Summary: The Ombudsmen will not investigate Mr P and Ms Q’s complaint. The Ombudsmen are unlikely to be able to add to previous investigations by Salford Royal NHS Foundation Trust. Also, we are unlikely to find fault with the Council’s actions.

The complaint

1. Mr P and Ms Q complain about the actions of Salford City Council (the Council) and Salford Royal NHS Foundation Trust (the Trust) after the Trust referred their son to social services with unexplained bruising on 22 February 2018.
2. Mr and Ms Q say:
• The Trust should have referred their son on 16 February, and it did not carry out the correct tests.
• The social worker did not take the lead during the safeguarding process or follow the relevant local policy.
• A paediatrician (Dr A) at the Trust did not listen to Mr P’s explanation for the bruising. Dr A also covered for the actions of another paediatrician (Dr B) who assessed their son the week before.
• The Council changed Mr P’s statement, removed their admission of errors and retracted its apologies in its second response to him.
3. Mr P and Ms Q say events caused them significant stress and anxiety. Mr P also says he had to turn down an interview for an overseas job as Ms Q cannot move away from her family.
4. Mr P and Ms Q would like an apology from the Trust, service improvements and a financial remedy from both.

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The Ombudsmen’s role and powers

5. 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’. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault, or could add to any previous investigation by the bodies.

(Local Government Act 1974, section 24(A)(6) as amended, and Health Service Commissioners Act 1993, section 3(2))

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How I considered this complaint

6. I considered information Mr P and Ms Q provided in writing and by telephone. This includes documents by the organisations complained about. I have also written to Mr P and Ms Q with my draft decision and asked them to provide any comments.

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What I found

Relevant law and guidance

Section 47 enquiries

7. 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.
8. Councils have a duty to conduct an investigation if they have 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))
9. 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 an initial assessment and a ‘core’ assessment (a more in-depth assessment). Assessments are intended, for example, to analyse a child’s needs and the risk of harm to the child.

Greater Manchester Safeguarding’s ‘Bruising Protocol for Immobile Babies and Children’

10. The policy states:
• “Unexplained bruising (or bruising without an acceptable explanation) in a child not independently mobile must always raise suspicion of maltreatment and should result in an immediate Referral to Children’s Social Care Services and an urgent paediatric opinion.”
• “If a referral is not made, the reason must be documented in detail with the names of the professionals taking this decision. All telephone referrals must be followed up in writing within 48 hours. Children's Social Care will co-ordinate multi-professional information sharing and assessment.”
• “A bruise/injury must always be assessed in the context of medical and social history, developmental stage and explanation given. Assessments will be led by Children's Social Care and a lead medical professional (local acute or community Paediatrician) to determine whether bruising is consistent with the explanation provided or is indicative of non-accidental injury.”

Key facts

11. On 15 February 2018 Dr B carried out a physical assessment of Mr P and Ms Q’s son, H.
12. The next day Mr P noted bruising on H’s feet, so took him back to the Trust. A paediatrician (Dr C) told Mr P they would refer his son to social services, in line with the bruising protocol for immobile babies. Dr B told Dr C there was no bruising during their assessment. Dr C later said a blood test showed prolonged clotting was the cause of the bruising. Therefore, Dr C did not refer H to social services.
13. On 21 February, the Trust held a meeting after a safeguarding peer review. Dr B said Dr C should have referred H to social services on 16 February and did not carry out a specific blood test to explain the bruising.
14. The next day, Dr B referred H to social services. A social worker asked Mr P and Ms Q to attend the Trust, so Dr A could complete a child protection medical. Dr A also needed to carry out a specific blood test to explain the bruising. The blood test result would not be ready until the next day. Mr P told Dr A the bruising was most likely caused by Dr B on 16 February. Dr A disagreed Dr B caused the bruising because the marks did not appear until later. The Council started interim safeguarding procedures that evening, so H stayed with Ms Q at the Trust overnight.
15. Early on 23 February, Dr A said H had a raised blood clotting level, which explained the bruising. All agencies agreed H could return home with Mr P and Ms Q. No further procedures or action was necessary. Dr A apologised the correct blood tests and safeguarding procedures did not happen on 16 February.

The lack of safeguarding referral on 16 February 2018

16. The Trust has accepted it should have made the safeguarding referral on 16 February 2018, which would have been in line with the local safeguarding policy. The Trust apologised for the distress this caused and developed a robust action plan to avoid similar fault happening again. The Ombudsmen must consider what material difference we can achieve by using public money to investigate. It is unlikely further investigation would achieve more for Mr P and Ms Q.

The social worker did not take the lead

17. Mr P says Dr A railroaded the social worker during the safeguarding investigation. I do not agree. The local safeguarding policy said assessments must be led by children’s social care and a lead medical professional. There was communication between Dr A and the social worker up until the blood test result explained the bruising on 23 February. I am unlikely to find fault with the Council’s and Trust’s cooperation at that time.

Dr A did not listen to Mr P’s views

18. I consider Dr A included Mr P during the decision-making process, which was in line with the local safeguarding policy. The Trust’s medical records show Dr A considered Mr P’s explanations for the bruising. Dr A provided a medical explanation why he disagreed with Mr P, and felt the bruising was still unexplained. I am unlikely to find fault with the Trust. Also, I do not consider Dr A was covering up for Dr B. It was just a difference of his professional opinion.

The Council’s complaint responses

19. I have compared the Council’s first and second responses to Mr P. The Council copied text from the first response into the second. At times the Council changed its wording in second response. For example, it removed “I sincerely apologise” and replaced it with “I regret”. I do not know why the Council did this. However, I am unlikely to find fault with this. The changes Mr P identified do not detract from the substance of the second response.

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Final decision

20. I consider the Ombudsmen should not investigate this complaint. I do not consider further investigation of these issues by the Ombudsmen would achieve more for Mr P and Ms Q.

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Investigator's decision on behalf of the Ombudsman