London Borough of Islington at fault for a delay in completing a needs assessment, and insufficient integration between Adult and Children’s services regarding documentation

Decision Date 23rd March 2020

What Happened

Ms X was registered blind, and lived with her elderly mother who received support from home carers. Ms X also provided her mother with support.

In July 2018 Ms X had a baby (Y). She arranged for her wider family to support her to care for Y.

In August, a visiting social worker raised concerns about whether the arranged support was meeting Y’s needs, and referred Y to Children’s Services for an assessment. Later that same month Ms X asked the Council to arrange an assessment for care and support for herself. Nothing happened until December that year, as the report will go on to explain.

Y’s assessment took place in September, where Ms X stated that Y received support 23 hours a day from herself and her family. The social worker referred Ms X to the sensory team for assessment to increase her independence with tasks related to Y’s care.

In October, Ms X again identified that there was an hour gap every day where she was alone with Y without support, but said she was able to manage. She declined the offer of a family group conference to set out what support family members could provide.

In November 2018, Ms X rang Children’s Services to say Y had choked on some medicine. A family member was present during the incident and assisted Ms X and Y.

A Children’s social worker visited Ms X and completed a further assessment. The report identified a gap where there appeared to be no family support between 7-10am, instead of the initial 1 hour Ms X stated. It also stated that there were no health or other concerns in relation to Y.

The Sensory Team also assessed Ms X, and identified the same 3 hour gap in support where Ms X was left without support. The report stated that due to Ms X’s sight loss, there was serious and imminent risk of harm to Y when Ms X was left alone with them.

The day after this assessment Ms X contacted the Council to say Y had fallen off the bed whilst she was changing Y’s nappy. The Council advised that she should change Y on the floor.

In December 2018, the Sensory Team met with Children’s Services to share the findings from their assessment. It was only at this point that Ms X got an official referral Adult Social Care for a needs assessment.

Ms X complained that there had been an unacceptable delay in referring her for a needs assessment, and that the Council’s failure to provide support caused her baby harm. The Council responded to Ms X’s complaint stating that, although it accepted Ms X had first requested an assessment of her care needs in August 2018, it had concentrated on the needs of her child ‘as a priority’.

Her needs assessment commenced on the 20th December. In January 2019 Adult social Care and Children’s Services met to discuss the case, and arranged to commission services from one provider.

Children’s Services offered Ms X 3-hours daily care support between 7am and 10am. The Adult Social Care social worker offered her an additional 27.5 hours of care per week. Ms X’s Care Act care and support plan did not set out how these hours were to be used in conjunction with the support from Children’s services.

In February 2019, Ms X’s mother was admitted to hospital, so she asked the Council to put on hold the 27.5 hours a week care. The report did not explain Ms X’s reasons why. Simply that the Council agreed, and put the package in place when Ms X told them she was ready for it in March.

The Council reviewed her plan in May 2019, but did not provide Ms X with a copy.

In June, Ms X complained to the LGO. She complained that the delay between completing her needs assessment between August and December 2018 put her child at risk. She said the Council had not provided her with clear information setting out the content of her care plan, and that there had been a lack of coordination between Adult’s and Children’s services.

The Council did not consider the 4-month delay of her needs assessment to be unreasonable. It disputed that there had been lack of co-ordination between Adult and Children’s services, as the two services had met in December 2018 and January 2019 to discuss Ms X and Y’s needs, and both services agreed to commission care from the same agency to ensure continuity for Ms X and Y.

The Council acknowledged there were two incidents that raised safeguarding concerns but said these were dealt with proportionately at the time and on each occasion a family member was present. It accepted there was inadequacies in the format of its records when multiple services are working together to meet identified needs.

Finally, the Council provided evidence that it had since reviewed Ms X’s care package several times and made appropriate adjustments ensure their needs continue to be met.

What was found

The LGO considered the 4 month delay in assessing Ms X did amount to fault. Councils should consider 4 weeks to be the longest that could be reasonable, unless there is a good reason otherwise. Even though the Children’s services were involved, this did not discharge the Council’s duty to Ms X.

The Council was not at fault in regards to the two safeguarding instances. The LGO stated that the Council had appropriately considered the incidents and provided advice to Ms X.

The LGO highlighted that despite both the Children’s services and sensory team identifying a three hour gap in her support, there was no evidence the Council properly considered that evidence, or whether an emergency care package was needed to cover that gap in support. This was fault. However, there was no evidence this fault caused Y any harm.

The delay in the increased support package starting was not fault by the Council, because it was at Ms X’s request.

There was evidence that the Adult and Children’s services communicated with each other and recognised the need to work together. However, the LGO stated that the Council could have considered closer integration in regards to the documentation. Guidance states that Councils should consider producing a combined plan, where two or more services are working together to meet needs. The care and support plan produced by the Council did not clearly set out how the Council planned to meet Ms X needs and did not include details of the care hours commissioned by Children’s services. This was fault.

Ms X said the Council did not include her in decision-making but the LGO did not uphold this part of her complaint, as there was evidence showing that the Council did visit Ms X as part of its assessment, and the documentation clearly recorded her views.

The Council was at fault for not providing Ms X with a copy of her reviewed plan in May 2019. However, this fault did not cause serious injustice, as the Council continued to provide care during this time and met Ms X’s needs. It also since provided her with a clear timetable of its care provision. 

The LGO recommended that the Council

  • Pay Ms X £200 to acknowledge the frustration and distress caused by the delay and the confusion caused by her unclear care and support plan.
  • Remind its officers that they should consider if there is a need for an emergency care package prior to completing the needs assessment, and to record its consideration of this;
  • Remind its officers of the need to consider combined or integrated assessment and care planning, where more than one service is assessing or meeting a person’s needs;
  • Review its documentation to consider enabling the recording of integrated care planning when appropriate;
  • Remind its officers of the need to provide individuals with a copy of their care and support plan and any reviews of this plan.

Points for the public, parent support groups, advocates, family members, service users and councils

When a disabled parent is assessed under the Care Act, one of the areas in which they can be found eligible is parenting.

When a child has a disabled child, the child can be seen as a child in need under the Children Act.

There are therefore two routes into getting services to meet the needs, and although the Care Act function is the primary route in, because of the nature of the duty, we find that Adults’ teams fight shy of treating the duty to meet needs in the same way as they would for other domains/areas of daily living.

There are some good reasons for that with roots in the ambiguity of the legal framework. Children’s teams will be advised that s17 does not trigger a duty to the child, merely a power, albeit an important one. They focus their attention and resources on s20 accommodation duties for very much worse off children, with disabilities of their own, or child protection functions where the parenting inadequacies (whether by reason of disability or any other reason) are perceived to pass the threshold for care proceedings.

Adults’ teams will often look to the disabled parent’s partner, when also a parent of the child, and on the scene, as obliged to do whatever the disabled person cannot do, as if parental responsibility were a joint and several liability like paying the mortgage, whereas in fact the Care Act makes it clear that the disabled parent is not to be prejudiced for want of parenting ability and can be entitled to support. The difficulty comes where a couple has made a deal with each other that the disabled one stays home to do child care, and the other goes out to work to maintain all of them; in that case, social services can end up feeling as if public money is being called upon to sustain that couple’s choices and lifestyle ambitions. We know of no case where a challenge to a limited offer, say for child care or extra personal care to assist with supervision of the children at home or for before and after school, as opposed to a rationally sufficient offer, or an offer based on what the parent(s) think that their child(ren) ‘deserve’ has reached the Administrative Court. We’ve also seen cases where councils have remained very firmly determined NOT to pay for the types of activities that might be regarded as for the privileged (eg afterschool care at the children’s private school) for teens, and cases where teens have been expected to sort themselves out, in the name of independence, rather than be provided with publicly funded housework, and we think that it is unlikely that a challenge to that sort of decision would succeed.

What is clear is that Adults’ Service cannot say “We don’t meet those needs, children’s services are where you have to go for that sort of thing”. No council could get away with that, in view of the inclusion of parenting inability to achieve in the eligibility criteria regulations.

It is also clear that Adults’ Services cannot threaten a disabled parent, partnered by anyone less then robotically energised to be able to do it ALL, with the risk of losing the child to care proceedings, unless the disabled parent prevails upon the other parent to do more. No council would want the reputational flak for that sort of a stance, and respect for private and family life under article 8 must surely mean that the kind of deal mentioned, when one stays home and the other does what they can to maintain the whole family, must be recognised as in no way out of the ordinary, whatever the gender of the partner who’s staying home.

What confounds us in these wrangles, however, is that the s 6 and s 7 duties to co-operate between defined partners (other public bodies) and integrate wherever that’s conducive to the wellbeing of the public, is not regarded as the gold standard for two departments in any one council! We think it would be easy for a children’s and adults’ team heads of service to agree a policy or a protocol for HOW costs of meeting the need in a joined up way would be met – by reference to percentages, or by reference to types of input or facility.

It is shocking to us, this long after the Care Act came in, to think that nobody’s designed a form for a combined assessment or a joint assessment, given the exhortation to head that way in the Care and Support Guidance, from its very first iteration.

We particularly liked the benchmark that councils should not take more than a month to respond to a self-referral for an assessment. Councils need reminding, we find, that the duty to assess is met upon evidence that the person asking MAY be in need of care or support, and time begins to run at that point, the time limit being within reasonable timeframe, given the circumstances. When a person with a sensory disability has sole care of a baby, that time frame would be an awful lot longer than a month!

We also liked the reference to councils’ ability to meet needs urgently, under s19 of the Care Act, regardless of the stage an assessment has reached, because it chimes with the law as set out in the recent Redbridge case, (Ali Raja) which you can find by searching in the search box.

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The full Local Government Ombudsman report of London Borough of Islington’s actions can be found here

https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/19-004-087