Decision Date: 1st July 2020
Mrs G complained on behalf of her daughter, Miss H.
Miss H was a young woman who had both physical and mental health problems (including schizoaffective disorder and multiple sclerosis).
Miss H had been receiving support from the Community Mental Health Team since April 2016, and lived at home with Mrs G.
In January 2017 her care coordinator contacted the Council to request a Care Act assessment. The social worker on duty stated that the NHS Trust would have to carry out the assessment.
In March, after hearing nothing, Mrs G approached the Council directly to request an assessment. She told the Council that Miss H was due to move into her own property and was pregnant. At this point the Council acknowledged Miss H needed an assessment.
However, neither the NHS Trust nor Council ended up completing an assessment at that stage. The report simply stated the reason was “the duty social worker referred the case to a community support worker on 18 April 2017. It appears the support worker was not working for the Council at that time. As a result, the assessment did not take place.”
In October 2017, shortly after the birth of Miss H’s child, her care coordinator completed an updated risk assessment and care plan. He felt Miss H’s needs arising from her MS diagnosis could be met through “[p]lenty of rest, relaxation and Physio recommended exercises.” The care plan also set out that Miss H would contact her GP if she experienced further health problems.
In May 2018, Mrs G contacted the Council again to request a Care Act assessment. Mrs G reported that she had been providing daily child care for Miss H but would be unable to continue doing so.
This led to a joint visit by the Council and NHS Trust, which resulted in the Council advising the NHS Trust to complete the assessment. The Council manager noted Miss H had complex mental and physical health needs, and stated that “[the Trust] are best placed to do this [as] they have the expertise in relation to [mental health] and there is already a worker in place, to add another worker to try and separate her physical need from her [mental health] need would be impractical and cause confusion for the family.”
The NHS Trust completed the assessment at the end of July 2018 (18 months after the original request) and produced a care plan for Miss H. This included 5.5 hours of care visits per week, with extra support provided by her family.
The care package did not start until January 2019. The NHS Trust did not apply for funding for the package until October 2018 (no reason provided in the report). However the initial application contained insufficient information, so had to be resubmitted in December 2018.
A financial assessment was not completed until April 2019, which concluded that Miss H needed to contribute to her care (the report did not elaborate how much). After finding this out, Mrs G asked the Council to suspend the care package, as Miss H could not afford to pay the assessed contribution.
What was found
Delay in assessment
Mrs G first requested an assessment in January 2017, which was not completed until July 2018. This was over 18 months later, and LGO found no satisfactory reason for the significant delay was ever provided.
There was no evidence to suggest the NHS Trust carried out an assessment when requested by the Council in January 2017. Similarly, the Council failed to take action when Mrs G approached it directly in March 2017, even though evidence showed Miss H’s circumstances had materially changed. There was no evidence to show any action was taken by the Council or NHS Trust after March 2017.
The LGO highlighted that the visit of June 2018 represented an opportunity to complete a joint assessment. Records suggested a joint assessment was indicated given Miss H’s complex needs and how long the process had already been ongoing. However, following the visit, the Council simply referred the case back to the NHS Trust again to complete an assessment. This led a to a further delay of over two months.
Statutory guidance emphasises the importance of effective partnership working between local authorities and local NHS services. The Council and NHS Trust failed to work together effectively to complete a Care Act assessment for Miss H within an appropriate and reasonable timescale.
There was then a further delay of almost six months before a care package was put in place. Miss H, a vulnerable adult, was left without proper care and support for two years which caused her significant distress. This was the fault of the Council, which has ultimate statutory responsibility for the assessment process under the Care Act 2014.
Upon reviewing correspondence between the Council, the NHS Trust and Mrs G, there was also significant confusion around charging, identified.
There was no evidence that the Council or NHS Trust sufficiently explained the charging process either when they visited, or when providing written information. Mrs G only became aware that Miss H had to contribute to her care a month after the care had been implemented. Thus the Council was at fault by failing to make relevant information available to Mrs G and Miss H as required by statutory guidance.
Delay in financial assessment
There was no explanation for the delay in carrying out a financial assessment other than “confusion between the Council and NHS Trust as to who would need to complete the referral”. This was fault. It meant an opportunity was missed to provide clarification at a much earlier stage, which caused avoidable confusion for Mrs G and Miss H adding to their distress, where the council was found at fault.
The LGO recommended that the Council:
- Apologise to Mrs G and Miss H
- Waive Miss H’s outstanding care fees in their entirety.
- Pay Miss H £250 in recognition of the distress she experienced as a result of the failings in her care.
- Pay Mrs G £500 in recognition of the distress she experienced
- The Council should review its service delivery model to ensure organisations providing services on its behalf provide care and support that is in keeping with the requirements of the Care Act 2014 and the supporting statutory guidance. This review would:
- Ensure there is a robust procedure in place for carrying out Care Act assessments, particularly for service users with complex health and social care needs.
- Ensure there is a clear process in place: for sharing relevant care charging information with service users and their carers and families; and for requesting and arranging timely financial assessments for service users with eligible needs.
- Ensure there is a robust escalation process in place to consider cases where there is disagreement between the organisations involved as to which agency should provide services. This should allow for prompt resolution of disputes. This process should also identify whether an organisation providing services on the Council’s behalf requires additional support.
- Ensure staff providing services on the Council’s behalf are appropriately trained in the requirements of the Care Act 2014 and the accompanying statutory guidance.
Points to note for councils, NHS and other professionals, people who use services and their carers, advocacy providers, members of the public
This complaint highlights the ways in which joint working can go appallingly wrong. This woman had to wait two years for the care and support she was eventually assessed as needing and then on receiving the care and support, had not been given information about charging so was effectively left to decide that she could not afford her contribution.
Firstly, there appeared to be confusion around who was responsible for what with regard to the Care Act assessment. The Care Act 2014 is clear for councils – councils have responsibility for assessing and meeting eligible needs. Councils can delegate their responsibilities to outsiders as long as competent, but ultimately remain liable as the LGO found here. It was right for the LGO to find the council responsible for the failings in assessment and provision of her care and support.
Health and social care professionals simply have no option but to understand their respective legal responsibilities to ensure that people do not fall through the net or fail to have their needs met as occurred in this complaint. The NHS and councils are expected to work together and in doing so should have robust arrangements to ensure that statutory responsibilities are fulfilled.
This also includes clarity about charging and financial assessment. Councils must ensure that they make information about this available and in this complaint the LGO inevitably found the Council at fault given the Care and Support statutory guidance sets out principles for charging and says this at paragraph 8.3:
‘local authorities should ensure there is sufficient information and advice available in a suitable format for the person’s needs, in line with the Equality Act 2010 (in particular for those with a sensory impairment, with learning disabilities or for whom English is not their first language), to ensure that they or their representative are able to understand any contributions they are asked to make. Local authorities should also make the person or their representative aware of the availability of independent financial information and advice’.
Despite the incredibly long wait for the care and support she was assessed as needing, Miss H felt that she could not afford to make the contributions and therefore went without the care. But the law is that the services should be provided anyway; the right to them is not dependent on agreeing to pay for them, nor even on actually paying for them!
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The full Local Government Ombudsman report of Essex County Council’s actions can be found here https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/19-005-954