Norfolk County Council at fault for poor management of transitioning between care providers, causing a 3 month gap in care – and poor communication over banking unused care hours

What Happened

Ms X complained on behalf of her adult son, Mr Y, who suffered from autism and ADHD.

Mr Y had a care plan in place and he had four hours support per week. The care provider Dimensions was commissioned to provide the four hours between November 2016 and the end of August 2018; then AEA took over from December 2018 until November 2019 when First Choice was commissioned to provide the support.  The complaint related to the transition of care between Dimensions and AEA in 2018 and the three month gap in care between September and December.

During a meeting with the social worker and a worker from Dimensions in May 2018, Mr Y said he wanted to suspend his care for that month, bank the hours and use them the following month if he decided to continue with the care package.  Subsequently that social worker left. The social worker who took over noted there was a lack of clarity in what was agreed as a result of the discussions regarding Mr Y’s request to bank care hours.

 In June 2018 Dimensions served notice on Mr Y. The LGO report did not elaborate as to reasons why. Dimensions would continue to provide care until the end of August 2018. Ms X spoke to the duty social worker stating that Mr Y had become distressed by the news and ‘smashed up his flat’. She told the social worker that he had banked 24 hours of support and asked if he would have to pay his fees for these hours.

Dimensions told a duty social worker in July that Mr Y had banked 10 hours of care. The social worker noted there was a lack of clarity as to what the agreement over banking care hours was.

A new social worker was assigned to Mr Y in August 2018. She spoke with Mr Y’s mental health worker who explained that changes in routine were very difficult for him to deal with resulting in challenging behaviour, and stopping his medication.

The social worker contacted Dimensions asking them to adjust the hours they were claiming (in order to reflect the actual hours of care given to Mr Y) which would produce a credit on the system for Mr Y.

The LGO report highlighted that it was difficult contacting Mr Y in August when the Council were trying to identify an alternative provider.

In the end, the social worker spoke to Ms X (with whom Mr Y was refusing to have contact at the time) and explained that Mr Y would get a credit on his account as Dimensions were adjusting the hours. The social worker explained that in the future hours could not be banked with the new care provider. Mr Y would need to agree how much notice he had to give in the future if he wanted to cancel care and not be charged for it.

Dimensions stopped providing care at the end of August 2018. Sometime during August or September – it is unclear from the report – AEA was identified as an alternative care provider. At the end of October the social worker discussed Mr Y’s needs with AEA. She highlighted that Mr Y was reluctant to meet new people as it was very difficult for him, but in the end managed to arrange a meeting for November 2018. AEA started providing care in December 2018.

The LGO found during its investigations that Mr Y struggled to engage with social workers. It was agreed that Mr Y would contact them when he needed a service, but evidence showed that sometimes months went by before he made any contact.

A new social worker assigned to Mr Y undertook a care and support plan review in April 2019, which highlighted that Mr Y was frustrated with social services and the manner in which he was informed that the previous care provider, Dimensions, would be ending their services.

In January 2020 Ms X complained to the Council that it knew long before she and Mr Y did that Dimensions were planning to end their services. She and her son had only found this out 6 weeks beforehand, but the social worker had known long before then. This realisation led to Mr Y becoming extremely distressed and destroying his belongings.

The Council failed to respond, so Ms X sent a second letter in March 2020 which contained additional complaints relating to AEA’s quality of care and organisation. The Council replied in July 2020:

  • It was sorry for the delay in responding;
  • The charges for her son’s banked (i.e. unused) care hours were waived. The agreement about banking hours was only intended as an arrangement for one month as Mr Y wanted to carry over the unused hours from May to June 2018;
  • Mr Y did not engage with AEA or his later service provider First Choice; he cancelled some but not all their sessions. Mr Y needed to give notice if he wanted to cancel sessions, otherwise he would be charged for those cancelled services;
  • Dimensions told the social worker in May 2018 that it was ending their contract of care services for Mr Y. It gave formal notice at the end of June and the council was sorry Mr Y was not told promptly of the ending of their services;
  • The new social worker found an alternative provider AEA to provide services to Mr Y, but their services could not start until Mr Y had been assessed and Mr Y was reluctant to engage with them;
  • The social worker could have assisted more to set up appointments with the proposed provider and Mr Y;
  • The Council was sorry Mr Y was without support when Dimensions care services were stopped. Earlier planning would have given a better chance of a successful transition; however it was hard to engage with Mr Y during this period.

What was found

The LGO stated that there was a lack of clarity regarding the banking of care hours. This was fault. The lack of clarity was not in line with expected standards of communication and customer focus, and caused avoidable confusion and distress for both Ms X and Mr Y.

The LGO also found that the Council failed to manage the changeover of care providers appropriately. The Council was aware that Dimensions would be giving notice to end their services in May 2018. They were also aware of Mr Y’s autism, and therefore the importance of managing his transition of care. The LGO stated that Mr Y should have been informed as soon as the Council became aware of Dimensions’ position, and the search for a new provider should have started much earlier. This could have helped ease Mr Y’s anxieties, and avoided the three month gap in care.

The LGO acknowledged that Mr Y was hard to reach at times, and had known difficulties with managing change. However, if the Council had started the transition process sooner and communicated properly, Mr Y’s distress could have been avoided or eased. 

The LGO also stated that the Council was at fault for the delay in its complaint response.

The Council had already apologised and waived the charges for banked care hours. However the LGO recommended that the Council should additionally pay:

  • £250 to Ms X to reflect the delay in responding to her complaint and the avoidable distress for a three-month period during 2018 when there was a gap in provision for Mr Y
  • £1000 to Mr Y to reflect the high distress and lack of service caused by the poor management of the transition between providers and the three-month gap in provision- during which Mr Y was without care and support.

Points to note for councils, professionals, people who use services and their carers, advocacy providers and members of the public

Care Act guidance doesn’t specify timeframes for assessments or for meeting identified eligible needs; however, public law principles state that the functions of the Act should be carried out in a ‘reasonable timeframe’ which is dependent on the circumstances of each case. With the circumstances taken into account, if there is a long delay which cannot be accounted for it is said to be an ‘unconscionable’ delay which is challengeable in the Administrative Court.  The cost of this process is often prohibitive and this is why the LGO complaints process is invaluable as a free alternative – it finds fault, instead of applying law, but the two fields overlap when the law is obvious and the council has ignored it. 

In this case the care package with the previous provider broke down and it was no longer able to meet the needs identified in the support plan. There would have needed to be a review to consider how the needs would then be met and a plan for identifying an appropriate provider. Mr Y and Ms X should have been involved at the earliest opportunity in discussions around the need to review the care and support plan. This would have enabled a more timely transition and, the LGSCO considered, avoided the delay in meeting eligible needs.

Difficulty in engaging with someone is not considered sufficient reason for not acting in a timely way, from the LGSCO’s point of view. This suggests that local authorities would do well to be proactive in reaching people so that they can show they made every reasonable effort to ensure timely processes.

Again, there is an issue here with information and communication from the local authority, both in relation to clarity about use of hours and communication about the transition of care provision. Clear, written, accessible information is needed. The local authority noted that the information on banking care was not clear, however did not act on this, which is clearly fault.

This case is an example of how the LGO can uphold standards of administration and customer service as well as legal duties – and provide a route for remedy in cases where these standards haven’t been upheld.

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 Norfolk County Council’s actions can be found here

https://www.lgo.org.uk/decisions/adult-care-services/charging/20-003-947

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