Bournemouth, Christchurch and Poole Council at fault for failing to cover or have suitable arrangements to cover unexpected leave.

DECISION DATE: 18th October 2022

WHAT HAPPENED

Mrs X, complained on behalf of her mother Mrs M, who had dementia and lacked capacity, that the Council had:

  1. communicated poorly when advised Mrs M was running out of funds to pay for her care
  2. failed to advise residential care homes had been found for Mrs M or to arrange assessments at them
  3. failed to communicate while Mrs M was in hospital

Mrs X said delays in arranging a residential care home placement led to:

  • Mrs M going missing
  • The family paying care fees for longer than otherwise necessary
  • anxiety and stress

Daily carers met Mrs M’s care and support needs while living at home. The cost of the care package was shared between the Council via DPs and Mrs M via a top-up payment.

In August 2021 Mrs M’s Social Care Practitioner was advised by her son – Mr S – that Mrs M had insufficient funds to continue paying her top-up fee.

After a few days the Social Care Practitioner advised Mr S that:

  • Mrs M’s needs could have been met in residential care (but this was not what Mrs M or the family had wanted, preferring care at home).
  • Enabling Mrs M to remain at home may entail the family paying the top-up or choosing a cheaper care provider.
  • The family could consider residential care.
  • The family could communicate their preferred option once decided
  • She (the officer) would be on leave for a week

In September Mr S reiterated that Mrs M had insufficient funds to maintain payment of her top-up fee. The Social Care Practitioner’s reply:

  • Apologised if her previous message was unclear
  • Repeated the previous options
  • Stated the family should inform her if they did not favour any of those options so that she could arrange a care package review

Soon afterwards, Mrs X emailed the Social Care Practitioner stating the family were not able to pay the fees and were considering residential care.

Over the following two days the Social Care Practitioner:

  • Left voicemails and emailed Mr S
  • Said she would discuss Mrs M’s case with her manager, then get back to them

In an email sent a few days later the Social Care Practitioner said:

  • The family had previously, refused residential care
  • If the care package was not sustainable a reassessment was needed to establish where Mrs M’s needs could be met and if in a residential placement she would work with the family to identify the most suitable placement
  • The family should let her know how they wanted to proceed and if they wanted her to, she would arrange a reassessment

The following day Mrs X advised the Social Care Practitioner that residential care was the only option and requested a reassessment. It was now mid-September.

Mrs X was present when the reassessment took place in early October reaching the decision that residential care was best to meet Mrs M’s needs. The Social Care Practitioner said:

  • The Council would identify suitable residential homes
  • She would provide this information to the family so they could consider the options

In mid-October the Social Care Practitioner unexpectedly went on leave. After a few days the Council identified four suitable care homes. The cheapest two said they could assess Mrs M and a note placed on the system asked the Social Care Practitioner to contact them to arrange assessments.

Mr S twice emailed the Social Care Practitioner a week later without reply.

At the end of October having been found wandering the streets by a member of the public, Mrs M was admitted to hospital, her case was transferred to their social work team and Mrs X updated the Social Care Practitioner by email

On the same day, having spoken to the Council, the care provider told the family:

  • The Social Care Practitioner was on leave
  • The Council had found two care homes but had not informed the family of this

Two days later – a Friday – Mrs X asked for call backs in two voicemails for the Social Care Practitioner’s manager and twice called the ASC team without answer.

In two further voicemails on Monday Mrs X again asked for call backs from the Social Care Practitioner’s manager who picked up the messages before asking the hospital social work team to return the calls as the Social Care Practitioner was still off work.

The same day the hospital social work team left a voicemail for Mrs X stating they were now the point of contact for updates about Mrs M and the hospital social worker confirmed to the family that a residential placement had been found.

In mid-November Mrs M was discharged from hospital into a care home and then Mrs X complained to The Council.

The Council’s complaint response noted:

  • The unfortunate fact of the Social Care Practitioner going on unexpected leave soon after asking the Council to identify care homes for Mrs M
  • That on her return to work the Social Care Practitioner had not communicated with the family as Mrs M’s case had been transferred to the hospital social work team
  • The confusion caused by failing to notify the family that the Social Care Practitioner was not Mrs M’s worker any longer and apologised for this.

The Council stated:

  • They did not cover the Social Care Practitioner’s absence until after Mrs M’s hospital admission and transfer to the hospital social work team
  • It was unable to arrange cover any earlier and apologised for this.

Then Mrs X complained to the Ombudsman.

WHAT WAS FOUND

The LGO stated the Council was not at fault in terms of

a. communicating poorly. After Mrs X advised Mrs M was running out of funds to pay for her care the council within five working days had offered alternate options for Mrs M’s future care, and then repeated those choices without delay. Also that when the family made a decision, the Council promptly arranged a reassessment.

The Council was at fault regarding

b. the failure to notify the family that residential placements had been identified for Mrs M or to arrange assessments at two of them. This was because although the Social Care Practitioner responsible for doing both of these things was unexpectedly off work when the placements were found, the Council did not have a process in place to cover unexpected staff absence and ensure no gaps or delays in meeting care and support needs. This caused Mrs X and the family injustice in the creation of uncertainty.

The Council noted the unexpected nature of the Social Care Practitioner’s leave was not easily accommodated by existing procedures for the handover of work to colleagues as happens with planned leave but that it recognised the need to introduce an appropriate arrangement which the ASC director has requested be created.

Regarding Mrs M going missing during the week in which the Council had found but not arranged provider assessments at new placements – the LGO found this delay had not resulted in Mrs M going missing as it was likely to have taken longer than a week to arrange assessments and transfer Mrs M to a new placement – and that Mrs M may have gone missing in that week even if provider assessments had been arranged.

Regarding the family having to pay care fees due to delays in arranging a placement: the LGO did not uphold the complaint here. The family contributed to the length of time it took, not telling the Social Care Practitioner their choice until mid-September, at which point the Council acted without delay to arrange the placement.

Regarding c. a failure to communicate while Mrs M was in hospital; the LGO noted that although by that time the hospital team was best placed to interact with the family about Mrs M, the Council should have responded to requests for call-backs. The Council knew the family were enduring a traumatic event and could have reassured and explained the transfer to the hospital team but instead their lack of response added to the family’s distress. The failure to return calls was not sufficient to constitute fault but the LGO noted the Council may wish to reflect on the findings and decide to return calls going forwards and that the Council’s plan to cover unexpected future absences should address this.

The LGO recommended and the Council agreed to pay Mrs X £200 in recognition of the uncertainty caused by the failure to cover unexpected absence of the Social Work Practitioner. The Council also agreed to share its new arrangements regarding the cover of such absences with the LGO within three months. The LGO requested to see evidence of these actions being completed.

Points for the public, service users, family members, officers, complaints staff, advocates and social workers

Under s6(6) of the Local Authority Social Services Act 1970 https://www.legislation.gov.uk/ukpga/1970/42/section/6 there is a provision still in force today that requires any council appointing a Director of Adult Services to secure adequate staffing for the discharge of the social services duties the Director is responsible for.

That means that of all the departments that should not be allowed to grind to a halt, it is social services that must be kept going the longest. That is why a duty is a duty and there is a notion at least in theory of a social services safety net for all. The disarray that is going on in this country right now is not an excuse for the breach of the duties to assess, review, revise and deliver on eligible people’s care plans.

No mention is made of this duty in this case and perhaps this was because it was only a case of unexpected leave. The point is a serious one though: what does happen when people are off work? How do email accounts get transferred to someone else, other than through an out of office message?

It seems to us that the LGSCO thinks that PLANNED leave is always covered by good human resources planning in social work teams, and yet we all know that that isn’t what the public experiences, at all.

It is also interesting to us the social worker in this case seems to have known and expressed that the person needed to be reassessed to see WHERE her needs could be met. That might have been ONLY at home, but the vast majority of people CAN appropriately be regarded as therapeutically adequately cared for in a care home setting, and in that case the council can offer the less expensive way of meeting the needs.

That said, the one option that the council should have considered when told that the client was no longer willing to co-fund her package at home as a top-up – was a reassessment straight away. It was just possible that this person needed to be fully funded at home – in terms of her needs, the promotion of her wellbeing and her human rights – and that option – the council funding the whole package even including what had been called a top-up – was not on the list of options, and that the LGSCO report says nothing about that. 

If that was the way it was put, with no possibility of staying at home at the council’s expense, then that would suggest that the council had an arbitrary limit to the cost it would underwrite, in a person’s own home, which is what paragraph 10.27 of the Guidance warns councils against.

We’re also interested in this case about the implications of this seemingly uncontroversial arrangement whereby Mrs M was paying for her own top up.

We have here a person with a direct payment choosing to pay what is called a ‘top up’ as well as the part of the budget that will have been her assessed charge. She wasn’t paying the ‘full cost’ of the package, as would be the case for an above threshold person, as far as we know. So she was a person with UNDER the capital threshold for getting a subsidy through charging in which case any of her capital between £14250 and £23250 would have been counted as tariff income already.

Anyone who tops up their own care, in this context, rather than challenge the adequacy of the budget that’s been allocated, or rather than contend that the extra cost is really needed, as opposed to just wanted, is effectively choosing to pay twice for their care. In the residential care arena, where third party top ups are part of the system for ensuring that ‘posher’ care homes charge extra for wants as opposed to needs, whilst still enabling the beds to be accessed by council commissioners for council funded clients, that aspect of double funding has always been the reason that FIRST party top ups are not allowed. The only context in which they are allowed is during the 12 week property disregard (from the value of the disregarded assets) and during a deferred payment arrangement because, morally speaking, the client should be allowed to choose what level of accommodation and services they want when the money is all going to come out of the charge on their property.

One would have thought that that logic should be the same for the HOME care charging system.

Here, though the LGSCO seems to be treating the existence of extra payments by clients of councils if they are cared for at home, as perfectly allowed and normal and not having any significance for the charging system

This may have become the accepted culture ‘out there’ because so many councils are applying a cost cap to home care amounts, which should themselves be challenged.

Or it could be that the LGSCO is relying on the fact that there is nothing forbidding first party top ups in the domiciliary care charging framework, other than the concern that someone is spending down their money on wants – we would have said – albeit wants in relation to care, not in relation to spending so as to avoid paying for care?

Or is it that the ombudsman has just not realised that the person here was in fact an above threshold person paying full cost for the service, thus getting a zero budget, despite eligibility, and was maybe mistakenly been told that the commissioning fee paid by above threshold clients and being paid here, was a ‘top up’? There is just a hint in the narrative in this report that the woman’s assets were depleting but unfortunately we are not told from what level or to what level, so we just can’t tell.

If you want help, please consider seeking advice from CASCAIDr via our referral form on the top bar menu of the site. The full Local Government Ombudsman report of Bournemouth, Christchurch and Poole Council’s actions can be found here: https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/21-017-826

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top