St Helen’s delays excused, regarding sourcing and arranging a residential placement; but fault found for providing inaccurate information which led to a reasonable belief a placement was going ahead.

Decision Date: 15/09/2022 

What happened

Mr and Mrs B’s son had been living at a residential college until 2019. After this came to an end he moved back into the family home following a failed placement at a residential setting; this was in July 2019. He was going to live with them whilst an appropriate residential placement was sought for him.

A care package was in place to support Mr and Mrs B’s son to access the community but this was stopped in April 2020 due to COVID 19 lockdown. 

The council looked into a number of different potential placements and in February 2020 identified a suitable placement (provider B). Mr and Mrs B identified a placement with provider A in May 2020 and felt that was best suited to meet their son’s needs, however. At this point Provider A had not even purchased the building to set up their residential service; its registration was only for domiciliary services. This meant that Provider A could not conceivably contract with the council.

In May 2020 the council asked Provider A to send details about care charges for outreach support with a view to Provider A eventually providing accommodation and support. Provider A confirmed they could administer insulin.

In June 2020 when Provider B said they could carry out an assessment of Mr and Mrs B’s son’s needs they confirmed they wanted to pursue using Provider A. The social worker told the family that the council could not commission a service from Provider A unless they were prepared to engage in the council’s procurement process. At the same time Provider B had provided costings and these were sent to the contract department to request funding.

In October 2020 an alternative care provider was identified by the council but Mr and Mrs B declined to pursue this option. At the same time Provider A told the council they would likely complete on a property in 3 weeks which should be ready for residents to move into in January 2021. The provider was reminded that the council could not commence the tendering process without them first being CQC registered.

In late October 2020 the package of outreach care to be provided by Provider A was agreed. In November 2020 the social worker told Mr and Mrs B that this package of care would start. The social worker also told Mr and Mrs B that the package of care would ‘help staff get to know their son before he moved into the residential care home’.

There were delays to the timeframe given for completion of the residential service’s preparation. First Provider A told the council they were hoping it would be ready by April 2021; then following further issues with the planning application process they predicted it would be ready by August 2021. In June 2021 the social worker told Mr and Mrs B there would be a meeting with the provider when the property was ready to discuss their son’s needs and that once the CQC registration was in place the support plan would be updated so that support was in place for him ready to move to the placement. This led Mr and Mrs B to believe there were no other barriers to the placement going ahead when it was ready.

In November 2021, a meeting was held with Provider A and the council during which the provider gave the costings for the placement; the council raised concern regarding the calculations. Later that month Mr and Mrs B asked for an update.

Provider A became CQC registered on 2nd December 2021. Mr and Mrs B complained about the delay and the council responded with an apology stating it was sorry they had been made to believe there were ‘no barriers’ to the placement going ahead once set up. In January 2022 the council visited the property and raised some concerns about it.

Later in January 2022, Mr and Mrs B were told that other care providers needed exploring as Provider A was not contracted with the council and therefore not a viable option. The council had contacted Provider A a number of times since, to request the information needed regarding costs but had yet to receive it. An alternative provider was identified in March 2022 but Mr and Mrs B turned this down as they felt it was not suitable.

What was found

The ombudsman found that the delay in putting in place an appropriate residential placement was not the fault of the council but that there was fault in information that was given to the parent carers from the social worker. The inaccurate information led them to believe the placement with Provider A would go ahead; which has ultimately caused ‘raised expectations and frustration’ and for that the ombudsman recommended an apology and payment of £500 to recognise this.

Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public. 

The Care and Support Statutory Guidance is clear about the need to involve people and their carers in the process of planning their care and support, and the need to give people accurate information regarding their care so they can make informed choices.

The Guidance tries but probably fails, in view of the rhetoric rife in the sector about choice and control, to convey that the decision is ultimately the council’s, and that cost is something that the council can consider as a reason for choosing one provider over another. Yes, relatives can convey their dissatisfaction with the assertion that a given home or service is suitable, but they can’t just do that by saying No. They have to engage with the council in order to explain why, by reference to its location, its set-up, the kind of residents or the staff ratios, or the space, or lack of it, or the implications for risk of the proximity of the front door to the High Street, etc etc, what MAKES it a choice that no reasonable care manager could possibly regard as therapeutically defensibly appropriate.

In order to make a sensible and defensible choice, any council needs sufficient skilled care planners in-house to be able to tell when a provider is simply milking the council’s unwillingness to provide care homes or supported living settings of its own, and when a skilled provider is making a serious point that some given aspect of a draft care plan won’t be likely to work or be sustainable, or is something that that company just won’t take the risk of doing. Unfortunately, care planning has dwindled and evaporated as a skill, and depends now on providers’ OWN agendas, which are inevitably driven by the crisis in the workforce, and their own concerns about viability. It should be a professional process with several rounds of discussion, and of course the client and their family should be involved.

In this case the care and support plan had not been finalised, but the process of planning the care and support plan was underway. Mr and Mrs B had made what they thought to be an informed decision about Provider A being the most appropriate provider to meet their son’s needs – however, they were not made aware that the choice was not for them, nor of the process a provider would need to follow before the council would commission care from them.

Had Mr and Mrs B been made aware of this information they may have made different decisions in regard to the care planning and the potential alternative providers. Not having this information prevented them from being fully involved in the care planning process.

Different councils take different attitudes to the requirements of public procurement when it comes to a package for an individual, is all we can say, as we are not procurement experts. It is not wrong for a council to have at least some standing orders about open framework tendering so that all providers are seen to be being treated the same. What we can say is that the usual answer for extending choice of provider – ie a direct payment – could not have been offered here to the couple with which to do business with provider A, even if costings had been resolved,  because it is still not lawful to turn a budget into a direct payment for permanent residential care.

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 on the actions of St Helens Metropolitan Borough Council can be found here: https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/21-014-673

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