Summary: The Ombudsmen uphold Mr R’s complaints about his son’s access to therapy, the Council’s communication and delays with complaint handling. Mr R and his son suffered frustration, distress and they lost the opportunity to access therapy and respite. The Council and Trust agreed to apologise and provide a financial remedy to remedy the injustice they suffered. The Trust also agreed to implement systemic improvements.

The complaint

1. The complainant, who I shall call Mr R, complains about the actions of Torbay Council (the Council) and Torbay and South Devon NHS Foundation Trust (the Trust).
2. Specifically, he complains that:
• the Council undertook an investigation under section 47 of the Children Act 1989, regarding his teenage sons, P and Q, which led to them being placed on child protection plans, instead of child in need plans;
• the Council failed to provide funding for the full amount of agreed therapy sessions;
• the Trust failed to provide the Council with his son Q’s full psychiatric diagnosis, which affected the decision to initiate the s47 investigation;
• the Trust failed to properly assess the risks faced by the family or provide appropriate 1:1 support for Q;
• Mr R’s personal health records were accessed as part of the s47 investigation, without his consent being sought; and
• the Council’s complaint investigation took over a year and the Trust failed to co-operate with the investigation.
3. Mr R says the failings by the Trust led to the incorrect decision to place his children on child protection plans. As a result, the family did not receive the appropriate support they would have received, had his sons been properly assessed for child in need plans. In addition, the Council’s and Trust’s failures left Mr R and P at risk from Q’s behaviour.
4. Mr R would like the Council to accept it was wrong to initiate the section 47 investigation and place his children on child protection plans. He would also like the outstanding therapy sessions to be provided. He is also seeking an apology and financial redress from both organisations.

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The Ombudsmen’s role and powers

5. 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, as amended, and Health Service Commissioners Act 1993, section 18ZA)
6. 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). Due to a number of reasons, including Mr R’s previous mental health problems, the time taken by the Council to conclude its investigation and the scale of the claimed injustice, the Ombudsman has decided to exercise their discretion and investigate this complaint.
7. 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).
8. The Ombudsmen cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. They must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3))
9. 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.
10. 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

11. I have considered information provided by Mr R, the Trust, the Council and a therapy provider. I have also spoken with Mr R on the telephone. Mr R, the Trust and the Council had an opportunity to comment on the draft decision. I considered any comments received before making a final decision.
12. 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

Key legislation and guidance

13. Councils have a duty to conduct an investigation if there is reasonable cause to suspect that a child who lives in their area is suffering, or is likely to suffer, significant harm. (Children Act 1989, section 47(1)). They must decide whether they should take any action to safeguard or promote the child’s welfare.
14. The government has issued guidance to councils managing cases where there are concerns about a child’s welfare or safety. (Working Together to Safeguard Children)

What happened

15. Mr R has two teenage sons, P and Q. The children’s biologic mother, who has a historic conviction for child abuse, left the family home when the children were very young. Mr R has since been raising the children as a single parent, supported by a close family friend.
16. In 2013, the Children and Adolescent Mental Health Service (CAMHS) received a referral in relation to Q, following an increase in aggressive behaviour. Following this, Q received around 80 sessions of Dyadic Developmental Psychotherapy (DDP) over 18 months, including a mix of 1:1 session and work with Mr R. Q attempted to harm himself twice between 2013 and 2015.
17. In mid-2016, CAMHS received an urgent referral for Q due to another increase in verbally and physically aggressive behaviour. Through CAMHS, Q saw a child psychologist in July 2016 and family therapy was offered multiple times. Mr R repeatedly declined to attend family therapy as he did not believe it was the most appropriate treatment and felt Q required further 1:1 therapy.
18. In September 2016, Q physically assaulted Mr R. As a result, a referral was made to Children’s Services. A social worker subsequently visited the family to better understand the issues involved.
19. In November 2016, following concerns that the situation had deteriorated, an Initial Child Protection Conference took place. P and Q were placed onto child protection plans. Mr R reluctantly agreed to attend family therapy.
20. Mr R, who had suffered a significant decline in his own mental health, made several unsuccessful requests over a short period for respite care for Q.
21. In January 2017, Mr R, P and Q were due to attend their first family therapy session. Mr R told the Council he would not attend family therapy without a risk assessment being completed, and for Q to receive anger management sessions before any family therapy sessions took place.
22. Following the cancellation of the planned family therapy sessions, matters quickly escalated to a Public Law Outline (PLO) meeting to consider next steps before the possibility of legal proceedings to remove the children from Mr R’s care. Mr R felt the escalation to a PLO was to ban a supportive friend from the family home, rather than due to his refusal to attend family therapy. When Mr R refused to ban his friend from the family home, the Council agreed to remove that expectation.
23. Shortly after, the allocated social worker left the Council. A succession of duty social workers and changes in allocated social workers followed.
24. By April 2017, Mr R said his mental health was improving.
25. In July 2017, a final PLO meeting took place and the Council agreed to fund between 12 and 41 therapy sessions.
26. Over the next few months, the Council said Mr R and his children participated in 12 therapy sessions. Mr R said one of his sons was excluded from those therapy sessions. The Council also said Mr R received Triple P parenting support. However, Mr R disputed that. He said he was only given a DVD to watch but never watched it.
27. On October 2017, the case was stepped down to child in need plans. Following the family’s last therapy session, the Council closed the case in January 2018.
28. Mr R complained to the Council and completed all three stages of the complaint procedure. The process took a year to complete, concluding in November 2018. The Council upheld several parts of the complaint and made some recommendations. CAMHS did not participate in the Council’s complaint investigation.

Complaints about the Council

The section 47 investigation

29. Mr R is strongly of the view that his children should have been placed onto child in need plans, rather than subject to child protection plans. He firmly believes that the Council failed to properly consider the extent of Q’s mental health problems and therefore failed to identify that what the family really needed was support and therapy for Q. He strongly disagrees with the Council’s view that family dynamics and Mr R’s own parenting skills were significant factors in the family’s difficulties. Mr R complains that, as a result, the children were wrongly placed on child protection plans.
30. Having reviewed the records, the decision to place his children on child protection plans was taken as a result of multiple factors. While the Council was clearly concerned about Q’s behaviour and the impact of that on the entire family, there were wider concerns about family dynamics too. Mr R’s mental health had significantly declined around this time and he had recently been put on medication for anxiety and depression. According to the Council’s records, there had been a sharp increase in contact from Mr R expressing that he felt unable to cope and requesting respite care and, on occasion, for the children to be accommodated. Both children, but particularly P, were having problems around attendance at school and this was impacting on Mr R’s employment. The safety plan put in place for when Q displayed aggressive behaviour, for example calling the police, was not always being followed. Further concerns involved family dynamics and parenting methods. Finally, the fact that Mr R had repeatedly declined family therapy, had not pursued the suggestion of an Autism Spectrum Disorder assessment for Q and had not attended an Understanding Your Child’s Mental Health course raised concerns that Mr R was not willing to engage with professionals.
31. Mr R feels the children were placed on child protection plans due to his refusal to engage in family therapy. He believes that if Q had received appropriate 1:1 therapy under child in need plans, then the escalation to child protection plans could have been avoided. While Mr R’s engagement with professionals was a significant factor, as explained above, there was a wide range of reasons which influenced the Council’s decision. Further, there were multiple reasons why the case was later stepped down to child in need plans, including an improvement in Mr R’s mental health, improved management of the children’s behaviour, increased school attendance, the children reporting they were feeling happier and no further reports from the police. Therefore, I am unable find that child protection proceedings would have been avoided if Q had been offered and accepted another type of therapy.
32. I appreciate that this was a very stressful time for Mr R and his family, and I acknowledge that Mr R strongly disagrees with the Council’s view about which issues needed to be addressed and how. It is clear that the Council recorded and considered Mr R’s views, although did not always agree with them. The Council has acted in line with the statutory guidance and I have not found fault in the way the Council reached its decision to place the children onto child protection plans and then to escalate to PLO.

Reliance on inaccurate evidence from the Trust

33. Mr R complains that the Council relied too heavily on inaccurate information provided by CAMHS which did not contain Q’s full diagnosis. As a result, Mr R believes this impacted on the Council’s decision to place his children on child protection plans. He believes that, had the Council been more aware of all of Q’s diagnosed mental health conditions, then the Council would have recognised that the family’s problems arose from Q not receiving adequate mental health support and would have focused on helping Q access 1:1 therapy under child in need plans rather than CAMHS’ recommendation for family therapy and Mr R’s refusal to attend.
34. As I will explore later, CAMHS has already accepted that the chronology it provided to the Council omitted some of Q’s secondary diagnoses. As such, the Council did not receive full information about Q’s mental health diagnoses from CAMHS. However, the records show that the Council had access to a range of information, including that provided by Mr R. The Council was aware that Q has complex mental health problems with a range of diagnoses. I also note that Q had seen one child psychologist and several psychiatrists who expressed a variety of views and did not always agree.
35. As explained above, the decision to proceed to child protection plans was taken after consideration of a range of concerns, including Q’s mental health problems but also several other significant concerns involving the whole family. Even if the Council had received full information from CAMHS including the secondary diagnoses, Q’s mental health was not the only factor which influenced the decision to escalate the case to child protection plans. Therefore, I have not found that child protection plans would have been avoided, even if Q’s full diagnosis was available to the Council.

Lack of updates between PLO meetings

36. The Council’s Stage 2 investigation recognised that, after the original allocated social worker left the Council in March 2017, several different social workers visited the family over a short period of time and a further two social workers were allocated before the case was closed. The Council has acknowledged that this caused a lack of continuity. Some of these visits were also outside of the statutory timescales. This is fault.
37. The Council’s Stage 2 investigation also accepted that PLO meetings should have been scheduled for every six weeks but this did not happen in line with local policy and procedure. Further, the Council’s records hold very little information about the PLO process which made it difficult to establish why the meetings were not arranged in line with the expected schedule. The Council further acknowledged that minutes of meetings had not always been recorded properly or shared with Mr R. This is also fault.
38. This inconsistency and lack of communication added extra worry and frustration at an already stressful period in Mr R’s life. However, the Council has already accepted these failings and apologised to Mr R. Further, several recommendations were made as a result of the Council's investigation to address these errors and improve the Council’s processes. Assuming the Council can demonstrate that the proposed actions were completed, I am satisfied that these has actions have resolved any systemic failings by the Council although it does not fully address the personal injustice to Mr R.

Respite care requests

39. The Council’s records show that Mr R made at least five requests for respite between November 2016 and January 2017, however none of these requests received a formal response. On one occasion, the social worker advised Mr R to wait until the Core Group Meeting the next day, where his request would be considered. However, there is nothing in the minutes to suggest that respite was discussed at this meeting.
40. The social worker’s notes generally record the view that respite would not be suitable in these circumstances as it would not address the issues of family dynamics and could make matters worse by making Q feel rejected. On one occasion, the social worker contacted Mr R’s parents to see if they would care for the children for a while, however this was unsuccessful.
41. In response to my enquiries, the Council explained that the normal process is for such requests to be presented to the Access to Resources panel, where the request can be considered by senior managers. The Council has been unable to find any evidence that Mr R’s requests were submitted to the Panel. I also note that the social worker submitted a request for additional funding for Intensive Family Support Service sessions, however the paperwork does not directly address the multiple respite requests.
42. While I note that Mr R was requesting a specialised psychiatric respite placement, which is not commonly available, the fact remains that his requests should have been formally considered and responded to. The Council did not follow its local processes, and this is fault. Even if the requested respite was not available, Mr R should have been properly advised of this.
43. The Council’s complaint responses accepted the mishandling of the respite requests and also proposed to make enquiries with the local health services to explore possibilities of specialised jointly funded respite placements for these types of circumstances. Again, providing the Council can demonstrate that this work has been satisfactorily completed, no further systemic actions are required. However, there is an outstanding injustice regarding the distress caused for Mr R and P.

Delays in complaint handling

44. There were clear delays at all three stages of the Council’s complaint handling, which the Council has already accepted and apologised for. In total, the whole process took a year to conclude. The Council has not always been able to identify why there was delay, however it has identified a variety of factors including the complexity of the case, annual leave of staff, inexperience of some staff and scheduling conflicts.
45. While I appreciate that some factors, such as the complexity of the case, will have impacted on the time taken to consider the complaint, these delays are fault. It would undoubtedly have been frustrating for Mr R. While the Council has offered appropriate apologies, it does not fully address the frustration and inconvenience encountered by Mr R.

Incorrect information about a staff member’s employment status

46. Mr R was advised that a particular staff member could not be interviewed as part of the complaint investigation as he had left the Council. However, Mr R later found out that the staff member was still employed. Mr R feels the Council has been dishonest with him.
47. The Council has explained that the person in question was not employed with the Council for a period of around 6 months, overlapping with the Stage 2 investigation. As a result, he was unable to be interviewed during this part of the process. The staff member then briefly returned to work at the Council, however he is no longer employed there. I appreciate that this caused confusion for Mr R however I have found no evidence that the Council gave Mr R inaccurate information.

Accessed medical records without consent

48. Mr R is unhappy that the Council had access to his personal medical information as part of the s47 enquiries without obtaining his consent.
49. The Council has explained that Mr R’s GP provided the information at a case conference. To fulfil its statutory duties, the Council routinely requests all professionals involved with families to provide information. Information about Mr R’s medical history, particularly his mental health at the time, was shared by the GP. The Council explains that it did not access Mr R’s medical records directly and the GP is the data controller and therefore it is up to the GP’s discretion what to share. The information obtained was relevant to the Council’s s47 enquiries and I have found no fault in the way it was obtained. I note that Mr R has already raised this complaint with the Information Commissioner’s Office who did not take further action. I have not found any fault in the way the Council obtained Mr R’s medical information.

Therapy sessions agreed at PLO

50. At the final PLO meeting, it was agreed that a therapy provider (the Provider) would ‘assess the family and then put in place whatever therapy they think is necessary. They have offered a minimum of 12 sessions but up to 41 sessions if these are necessary. The [Council] will fund these’.
51. Mr R, and later P and Q, attended a total of 12 therapy sessions. Mr R wished for the sessions to continue, however the Provider told him that the Council had not approved any further funding. Mr R is deeply disappointed that Q did not receive the full 41 sessions, which he feels were promised.
52. I have asked the Council about why the sessions stopped. Unfortunately, the Council has no records about what type of therapy was agreed, how it was funded, how many sessions were agreed or why it was stopped. This significant gap in the records is fault.
53. Following enquiries with the Provider, I have established that the Council asked it to provide the options available and the cost per session. The Provider initially provided costs for family therapy at £100 per session and DDP Informed therapy at £120 per session. The Council asked the Provider to proceed with 12 weeks of family therapy intervention and agreed to fund these. Mr R says he did not specifically request family therapy.
54. Towards the end of the 12 sessions, the Provider contacted the Council to ask if any further funding was likely to be available for the family. When asked by the Council for further costs information, the Provider put forward a variety of options including creative therapy at £100 per session, therapeutic parenting by a clinical psychologist at £110 per hour (requiring between 16 – 24 sessions), DDP Informed therapy at £135 per session and Video Interaction Guidance (VIG) at £120 per session. The Provider also had a Playfulness, Acceptance, Curiosity and Empathy (PACE) therapeutic parenting course available at the time which Mr R could have attended. The Provider did not receive a reply from the Council and therefore did not complete any further sessions as no additional funding had been approved.
55. Mr R has provided copies of text messages from the therapist his family worked with at the Provider. The therapist indicates that she had recommended further DDP Informed therapy sessions as Q was just beginning to engage, however these did not happen as they were not funded.
56. It is clear that the Provider felt further therapy for the family was required and had further funding been approved by the Council, additional sessions would have gone ahead.
57. Given that the Council has been unable to provide any evidence about the way the funding decision was reached, I have seen nothing to confirm whether this decision was made properly. When Mr R’s solicitor raised her concerns with the Council, the Council’s senior lawyer replied that “it is correct that the s17 funding has ended as the sessions have been completed and due to the positive changes within the family home, Q’s attendance at school and his general presentation, the case was in fact closed in mid-January”.
58. Mr R’s solicitor first raised concerns about funding for further sessions in December 2016 and chased it twice before finally receiving a response in February 2017. This delay of almost six weeks is fault and the uncertainty would have caused Mr R considerable worry. Further, the senior lawyer’s response fails to take into account that a request for further funding had been raised by the Provider in November 2016 and did not proceed because the Council did not respond. It is not reasonable to say, retrospectively, that ending funding was correct as the case had now closed. The funding should have been properly considered at the time, while the case was still open to Children’s Services.
59. I further note that this position appears contrary to the PLO agreement which indicates that it was for the Provider to decide what therapy and how many sessions were necessary and that the Council had agreed to fund them. The PLO agreement is clear that 12 was the minimum suggested by the Provider and there was plainly scope for further sessions which the Council agreed to fund at the time. The Provider felt further sessions were necessary and was willing to provide them, had it received further funding from the Council.
60. The Council has not provided records of how it made a decision at the time. However, evidence from Mr R and the Provider indicates that the request for further funding was not properly considered while the case was still open and any subsequent funding decisions made were not properly communicated to Mr R or the Provider.
61. The Council held a strong view throughout the proceedings regarding the importance of participating in therapy. It has provided no cogent reason for stopping funding abruptly, just as the whole family was starting to engage, when there was evidence it was improving the family’s circumstances and when the Provider had recommended further sessions as allowed under the PLO agreement.
62. The Council has not demonstrated that this decision was properly taken and the evidence available indicates, on balance, that it was not. As a result, the whole family, but particularly Q who was only just starting to engage and progress with therapy, have potentially missed out on additional therapy sessions to which they were entitled under the PLO agreement. While it cannot be known how much further therapy may have helped, the loss of additional sessions potentially had a significant impact on the whole family as they lost this opportunity at a pivotal time.

Complaints about the Trust

Provided inaccurate information to the Council

63. As explained above, Mr R considers that incomplete information provided by CAMHS about Q’s mental health diagnoses influenced the Council’s decisions to commence the section 47 investigation.
64. The Trust’s complaint response acknowledged that, while Q’s primary diagnosis of Post Traumatic Stress Disorder from his early years was included, some secondary diagnoses such as reactive attachment disorder were omitted from the CAMHS’ report, although some tertiary diagnoses were included. The Council has spoken to the author of the report but has not been able to establish why this information was missed out. Further enquiries during this investigation have also not found any new information.
65. The failure to include all Q’s diagnoses in the CAMHS report is fault, and the Trust has already acknowledged this. While the Trust has explained that different psychiatrists had reached differing views on Q’s diagnoses, these all should have been included in the information provided to the Council. I note that the Trust has apologised for the omission and any distress it caused and I am satisfied this is a reasonable response to this complaint.
66. The Trust has explained that CAMHS does not have a standard pro-forma for chronologies to be used at strategy meetings and therefore professionals have no guidance as to what should be included. This is an area where the Trust could improve their processes to ensure consistency.
67. While it was frustrating for Mr R that the information from CAMHS was not complete, I have not found that it led to the injustice he has claimed. I have not found that, had these secondary diagnoses been included in the CAMHS report, the case would not have escalated to child protection plans. As noted above, the Council had a wide number of concerns which led to the case being escalated, with Q’s mental health being just one. I also agree with the Trust’s position that Mr R was able to provide copies of the 2013 psychiatric reports and raise his concerns with all professionals at the meetings.

Failure to provide appropriate therapy for Q

68. Mr R complains that he was repeatedly offered family therapy, which was not an appropriate therapy. He further complains that, despite his multiple refusals, no alternatives were offered. Mr R believes the family’s difficulties were not due to family dynamics but instead arose directly from Q not receiving the mental health support he required. Mr R firmly feels that Q needed further 1:1 DDP therapy sessions which had worked well for him in 2013/2014. Mr R also explains that he declined family therapy as he did not feel it was safe and CAMHS refused to complete a risk assessment or provide Q with anger management sessions first.
69. It is clear from the records that both CAMHS and the Council felt that there were wider issues arising from the family dynamics, not just Q’s mental health, and therefore family therapy was the appropriate treatment.
70. I have sought clinical advice from an experienced consultant and adolescent psychiatrist working in a specialist Tier 3 CAMHS team. Tier 3 is the highest level for outpatients, providing specialised CAMHS intervention. The clinical advisor provided his view that, in the circumstances, family therapy was a reasonable and appropriate therapy to consider for Mr R’s family. I agree that it was initially appropriate to offer family therapy. All the information I have reviewed, submitted by the Council, CAMHS and Mr R, demonstrates that there were complex family dynamics between all three family members and it is reasonable to suggest that therapy for the entire family could help improve this. As such, I have found no fault with CAMHS’ initial recommendation for family therapy. Additionally 1:1 therapy, as Mr R was seeking, is not typically or usually available to CAMHS outpatients, or even inpatients. While Q had received a substantial number of 1:1 sessions several years before, it appears that this was no longer the usual treatment route.
71. Where family therapy was not acceptable to a family, there were other therapies which could have then been offered. These include trauma focused Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).
72. The National Institute for Health and Care Excellence (NICE) published guideline [NG116] Post-traumatic stress disorder, published December 2018 also states “Treatment for children and young people – 1.6.11 Offer an individual trauma-focused CBT intervention to children and young people aged 7 to 17 years with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a traumatic event. 1.6.13 Consider Eye Movement Desensitisation and Reprocessing (EMDR)…. Only if they do not respond to or engage with trauma-focused CBT.’
73. The NICE guidelines for ‘[NG26] Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk or going into care - 1.4 Interventions for attachment difficulties in children and young people on the edge of care.’ Paragraph 1.4.12 suggests offering trauma focused CBT and other interventions in line with the PTSD guidance for children showing signs of PTSD, along with considering parental sensitivity and behaviour training to improve attachment difficulties.
74. There were other therapy options which could have been offered. While the clinical advisor explains that 1:1 sessions are not commonly offered, the NICE guidelines show that there is scope for individual treatment. I have not seen any evidence to suggest that any other therapy sessions, beside family therapy, were considered or offered for Q. While it was initially appropriate in the circumstance to offer family therapy, once it became clear that Mr R was strongly opposed to participating and showed no indication of changing his mind, the Trust should have considered other options. Given that the family was highly unlikely to engage in family therapy and as a result the family was receiving no therapy at all, the Trust should have been proactive in promptly identifying and offering alternative treatments. By not doing so, Mr R and his family missed the opportunity to consider whether these other types of therapy were more acceptable. I note that some additional options, such as an Autism Spectrum Disorder assessment for Q and attendance on an Understand Your Child’s Mental Health course were offered to, and declined by Mr R.
75. Mr R is concerned that Q has not received any further therapy since the 12 Council funded sessions in 2017. Mr R has been advised by the Council to contact CAMHS to discuss what treatment options may be available, however he says he has lost all confidence in CAMHS and feels unable to engage with them at this time.
76. Regarding Mr R’s request for a risk assessment, there is a general need to carry out an assessment of risk but there is no specific need or recommendation to carry out a risk assessment for family therapy. Further, risk assessments can be carried out in different ways using a clinician’s professional judgement, such as using specific tools or clinically assessed as part of sessions.
77. The Trust has no record of Mr R requesting a risk assessment when accepting or declining family therapy. The Council’s minutes of a core group meeting in January 2017, shortly after Mr R had declined to attend the first scheduled family therapy session, records discussions of this matter. The minutes note that Mr R raised concerns about risk and was assured that anger management came under the wide umbrella of family therapy and emotional regulation would be addressed as part of the session. It also says Mr R was advised that sessions would take a slow pace, would likely start with some individual work and risk would be assessed as part of the sessions.
78. As there is no requirement to complete a formal risk assessment prior to the start of family therapy sessions, I have found no fault.

Refusal to engage with Council’s complaint investigation

79. The Council’s Stage 2 complaint response stated that the CAMHS staff contacted as part of their investigation declined to be interviewed. When asked, the Trust said it had no record of its staff being asked to participate.
80. The Council has provided copies of internal emails which indicate that two members of CAMHS staff were directly approached and invited to be interviewed by the Council's Investigating Officer. The Council’s papers record that the staff declined this offer as they were not Council staff.
81. The Council’s Stage 2 and 3 responses expressed its disappointment that the CAMHS staff did not agree to contribute to its investigation.
82. The statutory guidance for local authorities ‘Getting the Best from Complaints’ states as paragraph 7.5 ‘Sometimes a complaint crosses over boundaries between a local authority and the NHS. When this happens, [complainants] should not have to worry about who they should approach with complaints about different aspects of the service they receive. Instead, the complaint can be made in its entirety to any one of the bodies involved.’ The guidance lays out that both organisations should work together to address the complaints as fully as possible and to provide responses at the same time. CAMHS refusal to engage with the Council’s investigation was unhelpful and contrary to statutory guidance. This complicated the complaint process unnecessarily, caused frustration for Mr R and meant some of his complaints were not fully considered. There is an outstanding injustice on this point.
83. The Council’s complaint responses identified that work needed to be conducted with CAMHS both in relation to generally working more closely together and also in relation to complaint handling. The Council’s Stage 3 response refers to recent improvements such as the new Therapeutic and Wellbeing Service designed to improve relationships between CAMHS and the Council and further work to explore the possibility of joint investigations. Providing the Council and the Trust can provide evidence of these changes, I am satisfied that these are appropriate responses to the process faults and no further systemic improvements are required.

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Agreed actions

84. The Council has accepted fault regarding respite, sharing minutes and working closely with CAMHS. The Council complaint responses show it was undertaking work exploring respite options, new processes for sharing minutes and reports and how to improve relationships with CAMHS both generally and through complaint handling. My current view is that these are suitable ways to improve services, providing the Council and the Trust can show they have taken these actions, or commit to completing them within three months of this decision.
85. While the Council has proposed several actions to address the systemic issues, outstanding personal injustice remains for Mr R and his family. Cumulatively, multiple areas of fault by both the Council and the Trust added frustration and inconvenience during an already difficult period for the family. While some apologies have been offered, I do not consider these fully remedy the family’s injustice. Further, there were significant losses of opportunity in relation to therapy session options.
86. Within one month of this decision, the Council should:
• Review its decision in relation to funding the therapy sessions agreed at the PLO. If it finds it should have provided further funding, it should discuss with the Provider what therapy and how many sessions are appropriate now and provide that funding.
• Pay Mr R £250 for frustration and distress.
• Pay Mr R £500 for the lost opportunity to attend further therapy sessions with the Provider, and the lost opportunity in relation to his respite requests.
• Apologise and pay Mr R £500 for P and £500 for Q in recognition of the lost opportunity to attend further therapy sessions with the Provider, and the lost opportunity for respite. Mr R then can identify with P and Q how this money can be used for their benefit.
87. Within one month of this decision, the Trust should:
• Apologise to Mr R and his sons for failing to explore alternative therapy options.
• Apologise to Mr R for not participating in the Council’s complaint investigation.
• Pay Mr R £250 for frustration and distress.
• Pay Mr R £250, £250 for P and £250 for Q in recognition of the lost opportunity to explore alternative therapy options. That caused the family uncertainty at not knowing if alternative support would have helped them. Mr R then can identify with P and Q how this money can be used for their benefit.
88. As responsibility for CAMHS has passed to a different trust, I cannot make recommendations to change any processes or procedures within the Trust. However, within one month of this decision, the Trust should share the key learning points with the new trust, in that:
• A standard pro-forma and guidance for staff submitting information for child protection proceedings would improve consistency.
• Staff have a responsibility to ensure they comply with national statutory guidance in relation to complaint handling.
89. The Council and the Trust have accepted my recommendations above. They should write to Ombudsmen and Mr R to provide evidence they have completed the recommendations.

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Final decision

90. I have completed my investigation and uphold Mr R’s complaint. There was fault by both the Council and Trust which caused an injustice to Mr R and his sons. I am satisfied the Council and Trust will take sufficient action to remedy their injustice.

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Investigator's decision on behalf of the Ombudsman