A council’s multiple breaches of the Care Act and failure to give due regard for a woman’s human rights left her malnourished and degraded, a report has found.
The Local Government and Social Care Ombudsman found that Gloucestershire council failed to appropriately assess or meet Miss X’s needs or support her partner, Mr L, in caring for her, leading him to burn out and leave.
It also ignored professional medical advice about her dietary needs from her GP and a dietician, despite them pointing out that Miss X, who has ME/chronic fatigue syndrome and severe dietary intolerances, was not eating enough because of a lack of care.
And the council’s failure to reassess her night-time care needs meant she suffered the “degrading consequences” of not being able to use the toilet during the night.
The ombudsman also criticised the level of communication provided by Miss X’s then social worker, who went a month without contacting her, including a week in which she went without overnight care between two of a succession of hospital admissions.
Council ‘did not listen to those involved’
Ombudsman Michael King said: “This case is a prime example of the council simply not listening to people involved in the case. It failed to take on board information from the woman, her former partner and the medical experts involved in her care.
“It seems very likely that, had the council assessed the woman’s former partner properly and arranged appropriate support and respite, he may have been able to carry on with his caring role for longer. And because it did not act sooner, the council had to put in place hastily arranged support when their relationship broke down.”
The council has accepted the watchdog’s recommendations to:
- Apologise to Miss X for the injustice caused and pay her £2,050 for failing to assess or meet her needs, consider relevant professional information, support Mr L as her carer. reassess her night-time needs or communicate properly with her.
- Apologise to Mr L and pay him £300 for the injustice caused.
Gloucestershire also agreed to remind staff of the need to reassess people, under the Care Act, when their circumstances changed or deteriorated, consider medical opinion and evidence, in line with act, and follow the act’s statutory guidance in carrying out carers’ assessments.
Carer breakdown
Mr L had, as part of Miss X’s care plan, bought food for her, prepared meals and helped her with toileting at night, while the council also provided her with direct payments with which she employed personal assistants.
In September 2018, Mr L told the council he was struggling to cope, leading the council to increase Miss X’s care hours and explore a respite placement; however, this service could not meet her dietary needs.
He told the authority again in December 2018 that he could not cope while, in March 2019, Miss X told a council assessor the same and that Mr L could not continue supporting her. The assessor told Miss X that she needed to be reassessed, and a social worker then visited and said respite care was “clearly needed”.
However, in April, Mr L, with two days’ warning, told the council he was leaving.
‘No evidence of carer’s assessment’
Despite the council saying it had commissioned the local carers’ hub to assess Mr L, the ombudsman found no evidence that a carer’s assessment had been done. He said this was fault and contrary to the Care Act, section 10 of which requires councils to assess any carer who may have needs for support, now or in the future.
The ombudsman also said the council was at fault for the absence of any plan for responding to carer breakdown in Miss X’s care plan dated October 2018, despite this being weeks after Mr L said he was struggling to cope.
He concluded that, had Mr L been assessed and appropriately supported, including through respite, he may have been able to continue in his role for longer. The absence of contingency planning meant that he had to act quickly when the relationship broke down.
As well as breaching the Care Act through its failure to assess Mr L, the ombudsman found that these faults meant the council had failed to show due regard to Miss X’s right to private and family life under Article 8 of the European Convention on Human Rights.
‘Ignored’ professional advice
Following Mr L’s departure, Gloucestershire increased Miss X’s direct payments by eight hours to enable her PAs to do some batch cooking.
However, over the next few months, Miss X, her GP and her representative, Ms P, repeatedly told the council that that Miss X did not have enough food because the carers did not have time to prepare it for her.
In July 2019, the GP said that Miss X was at risk of malnutrition, with a dietician saying she was at high risk, in September of that year, “primarily due to the significant lack of time carers had to shop, check food labels, and prepare food”.
However, despite this, the ombudsman found no evidence that the council reassessed Miss X’s needs in response to the GP and dietician’s advice.
The ombudsman found that this was not in line with requirements under Care Act assessment regulations for councils to consult people with expertise in the person with needs’ condition or circumstances where required.
Gloucestershire “ignored the professional advice and input from people with relevant expertise”, the watchdog said.
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‘Degrading consequences’
The ombudsman also found that Miss X went a week without support for her night-time needs following a hospital admission in October 2019.
Ms P said this effectively forced Miss X to be incontinent, resulting in a urinary tract infection that led to her being readmitted to hospital, and her having to throw away linen, clothing and a mattress due to extreme soiling.
The council said that, at the time, she was not assessed as needing overnight care, however, the ombudsman found that the authority had recognised the need to reassess her overnight needs at least six months previously.
Gloucestershire gave Miss X incotinence pads during the week in question, but these were ineffective and left her extremely soiled. During this time, Miss X made numerous attempts to contact her then social worker but without success.
The ombudsman found that the council was at fault for the fact that Miss X was unable to contact her social worker or anyone else in the department at such a crucial time. In total, he found that there was very little, if any, communication between the social worker, who no longer works for the council, and Miss X for a month.
This was on top of its fault in not reassessing her night-time needs having recognised the need to do so, which also involved a failure to show due regard for her rights under article 8 of the ECHR, given the “degrading consequences” she faced as a result.
‘Sincere apology’
Sarah Scott, executive director for adult care services and public health at Gloucestershire, said: “We sincerely apologise to ‘Miss X’ and ‘Mr L’ for letting them down. Although this was an extremely complex set of circumstances, not replicated in any of the more than 5000 other adults we support in formal care settings, we know we could and should have done better. Without exception, we accept the ombudsman’s findings and have already made significant progress towards implementing all of their recommendations.
“As well as the steps taken in response to the LGSCO’s recommendations, we have radically changed the way we deliver adult social care services over the past three years. I am confident the standards of practice, supervision and accountability in place now will prevent a similar situation arising again.”
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“Malnourished”. In 2021. In the 6th richest world economy. But nevermind. SWE and its happy little helpers are beavering away to ensure competent and safe practice. Have you uploaded your CPD yet?
What we are never told in these reports is HOW it happens – and is not corrected when the person first complains to the council – as one MUST do before even going to the LGSCO?
How does it happen that a service user gets a case manager or social worker who knows nothing about the Care Act? And has a manager, and a senior manager, too, who also know nothing about the legal framework that governs their daily functions? And then a complaints officer who does nothing about it, and a safeguarding officer who does nothing, and then a legal department that does nothing? And not even a Monitoring Officer or a Head of Service with the grasp to see that not resolving this would only lead to lasting reputational damage?
Does anyone know how it happens?
It happens because some budget holders regard some people as being undeserving. I am suoervisedby one.
This is what happens when senior management in Adult social care are not registered social workers, so can’t be held to account by social work England for their behaviour and decisions.
Under the GSCC, I think every officer in line management of social work had to be a registered social worker. What changed?
There is nationwide disregard to the duties in the care act. Hopefully The Care Quality Commissioning inspections may put that right, as clearly a slap on the wrist from the ombudsman has no impact, as things are getting worse, not better.
This case highlights quite well the problems associated with imperfect knowledge of The Care Act and also the issue that these huge Care Packages cost and the problems that Social Workers have in getting expensive support plans agreed. The backdrop to these repeated failures are to do with the fact that Local authorities have no money to meet these needs. They are required to meet needs under the Care Act regardless of resources available hence that is why many are on the brink financial collapse. The facts are that Adult Care and Children’s Care is taking more and more resources and referrals have exploded in and after the pandemic. Also it has too be said the amount of knowledge required to do the role of Social worker has exploded hence the reason many are leaving the profession. Social Workers are now expected to have extensive knowledge of law as well as managing high case loads. The ever tightening regulation of Social Workers is also causing many to quit their jobs never to return. The stress now is on a scale never before experienced.
Compassion versus budgets can’t be squared by the pretence that as a regulated profession social work serves the public good.
Compassion is for feel good tweets and self congratulatory blogs. In the social work grind I practice in managers say with no embarrassment “if we don’t have the budget we can break the law and hope there isn’t a complaint.” Almost a verbatim quote from the commissioner in my authority. Sorry if that sounds negative to some leaders. Being a social worker is a choice and a privilege but not one shared by many with power where I work.That is my world. Feel free to dismiss it.
Degrading a persion to the point where they are malnourished has nothing to do with resources and much to do with our so called leaders debasing social work to the point where common humanity and decency are no longer central tennents of our practice. Blame the Tories, blame lega complexities, blame the difficulties of getting care packages approved but none of that excuses callousness. Still we have the Social Work Awards to bury the shame we should feel by blathering on about Justice.
Sadly most LA’s will have examples similar to Mrs X and Mr L. Not only are there shortages of funding for care packages this extends to social workers commissioners and support staff for Adult Social Care Services. Inevitably this leads to delays, rationing and mistakes! Social Care is an inconvenient truth to CEO’s S151 Officers and Council Members, it swallows up the majority of the the LA’s resources but only serves a tiny fraction of the public. Not a good return on investment when your currency is votes at the ballot box!
It may well be that vacancies, incompetent commisioners and shortages of budgets play a huge part. The inconvenient truth is somewhat more basic in this case though isn’t it? For starters we are told medical advice was ignored, night time needs were not assessed, there was no communication from a social worker during two hospital admission where no night time care was provided and so on. No social worker should be content to blame resources when a judgement is made that “this case is a prime example of the council simply not listening to people involved in the case.” Are we now so overwhelmed that our bosses have to “remind” us that we should reassess people’s needs as their circumstances change? What are we for if we don’t instinctively understand the circumstances of the people we are meant to work with? We should feel shame hearing practice like this not explain it as a “mistake” due to some structural deficit. We used to be accountable to higher moral standards whatever the pressures our work put on us. Resources may be more scarce and staffing levels poorer but I have never worked in an authority where I felt everything was a bounty of opulence. How did it come to it that we respond to such an appaling judgement with “lack of resources” as our shrug rather than feel the distress and the humiliation experienced? I have one basic principle: how would I like to be treated? Degraded, ignored and humiliated is not for me, why should it for anyone else. I work in adult services, I have 29 people, some isolated, some with family support, some with “complex needs”, some getting on with their lives without me doing much. I have never not had the time to phone someone, even if the call is made in my care between visits. If we can find the time for a self basting greasing of the egos for a “Celebration of Social Work” we should have time to do our jobs. A more thoughtful profession would at least acknowledge that there is nothing to celebrate in malnutrition and incontinence pads as ‘care’ though. Surprise us with a more sincere apology than a “1 in 5000” justification next time. For there will be a next time when resources become the moral compass. Maybe the Social Worker of the Year will reference something more than “the pandemic” in their speech and surprise us.