Mr Y’s and Ms Z’s needs. And, it was almost a year‑and‑a‑half after Mrs A had highlighted the oncoming need for post‑college support for Ms Z. This was far too long.
  10. Mr Y and Ms Z have complex needs and the situation is complicated by the consideration of how their needs would interact when living together. There was also a need to consider the suitability of the home environment for caring for both together. Further, there was a need to speak to possible providers about the feasibility of providing what Mr Y and Ms Z were likely to need. As detailed above, the Care Act and associated guidance does not set out a specific timescale for completing assessments. On balance, in this context it would be reasonable to expect the Council to have gathered the necessary information and completed an assessment of Mr Y’s and Ms Z’s needs within six months of the Best Interest meeting. This is particularly in view of: the ready access it had to previous assessments; the opportunities it could have used to speak to other professionals with knowledge of Mr Y and Ms Z; and, in view of the evidence of how quickly Mrs A responded to requests made of her.
  11. Therefore, there was an unreasonable and avoidable delay of approximately 25 months after the Best Interest meeting. This, combined with the delay before the Best Interest meeting, means there was a total avoidable delay of over 31 months. This is an extensive delay and is fault. While the funding for Mr Y’s and Ms Z’s support was joint it is evident the Council had the lead for completing the assessments. As such, the Council was responsible for the fault.
  12. As a result of this fault Mr Y did not return home until three years after Mrs A made the request. This is in spite of early notes about how upsetting it would be for Mr Y not to return home, and in spite of the agreement that it would be the right thing for him. This situation, in turn, caused Mrs A a significant amount of stress and frustration along with time and trouble. This is an injustice to her which the Council has not adequately addressed. I have made recommendations about this below.

Delays in complaint handling

  1. Councils and NHS organisations responsibilities for handling complaints are set out in the Local Authority Social Services and NHS Complaints (England) Regulations 2009 (the Regulations). Section 3 states that each organisation must make arrangements to handle complaints in line with the Regulations. Section 14(1) details that organisations should investigate complaints ‘in a manner appropriate to resolve it speedily and efficiently’.
  2. After informally urging the Council to expedite matters on a number of occasions Mrs A made a formal complaint in March 2019. Following some attempts to arrange a meeting the Council wrote a reply at the end of June 2019 (although Mrs A did not receive this until late September 2019). The Council apologised for the delay in completing reassessments of Mr Y’s and Ms Z’s needs. It accepted it had not met the required timescale set out in guidance and accepted this was unacceptable. The Council also apologised for the delay in responding to the complaint. It said a manager had been trying, unsuccessfully, to arrange a meeting with Mrs A from March to 11 June. The Council said it had hoped to hold a meeting before issuing a written response.
  3. The Council provided a further response to the complaint in January 2020. It noted it had delayed sending it after September 2019 (when it agreed the support plans) to see if it could also address Mrs A’s concerns about charges. The Council said “this has probably not been the approach that we should have taken” and apologised for the delay. The Council reiterated its apology that support plans had not been in place for July 2019. However, it did not comment on the extent of the delay since the initial request for Mr Y to move home.
  4. Overall, as the Council has already acknowledged, there were avoidable delays in its handling of Mrs A’s complaints. This is further fault on the part of the Council.
  5. Mrs A made it clear in her complaints that her primary objective was to resolve the ongoing delays in arranging support packages for her children. When the Council sought a meeting she confirmed this, noting she wanted the focus to be on resolving current issues rather than addressing historic matters. Therefore, this fault compounded the stress and frustration Mrs A experienced because of the delays in the assessment process. The assessment remained outstanding despite her efforts with the social care team, and despite her efforts to escalate the situation through a formal complaint.

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Agreed actions

  1. Within one month of the date of the final decision the Council should write to Mrs A to acknowledge the full extent of the avoidable delays in its assessments of Mr Y’s and Ms Z’s need for support at home. It should also reiterate its acknowledgement of delays in the complaints process. The Council should also apologise to Mrs A for the avoidable stress, frustration, time and trouble these delays caused her.
  2. Within two months of the date of the final decision the Council should pay Mrs A £1,000 to serve as a tangible, symbolic recognition of the injustice she suffered, and the prolonged nature of it, as a result of the delays in this case.
  3. Within three months of the date of the final decision the Council should review the circumstances of this case to identify the reasons why the assessments took so long. This should look at the actions of staff on the ‘front line’, along with line management and any other relevant oversight arrangements. The review should attempt to establish whether any shortcomings were specific to this case or evidence of more systemic issues. Finally, the Council should produce a SMART action plan to address any issues its review identifies, with the aim of preventing recurrences.

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  1. There was an injustice caused by fault on the part of the Council which will be addressed by the recommendations I have made. I have closed the case on this basis.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman

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