Decision Date: 30th September 2019
Mr B complained to the Council on behalf of himself, as a carer, and his mother, Mrs C.
Mrs C was an elderly lady, who suffered from several health problems. She needed help with personal care and often to mobilise. She was also at risk of falling from her bed during the night.
Mr B was her main carer.
In March 2017 the Council completed a full initial assessment and put in place a care plan. The package of care remained in place until February 2018, when Mrs C was admitted to hospital.
When the hospital discharged Mrs C the package of care resumed. The Council does not appear to have reviewed the care package at this time. However, it carried out a carer’s assessment for Mr B in March 2018.
The carer’s assessment found Mr B was happy to continue in his caring role but would like more support. Mr B said he was now staying at Mrs C’s house overnight more frequently because she slept badly and more often fell from bed. He said Mrs C had become incontinent since the last assessment and he had to support with personal care and changing her pads. Mr B said he felt socially isolated, often felt low moods because of the caring role and was limited in gaining employment.
The assessment found Mr B was at risk of continuing stress and possibly physical harm from lifting Mrs C. The Council offered Mr B moving and handling training, but he declined for unknown reasons. It put in place a personal budget of £300 for Mr B so he could take a break away.
Mr B said that from between April and June 2018 he started to call the Council frequently and leave messages that said he was not coping and needed more support. He said it was often late at night or during the early hours of the morning that he called as these were the times he was struggling most.
The Council had no records of any calls from Mr B until July 2018. At this point a council officer spoke to Mr B who said he was not coping and needed support urgently. The officer sent a request for an urgent review of both Mr B’s and Mrs C’s support packages.
Mr B did not hear back.
The Council’s records showed he called again two months later, in September 2018, but Mr B said he called more times in between, again possibly out of hours.
Mr B said his mother’s health had worsened, she was injuring herself and the care package was not now meeting her needs.
After the call in September, the council officer saw the review was overdue so sent a further request for the review team’s immediate attention.
The following day the Council allocated the case for a review. However, two days after that Mr B called to say Mrs C had sadly passed away.
Mr B complained to the Council.
The Council apologised to Mr B as it said it could have arranged a review sooner. It said the reason for the delay was because of a large volume of requests at that time. The Council said it was going through a service wide transformation, with new staff, systems and procedures which likely played a part. The Council accepted it provided a poor standard of service to Mr B and Mrs C and apologised.
What was found
Councils should review a person’s care plan at least once a year. The Council assessed Mrs C and put in place a care plan in March 2017. A review was therefore due in March 2018. However, the Council failed to review the care plan before she passed away in September 2018.
The Council said Mrs C’s care plan ‘would’ have been reviewed when she was discharged from hospital in February 2018. However, it provided no evidence of any review. The correspondence provided suggested it merely reinstated the existing care package.
Therefore the LGO found the council at fault in failing to conduct an annual review of Mrs C’s care plan.
However, the Council did conduct a carer’s assessment for Mr B. It put in place support for Mr B in terms of a personal budget to allow him a break. However, during that assessment Mr B said his mother’s needs had increased.
This itself may have been enough for the Council to consider a review of her support package and therefore added to the fault that it did not conduct an annual review when one was due by this point.
The LGO had to consider that without records of Mr B’s calls, it could not say whether the Council could or should have responded. If Mr B left clear messages that council officers could respond to, they should have passed these on to the relevant team. However, without any file notes or recordings, there was not enough evidence to make a finding on this point.
The records provided by the Council showed that Mr B first requested a review in July 2018. The Council accepted it could have actioned a review sooner. Normally a timeframe of four to six weeks is acceptable in terms of arranging a review. However, in this case Mr B was clearly distressed and asking for urgent help. The review request was marked as urgent. This suggested the Council should have arranged a review at the earliest opportunity.
It did not allocate the case for a review for two months. This was fault.
Mr B said the impact of the fault was that he continued caring for his mother with a care plan that did not provide adequate support for him or his mother. This caused him distress and risk of physical injury from moving his mother. The LGO recommended the Council pay Mr B £300 in recognition of this injustice, apologise for the delay in reviewing his and his mother’s support plans, and for not carrying out an annual review of his mother’s care package.
Points for the public and for the council
- This baleful and sorry tale of our times underlines what is happening all over the country due to redundancies and frozen vacant posts whilst cuts from central government continue to take effect.
- We are surprised that the LGSCO did not refer to the legal duty in the Local Authority and Social Services Act 1970 that is still in force, and binding on all councils – the duty to ensure that social services departments are furnished with sufficient staff for the discharge of their functions.
- Assessments, reviews, and revisions to care plans are at the very heart of social services functions, and are statutory duties. Unless the man in this case was regarded as making up the calls that he claimed to have made, there is no possible excuse for failing to get someone to review this package, and a referral to the Monitoring Officer would have been a better thing to do, we think, in this situation.
- Someone died in this case, and the carer was clearly at the end of his tether. There can be no confidence that that outcome could not have been avoided by proper due process and the all important timeliness that the statutory Guidance requires of adult social services.
- Section 27 of the Care Act allows anyone to be reviewed upon any reasonable request, not merely an annual review as expected in the Guidance. When the sort of delays above occur, we have to wonder whether we still live in a society with any respect of the rule of law.
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The full Local Government Ombudsman report of London Borough of Hammersmith & Fulham’s actions can be found here