Summary: Mrs G complained about the decision by NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board (the ICB) to reduce the night-time support for her child, D. She also complained about the way Milton Keynes Council (the Council) considered respite for the family and a preferred placement. We found fault in the way the ICB decided to reduce night-time support as it did not follow the recommendations from an independent assessment or properly consider the impact its decision would have on D’s parents. This likely caused D’s parents avoidable worry and distress. The Council did not provide enough support to meet the family’s needs but acted to put things right during our investigation. There was a lack of joined up working when assessing D’s health and social care needs. The ICB and Council have accepted our recommendations to complete a holistic review of D’s needs, apologise to Mrs G, make acknowledgement payments and improve their processes. We have now completed our investigation.

The complaint

1. The complainant, Mrs G, complains about the decision by NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board (the ICB) to reduce her child’s night care and support arrangements from seven nights of support from a trained nurse to six nights of care from two trained carers. Mrs G says this increases the risk of harm to her child due to her child’s complex health and social care needs.
   Mrs G says the family is entitled to respite care from Milton Keynes Council (the Council) under the terms of the Children Act 1989 but the Council has refused to fund the only suitable placement. The complainant says the Council should have acted independently from the ICB to ensure it met its social care responsibilities. She complains the Council and the ICB do not work together effectively.

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The Ombudsmen’s role and powers

2. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
3. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended). If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
4. When investigating complaints, if there is a conflict of evidence, we may make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
5. If we are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

6. We have considered information about the complaint provided by Mrs G in writing, and by speaking to us. We have considered information provided by the Council and the ICB in response to our enquiries. We have considered the law and guidance relevant to this complaint. Mrs G, the Council and the ICB have had an opportunity to comment on our draft decision.
7. Under our information sharing agreement, we will share this decision with the Office for Standards in Education, Children’s Services and Skills (Ofsted).

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What I found

Legal and administrative context

8. The Children Act 1989, section 17, requires councils to safeguard and promote the welfare of ‘children in need’ in their area, including disabled children, by providing appropriate services for them. All disabled children are regarded as ‘children in need’ and entitled to an assessment under section 17.
9. Where a council’s children’s social care department decides to provide services, it should develop a multiagency Child in Need Plan. The Plan sets out which organisations and agencies will provide which services to the child and their family. While some services are offered directly to the disabled child, services can also be offered to parents or carers. (Working Together to Safeguard Children) 
10. The National Framework for Children and Young People’s Continuing Care 2016 (‘the C&YP Framework’) sets out an equitable, transparent and timely process for assessing, deciding and agreeing bespoke continuing care packages for children and young people whose needs in this area cannot be met by existing universal and specialist services.
11. The C&YP Framework also says the assessment phase is the first stage of the continuing care process and should be led by a nominated children and young people’s health assessor as to whether a child or young person has continuing care needs than cannot be met by existing universal or specialist services. Following assessment some children or young people will need a package of continuing care involving bespoke commissioning and funding arrangements.
12. There are four key areas of evidence that should be considered in the assessment:
• the preferences of the child or young person and their family;
• a holistic assessment of the needs of the child or young person and their family;
• reports and risk assessments from a multidisciplinary team or evidence collated during the Education, Health and Care plan assessment; and;
• the Decision Support Tool for children and young people.
13. The Decision Support Tool (DST) for children and young people is intended to bring assessment information together in a concise, consistent way. It is designed to help ensure that all relevant needs are assessed and captured. The DST is not stand-alone. The nominated children and young people’s health assessor will have worked alongside a multi-agency or multidisciplinary team to compile the information required to complete the DST.
14. The C&YP Framework says, when considering any existing care, it is essential to test it against the wishes of the child or young person and their family, and also against the outcomes which are to be delivered. This evidence can only be obtained if the child or young person and their family are involved in every stage of the process, and the ICB, or their service provider, is active in engaging with them and documenting this evidence.
15. Where a child needs constant supervision or care which is largely provided by family members, the family may need professional support to allow them time off from caring responsibilities. The Council has a duty to provide breaks from caring to help parents who provide care for disabled children (‘short breaks’). Short breaks can include daytime and overnight care in the home of the disabled child or elsewhere. The C&YP Framework says the ICB and the Council (which is usually the commissioner of respite / short break care) may need to agree on the respective contribution to this. (National Framework for Children and Young People’s Continuing Care 2016; The Breaks for Carers of Disabled Children Regulations 2011; Part 3 Children Act 1989)
16. The C&YP Framework says the ICB should ensure effective liaison with the Council and effective management of the continuing care process. Joint commissioning or bipartite (two-party) arrangements may be needed to ensure the child’s health and social care needs are catered for in the package of care.
17. The C&YP Framework says, ICBs and Councils should agree a local dispute resolution process to resolve cases where there is a dispute over a child’s continuing care needs and/or over responsibility for the funding of a package of continuing care. ICBs must also have complaints procedures in place to handle disagreements from the child or their family / carer about any part of the continuing care process. They should also have a review / appeal process, to provide greater patient confidence in the impartiality of decision-making.
18. There are clear limits on what care councils should fund, which should not be a substitute for NHS care for children that meets ‘essential medical needs’. This is known as ‘the Haringey judgment’. It looked at the scope of a council’s duties under the Children Act 1989 to provide nursing care for a disabled child to offer respite for the child’s parent. A multi-agency assessment may highlight that care is being commissioned inappropriately by a particular commissioner.
19. The legislation and the respective responsibilities of the NHS, social care and other services are different in children’s than in adult services. The terms ‘continuing care’ (in relation to children’s services) and ‘NHS continuing healthcare’ (in relation to adults) have different meanings.
20. The ICB has a children and young people continuing care operational policy in place from March 2022. The purpose of the policy is to detail, for transparency the approach taken by the ICB when determining its responsibilities to children and young people in line with the C&YP Framework. The ICB also has a Dispute and Appeals Policy in place which provides guidance to families.

Background

21. Mrs G lives in the community with her family including her child, D who has complex health and social care needs because of a rare genetic condition. D experiences severe epileptic seizures day and night as well as other impairments and difficulties. She receives formal care and support from the Council and the ICB as a part of a children and young people’s continuing care package (continuing care) and the Council’s wider social care responsibilities. D also has an Education, Health and Care Plan.
22. The formal support D receives includes ICB funding for care from trained nurses to meet her health needs at night and funding from the Council to meet her social care needs during the day through direct payments. Mrs G uses the direct payment from the Council to employ a nurse and a care worker. This works alongside the informal support provided by her parents.
23. In 2021 D’s case transferred to the ICB from a predecessor health authority. The ICB completed a reassessment and recommended a reduction in care arrangements from seven nights nursing care to four nights support by care workers. The ICB said the predecessor health authority had also recommended a reduction in the number of nights of care. D’s parents disagreed with this decision. They specifically had concerns about D’s night-time care and seizure management if the support arrangements changed. They were also concerned about the impact on them as carers.
24. Mrs G complained to both the Council and the ICB about the care arrangements due to what she referred to as a lack of joined-up working and proper consideration of the family's needs. This included the respite care provided by the Council and the changes to the night-time support proposed by the ICB. She also followed the ICB’s continuing care appeals process during the dispute period but remained unhappy with the outcome.
25. The Council and the ICB responded to Mrs G’s complaint in October 2023. The ICB referred to an independent review it had completed as part of the continuing care appeal process. It also said it would complete a continuing care review in November 2023. The Council said it worked with the ICB and other organisations to deliver and support complex health care packages to those in need. It said the care provision for D had been delivered in line with the continuing care package agreed by the ICB and the Council.

Findings

The actions of the ICB and the Council

26. The Ombudsmen cannot decide whether the ICB’s decision about continuing care hours, or the Council’s decision about social care, is right or wrong. We do not question the merits of a decision that has been properly taken. However, we can look at whether there was fault in the way the organisations reached the decision.
27. The nature of D’s needs requires the Council and the ICB to work together to determine the formal social care and health elements of her care and support arrangements. This includes considering and meeting the needs of her informal carers. The continuing care assessment is led by health and eligibility is determined by a child’s presenting health needs. Any eligible health needs are the responsibility of the ICB. The Council is responsible for D’s social care needs.
28. The ICB decided it would reduce the number of nights of support D received and change from nursing care to trained carer workers once there had been a transition period. In response to our enquiries the ICB confirmed the night support did not reduce throughout the dispute and appeals process and remains in place while it finds a provider.
29. When Mrs G appealed the ICB’s decision it was considered by a Senior Appeals Panel. The Senior Appeals Panel could not agree on the decision to reduce the night support because there was a lack of rationale to show why the number of nights should reduce from seven to four nights. The Panel said, “there appeared to be a considerable focus on the reduction of the number of night care being provided with limited or no rationale as to the reasons for this”.
30. The Panel wrote to Mrs G in September 2022 and confirmed it could not reach a decision. It recommended an independent assessment of D be completed by an alternative ICB children continuing care team (ICBX) for their opinion. This would include a full holistic assessment incorporated into a new DST. The Panel said it would aim for the assessment to be completed within 12 weeks. It confirmed the current care arrangements would continue.
31. Mrs G questioned the independence of this assessment due to written information the ICB shared with ICBX about D’s needs. The ICB’s continuing care dispute policy states the DST should be peer reviewed which would mean the ICB needed to share a copy of the DST with ICBX to inform the peer review. We do not find fault with this decision to share previous information about D’s needs.
32. Mrs G also said the ICB’s officer shared inappropriate and inaccurate information with ICBX about her to influence the assessor. The documentary evidence strongly suggests the ICB’s officer shared what was referred to as “confidential information” about Mrs G with ICBX’s officer before it completed the independent assessment. It is unclear why this information was shared as it is unlikely the confidential information would have aided the independent assessment of D’s needs. This was fault. It is understandable Mrs G felt aggrieved by the information shared about her.
33. Following its assessment ICBX made recommendations which the Senior Appeals Panel considered in January 2023. The recommendations included the following.
• All care should come from one care provider jointly funded by the ICB and the Council to ensure risk assessment recommendations and guidelines for D would be relevant during daytime care and night-time care.
• Seven nights of health care were recommended with regular nurses to manage D’s seizure activity based on clinical evidence. This would also relieve pressure on parents.
• A longer-term plan to move from nursing care to child specific trained care workers who were confident and competent in all aspects of D’s healthcare needs. This would be based on careful clinical management and paediatric nurse led supervision for the night care to be slowly weaned before any changes were made.
• Establish time during the weekend hours where D could be supported by care staff which would allow parents some time out for themselves and their other children.
34. The review from ICBX did not make recommendations about respite but said this should be discussed locally based on resources available.
35. The Senior Appeals Panel wrote to Mrs G in February 2023 to confirm the outcome of her appeal. It confirmed it had considered the independent review and DST from ICBX. The panel upheld the recommendations from ICBX. It said this would enable a period of stability and opportunity to provide training to D’s care workers across health and social care. The panel also said the ICB should review D’s needs to support transition from nurse led care arrangements to specialist care workers with paediatric nursing support and assessed short breaks (respite). Mrs G says there are no specialist care workers available in her area and that paediatric nursing support is reality telephone support by a nurse who has never met D. Mrs G considers this to be dangerous for D.
36. The panel recommended the care arrangements be reviewed within six months and only at this time, once the support was stable and sustainable, should conversations take place about any reduction in the number of nights required.
37. Mrs G provided a copy of a letter from a Lead Consultant Paediatric Neurologist dated August 2023 which confirmed D’s diagnosis. The Consultant recommended patients such as D be provided with “night-time support by a professional who is qualified to use VNS [a device to stimulate a nerve in the neck], oxygen therapy and rescue medication due to the fact these types of seizures can be very dangerous and lead to Sudden Unexpected Death in Epilepsy (SUDEP)”. The ICB said it considered this information when considering D's needs.
38. The ICB completed a continuing care 12-month review in September 2023. The document records the care and support arrangements at the time as 10 hours of night support, seven days a week from a nurse funded by the ICB and 24 hours weekly of social care funded by the Council. In relation to seizures the assessor noted D had an individualised seizure plan in place and had a severe level of need.
39. The Council confirmed it attended the ICB’s continuing care meeting in
    November 2023. It started a CIN plan review in the same month. It noted it would review the 24 hours of social care support monthly or sooner if required.
40. In December 2023 the Senior Appeals Panel wrote to Mrs G to confirm it had considered the outcomes of the 12-month continuing care review/DST. The panel said the following.
• There was clear rationale for the recommended joint package of care the panel understood to consist of six nights weekly with two carers.
• The panel understood conversations needed to be held with commissioning parties to approve the recommendation but the panel across health and social care supported the proposal.
• The panel reiterated the need for a clear transition period and a training package for carers which included clear support mechanisms for out of hours nurse support.
41. The ICB said parents have primary responsibility for the care of their child with statutory agencies supporting them to meet the child’s identified needs. The ICB said it promotes an approach to build and sustain parental resilience and not to encourage professional dependence and it was essential families do not rely on continuing care to fulfil their primary care responsibilities. Mrs G disagrees with the ICB’s position and does not consider that parental responsibility extends to providing the types of complex medical care D needs.
42. D’s parents accept they have primary responsibility for their child and other children. The complaints Mrs G has represented relate to the way the ICB and the Council acted to provide or commission health and social care services to meet her child’s eligible needs and parents’ needs as carers. The ICB and the Council both have responsibilities under their respective NHS and children’s social care legislation.
43. In response to our enquiries the ICB said it considered all the information to ensure a safe transition of D’s care from nurse to care worker support. It said it has authorised the nurse funding to continue while its lead provider finds trained care workers for four nights’ care to meet D’s health needs. It said it expects the transition period to be three months. What the ICB said is not in line with the recommendations from ICBX which the Panel accepted and outlined in the letter to Mrs G following the independent review.
44. We have not seen evidence to show the Senior Appeals Panel or the ICB provided Mrs G with evidence to support the rationale for its later decision in
    December 2023. For example, the Panel said it supported the recommendations from ICBX following the independent review. Yet ICBX recommended seven nights of nursing care and transition to child specific trained care workers. ICBX said once care had transitioned to care workers a review should be completed within six months and only then should there be discussions about the reduction of nights.
45. The DST provides evidence to show the ICB’s assessor consulted other clinicians about D’s needs around seizure management. In summary, clinicians felt those caring for D should be competent on the use of VNS, administration of oxygen therapy and rescue medication.
46. The DST records the view of a Consultant Paediatric Neurologist who said, “those caring for [D] will need to use clinical judgement at all times in view of her complex needs and inability to verbalise/advocate for herself”. The Consultant also confirmed D’s care could be safely delegated dependent on consistency of carers who are familiar with, and competently trained in supporting D’s seizure needs.
47. The ICB confirmed the transition to trained care workers has not happened yet. The ICB has not provided evidence to show it has sufficiently trained care workers over a transition period who are competent in supporting D’s seizure needs and who can always use clinical judgement. D’s night-time support continues to be met by registered nurses. The ICB’s decision to instruct its lead provider to find care workers for four nights of care was taken with fault. The ICB has not provided a cogent rationale to show why it is only responsible for four nights of night-time care as opposed to the seven nights it currently provides.
48. The DST did not record any change or improvement in D’s needs. The information in the DST and information from the Council supports the view D’s parents would be at increased risk of carer’s strain if formal support was not in place. There is not enough evidence to show the ICB properly considered the impact the proposed changes would have on D’s parents as carers.
49. The DST provided by the ICB does not record the recommended provision which should include rationale and current support. The section of the DST where this information should be recorded states “TBC”. This is not in line with the process set out in the C&YP Framework which says, “the nominated children and young people’s health assessor should produce recommendations for presentation to the decision-making forum”. The ICB is at fault.
50. The ICB’s continuing care operational policy also says, “the ICB must guard against making changes to a package of care, where the child or young person’s underlying needs have not changed, any changes must be evidenced by the review conducted by BLMK ICB Nurse Assessor”. The information from the ICB does not provide enough evidence to show it has properly followed its own policy. This is fault.
51. The ICB’s continuing care operational policy says following the assessment the Nurse Assessor “will also make recommendations with regards to eligibility for Continuing Care, around any outstanding actions required to further support the child/young person and how the proposed package of support will meet the desired health outcomes the child/young person and their family wish to be achieved. … The Panel members must consider the evidence presented and the Nurse Assessor’s recommendations and decide together the eligibility”.
52. It is unclear what recommendations from the DST the Panel considered when it met in December before writing to Mrs G as the DST has no recommendations. The letter from the Panel to Mrs G does not provide a written explanation or rationale for its decision. This is fault. It is likely this caused D’s parents avoidable distress and worry over a prolonged period.
53. Mrs G provided a risk assessment completed and followed by the current care agency when providing care to meet D’s daytime and night-time care needs. The risk assessment details the measures in place to safeguard D from harm or risk of harm. The risk assessment states, “nurse to lead on all clinical care and [health care assistant] to assist the nurse”. Mrs G has always used the direct payment from the Council to pay for nursing care with the Council’s knowledge. This led to a shortfall in the 24 hours of weekly support due to the cost of nursing care above the cost of care workers.
54. The Council completed two children and family assessments over the last two years, the last one being in June 2024. It said its latest assessment showed a higher level of need for respite. It said, “in order to provide reasonable and meaningful respite where the parents can safely and confidently leave [D] in the care of professionals nursing care will be necessary alongside a carer”.
55. The Council confirmed senior colleagues from the Council and the ICB met during our investigation. It said there are “strongly held and different professional opinions on the service provision for [D]”. The Council said it did not agree with the ICB’s current assessment of service provision for D. It said it recognised there had not been a joined-up and holistic approach between the Council and the ICB when assessing D’s needs.
56. The C&YP Framework makes it clear there should be a holistic and multi-agency assessment of the needs of the child and their family/carers. It emphasises the need for collaboration and effective liaison between health and social care organisations, to ensure the child and their family’s needs are appropriately met. The lack of holistic assessment and multi-agency working in this case is not in line with the C&YP Framework. The ICB and the Council are at fault.
57. The Council confirms it considers the night-time support a health need which should be met by the ICB. The Council’s view is there is a shortfall in the support the ICB is suggesting. The Council also said the social care support it previously provided was not enough to meet D’s needs.
58. The ICB’s continuing care operational policy says, “a continuing care assessment is health needs led and should not be undertaken to shift commissioning responsibility, either within the [ICB or between the ICB and the Council]”. The ICB has always had responsibility for D’s night-time needs related to seizure management over seven nights. Mrs G says the ICB expects the Council to have responsibility for two nights (as respite provision) although the evidence shows D’s night-time needs are health.
59. The Council’s view should be considered by the ICB when determining its responsibilities. This ICB must comply with the statutory guidance within Working Together to Safeguard Children and work with the Council using a child-centred approach.
60. The C&YP Framework says, multiagency groups should work with the family to support the health assessor “to produce the child or young person’s continuing care options which are safe and effective, taking into account the child or young person’s and their family’s preferences. Involvement of the family is essential, not least to discuss options in relation to the parental role as carers”.
61. The ICB should also have due regard to the C&YP Framework and the Haringey judgement which states there are clear limits on what a Council should fund. It is unclear whether the ICB has done this. The lack of holistic assessment and
    multi-agency working is likely to be a contributory factor for the differing views between the Council and the ICB. Both organisations should consider their responsibilities within a holistic assessment to avoid inappropriate commissioning.

More recent action by the Council

62. During our investigation the Council provided evidence to show it has acted to put things right in the interim following its assessment of D and the carers’ needs of her parents.
63. The Council said it completed 624 residential searches when looking for suitable respite provision but could not secure a suitable placement. It now accepts D’s needs can be met in the preferred placement Mrs G identified before she complained to the Council. As the placement is not accepting new referrals until November 2024 the Council has provided 48 hours of respite support within the family home until it can secure the preferred placement. This comprises 48 hours of care from a nurse and 48 hours of support from a care worker.
64. The Council considered the impact its faults had on Mrs G and her family due to the shortfall in support it should have provided. As well as acting to provide support it also offered a payment of £5,000 to acknowledge the injustice and the time and effort D’s parents have spent throughout the care planning process.

Conclusion

65. The ICB did not follow the recommendations from an independent assessment which were accepted by the Senior Appeals Panel in response to Mrs G’s appeal. The Panel later agreed new recommendations despite there being no change or improvement in D’s needs. The Panel did not provide documentary evidence or a written explanation and rationale to show why it departed from its decision made months earlier.
66. The ICB instructed its lead provider to find a care agency based on a reduction in night-time hours from seven nights to four nights. Before doing this and, in accordance with the independent assessor’s recommendations, it should have gathered evidence to show D’s night-time health needs have been successfully transferred to trained care workers who are competent and have the clinical knowledge to manage D’s needs over a stable period before taking steps to reduce the number of nights of support. This likely caused D’s parents avoidable distress and worry.
67. The ICB is entitled to have a commissioning strategy in place. However, there is not enough evidence to show it properly considered the impact its decision to reduce care would have on D’s parents. It should have worked jointly with the Council while considering any social care assessments, risk assessments and evidence from the family to ensure safe and effective continuing care options.
68. The Council accepts the care and support it initially provided was not enough and this caused Mrs G and her family injustice. It now believes D needs nursing care alongside any social care she needs day and night. The Council acted to put things right during our investigation. This is good practice by the Council.
69. The Council and the ICB did not work together effectively to consider D and her family’s care and support needs in a holistic and multi-agency way. It is likely this led to gaps in the support D needed and may have led to inappropriate commissioning.

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Agreed actions

70. To remedy the injustice caused by the faults, the organisations will take the following actions within one month of our final decision.
• The Council and the ICB will apologise for the impact their failure to assess D’s care and support needs jointly and holistically in line with the guidance in the C&YP Framework had on Mrs G and her family. The ICB will also apologise for the impact the sharing of confidential information had on Mrs G.
• The Council will pay Mrs G and her family £5,000 in recognition of the injustice it caused to them, as it offered when responding to us.
• The ICB will pay Mrs G and her family £1,000 in recognition of the avoidable distress and worry they experienced due to its failure to act in line with the independent recommendations it agreed to and to properly consider the family’s needs. It will also acknowledge the significant time and effort Mrs G has spent pursuing the appeals and complaints process.
71. Within two months of our final decision, the Council and the ICB will do the following.
• Arrange a joint review of D’s nighttime care package, respite care package and the carers’ support offered to Mrs G and her family. The organisations should make sure they take into account: D’s and her family’s holistic care and support needs, the C&YP Framework and their wider safeguarding duties. The review should consider commissioning responsibilities to ensure care is not commissioned inappropriately taking into account the Haringey judgement. The review decision should ensure there is clear agreement about which organisation is responsible for commissioning and funding different parts of each care package. This review should take place as an additional event, rather than as part of any annual review process. Where necessary, the ICB and the Council should follow any local dispute resolution policy if they disagree with each other.
• The ICB will have due regard to the independent assessment, the advice from D’s clinicians, and D’s current care provider, about the competency and knowledge staff need to have to successfully manage D’s healthcare needs whether during the day or night.
• The ICB will follow the recommendations made by ICBX it agreed to, unless it can provide Mrs G and the Ombudsmen with a cogent rationale to show why it and the Council, which is part of the Senior Appeals Panel, should not do so. The rationale for any changes should be clearly explained in a letter to Mrs G showing agreement between the ICB and the Council. The letter should include an explanation of how the ICB and Council considered any opposing views from family and professionals and why they disagreed with them. This should be shared with the Ombudsmen.
• The ICB will remind its staff of the importance of completing all sections of a DST when assessing the needs of children and young people who have complex needs and may be eligible for continuing care.
• The ICB will remind its staff of the importance of only sharing information which is relevant, necessary and proportionate with other professionals or organisations.
72. Within six months of our final decision, the ICB will work with the Council to provide an Action Plan with details of the review of their continuing care procedures to ensure assessments are carried out in a joined up and holistic way, in line with the C&YP Framework. This review should address how the organisations will ensure assessments represent a holistic and multi‑agency consideration of a child’s needs alongside those of their family. The results of this review, and details of any remedial action taken, should be shared with the Children and Young People Scrutiny Committee and the Ombudsmen when completed.
73. The organisations will provide us with evidence they have complied with the above actions.

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Final decision

74. We have upheld Mrs G’s complaint and found fault causing injustice. The Council and ICB have accepted our recommendations. We have therefore completed this investigation.

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Investigator's decision on behalf of the Ombudsman