Decision Date: 17 Oct 2024
Summary
A woman, Ms X, repeatedly informed the council that her father, Mr X, was vulnerable and could not live alone. The LGSCO was satisfied that the Council had responded appropriately to Mr X’s needs by agreeing additional measures such as increased care and rolling respite, even though he then had an accident at home.
What happened
Mr X lived on his own and was diagnosed with dementia. The Council had arranged a care package whereby a care provider would visit Mr X three times per week to assist him with domestic tasks and make sure that he was taking his medication. Further, the Council had completed a support needs assessment of his daughter (Ms X), giving her guidance and a small carer’s budget to support her in caring for Mr X during her daily visits to his house.
In February 2023, Mr X’s GP contacted the Council to discuss his needs and the safety of his home, remarking that Mr X’s behaviour had changed and he was at risk of becoming socially isolated.
In response, the Council suggested a befriending service, which it discussed with Ms and Mr X [the report is unclear as to whether this was pursued].
The Council agreed to increase the number of care and support visits Mr X received, providing an extra 30 minutes in which a carer would assist Mr X with his shopping.
As Ms X and her sister explained that caring for Mr X was leaving them feeling burnt out, the Council also put in place 40 hours rolling ad hoc respite per year in the form of extra paid input from the current agency carers; this would give Mr X’s family a chance to take a break from their caring responsibilities by having someone else look after him during this time. Ms X could use this to request respite care as and when she needed it.
At the end of April 2023, Ms X contacted the Council to request off site respite care for Mr X, as the family were planning to have building works done at his house. The Council visited Ms and Mr X on 10 May 2023 to discuss this, and Mr X said that he would accept respite care in a care home, if offered but would want to return home. However, the Council ultimately refused this request, explaining that it would not provide off site respite care for Mr X during the rebuilding period as respite should only be used for the purpose of giving carers a break. The Council clarified that this would not prevent Ms X from using the current carers for rolling respite during the works if she wanted to use it for its intended purpose of taking a break for herself.
The Council agreed Ms X’s request for three weeks respite care in a home during July (when she had her own work commitments) and said it would consider further respite care from the end of June 2023. Further, the Council sent Ms X a list of care home vacancies and informed her that it would consider adding an evening care call to Mr X.
Ms X contacted the Council in May regarding Mr X’s behaviour, which she described as irrational, explaining that he was eating out of date food. In response, a social worker assured Ms X that the carers would check for and dispose of any further expired food if found, and contacted the care provider with this advice to this effect.
In June, Ms X contacted the Council again regarding Mr X, whom she said the family could no longer support, given his increasing demands. When called by the social worker, Ms X explained that Mr X was struggling to stand; the worker advised her to contact Mr X’s GP. Further, the social worker told Ms X that she was waiting for the Council’s commissioning service to send her a copy of the residential vacancy list, and would reach out to the care homes in the meantime to determine their suitability for Mr X.
A week later in June, Ms X again informed the Council that the family couldn’t cope and that Mr X really could not be left on his own. The social worker emailed her the residential care home vacancy list on 15th June and asked the care agency if it could increase its daily care calls to Mr X from what had been one a day by this point, to three, which it agreed to implement from 27th June.
On 21st June, Ms X told the Council that the social worker had not sent her the respite care vacancy list and asked what respite care had been put in place for Mr X. In response, a senior social worker sent Ms X a copy of the list and apologised for the delay, explaining that the initial social worker had gone on leave and informed Ms X that she could start looking at potential respite placements for Mr X given respite care had been agreed. However, the senior worker said that Ms X should not start looking for longer term residential care options for Mr X at this time, as the Council would need to consider the least restrictive option for Mr X before proceeding down this route.
On 22 June, Ms X called the Council to alert them that Mr X had fallen during a visit to a care home. Although he had been seen by his GP and was now returning home, Ms X was concerned that he could fall again, as he was refusing to sleep downstairs, so requested crisis care. The social worker checked that there were handrails fitted in the house to support Mr X and arranged for a care agency crisis service to visit Mr X that evening and the next morning.
The following day, the social worker told Ms X that she had identified a respite care home that could cater to Mr X’s care needs, but Ms X said that she could not afford the top up fee. In response, the social worker told Ms X to research the other respite care homes on the list. Mr X had seen his GP but was very confused by this point.
In July, Ms X complained that the Council had not responded to her concerns about Mr X’s safety after he had suffered another fall, for which he was admitted to hospital. Her position was that the Council had not safeguarded Mr X, despite 27 calls in the previous month, and the care agency supported her stance by raising a safeguarding concern against the Council for both neglect and omission.
An internal investigation against the Council’s adult social care team was conducted, which found the accusations of neglect and omission to be unsubstantiated. The Council sent an officer to inform Ms X of the result in October and she received formal confirmation of this in November. Mr X died at home after having another accident between the time of Ms X’s complaint and the start of the investigation.
Ms X asked for the Council’s response to her July complaint, which it eventually sent in January 2024, explaining that it had not investigated her complaint while the safeguarding investigation was ongoing. The Council apologised for its delayed response, which it partly attributed to the senior manager’s unexpected absence.
The Council defended itself against Ms X’s accusation that it had failed to act when Mr X was at risk, highlighting that it had provided rolling respite since March 2023 and had arranged a package of care for Mr X, which included a plan to admit him to respite care from 26 June 2023. As such, the Council claimed that the social worker had acted appropriately and dismissed Ms X’s complaint.
What was found
The LGSCO did not hold the Council at fault, finding that it had taken reasonable and appropriate measures in response to Mr X’s needs, such as additional carer visits and rolling respite. The LGSCO investigator reported that it was unclear why Ms X had not used the rolling respite, given this could have mitigated the stress she reported.
Further, the LGSCO found that the Council had been receptive to Ms X’s concerns by bringing forward the agreed date for Mr X’s admission to a respite care home from July to June 2023, and also assisting Ms X when visiting care homes with Mr X. Regarding the residential care home vacancy list, the LGSCO held that it was unclear whether Ms X received this when it was first sent, but was satisfied that it was resent a week later.
While the LGSCO acknowledged that Ms X was unable to contact the social worker for a brief period in mid-June, this did not amount to fault. Further, the LGSCO did not think that this was relevant to the short delay in implementing the Council’s decision to increase Mr X’s care visits – which was also not regarded as fault.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
This report leaves at least three elephants to gambol about in the room, unscrutinised.
One is the system for passing people’s welfare on when a member of staff goes on leave – ombudsman’s reports regularly raise omissions in this regard and characterise them as fault. There is a duty to ensure that there are sufficient staff for the discharge of all social services functions at any given time, but that’s a duty that councils take little notice of and the public does not bother to enforce, it seems.
The other is the question of how long a delay in implementing a response to an eligible unmet need is legitimate, in public law terms, that is. Here the respite was urgently needed, whether it was short term or a longer term move – the risk was rising tangibly and the man had two accidents – albeit the first one happened when he was accompanied and visiting a care home! The idea that an existing bannister was regarded as enough to manage that risk is eyebrow-raising, to our minds.
The third is the cost of the residential beds that Ms X had been encouraged to look at. A top up is for wants and not needs, but it had already been made clear that the family could not afford a top up, yet it was a home with a top up that had a vacancy, implying that others did not have a vacancy. The law in that situation is that it should have been commissioned at the full rate by the council, if it was the only way of meeting the need.
Having said all that, this report is a useful reminder that one does not get compensated for the fact that something bad happens, which might not have happened if this public law duty had been discharged more professionally and comprehensively. The ombudsman’s investigator is very careful not to question the actual professional judgement of the social work staff, having checked whether anything that the ombudsman treats as a failure in HOW the situation was addressed, had actually gone wrong. The problem with the report, in our view, is that the investigator could not know what he or she did not grasp was also a public law wrong that should have altered the investigator’s overall evaluation of the situation.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Lancashire County Council (23 018 203) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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