Summary: We uphold Mr X’s complaint about the way his grandmother’s discharge was handled. We have found the Council failed to properly consider the option of Mrs Y returning home with 24-hour care in place. As a result, Mrs Y and Mr X were caused unnecessary frustration, uncertainty and distress. The Council will apologise, reviews its processes and pay a total of £500.

The complaint

1. Mr X complains on behalf of his grandmother, Mrs Y. He complains about the way Mrs Y’s discharge was handled in 2022 by Doncaster Metropolitan Borough Council (the Council) and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (the Trust). Specifically, he complains about the way Mrs Y’s mental capacity assessments were carried out, a Best Interests meeting and the decision to discharge Mrs Y to a care home without properly exploring returning home.
2. As a result, Mr X says that incorrect assumptions were made about Mrs Y’s mental capacity, which impacted on her discharge arrangements. He says Mrs Y was moved into a care home against her and her family’s wishes, without proper consideration of discharging her home with a care package.
3. Mr X is seeking apologies, acknowledgement of fault, service improvements and financial redress.

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The Ombudsmen’s role and powers

4. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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).
5. 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.
6. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their 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

7. I have considered the information Mr X provided in support of his complaint. I have also received information from the Council and the Trust, including Mrs Y’s mental capacity assessments and transcripts from discharge planning and Best Interests meetings. I have carefully considered all the written and oral evidence submitted, even if it is not all mentioned within this decision statement.
8. I have shared this draft decision with Mr X, the Council and the Trust and they had the opportunity to comment. I have carefully considered the comments I received.

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What I found

Key legislation and guidance

Quick Guide: Discharge to Assess

9. ‘Definition of ‘Discharge to Assess – ‘Where people who [no longer need hospital treatment], but may still require care services, are provided with short term funded support to be discharged to their own home (where appropriate) or another community setting. Assessment for longer-term care and support is then undertaken in the most appropriate setting and at the right time for the person.’
10. ‘Wherever possible, people should be supported to return to their home for assessment. Implementing a discharge model where going home is the default pathway, with alternative pathways for people who cannot go straight home, is more than good practice, it is the right thing to do.’
11. ‘Principles for Discharge to Assess model include:
• ‘Supporting people to go home should be the default pathway, with alternate pathways for people who cannot go straight home.
• Putting people and their families at the centre of decisions, respecting their knowledge and opinions and working alongside them to get the best possible outcome.
• Take steps to understand both the perspectives of the patient and their carers… [and] their needs…’

Mental Capacity Act and Code of Practice

12. A ‘person who lacks capacity’ means a person who does not have the ability to make a particular decision or take a particular action for themselves at the time the decision or action needs to be taken. A person may lack capacity to make some decisions for themselves but will have capacity to make other decisions.
13. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
14. The Mental Capacity Act says:
• A person must be assumed to have capacity to make decisions unless it can be proved otherwise,
• Wherever possible, a person should be helped to make their own decisions,
• Any decision made on behalf of someone who lacks capacity must be in their best interests.
15. Any decision made on behalf of someone who lacks capacity should be an option that is least restrictive of their basic rights and freedoms.
16. There are two stages that need to be considered when assessing a person’s mental capacity. Firstly, whether that person has an impairment of the mind or brain. Then, whether that impairment means that person is unable to make a specific decision when they need to do it.
17. A person is considered unable to make a decision if they cannot understand the information relevant to the decision, retain and weigh up that information to make a decision and communicate their decision.

Care and Support Statutory Guidance - Care Act 2014

18. The Care Act 2014 and the Care and Support Statutory Guidance (the Guidance) is the legal framework for Adult Social Care. It places a duty on councils to support and promote the wellbeing and independence of people who need care and support. Section 10 relates to person-centred care and support planning.

What happened

19. On 6 January 2022, Mrs Y fell at home and fractured her hip. She was admitted to Doncaster Royal Infirmary. Prior to admission, Mrs Y had been living at home with three daily care visits.
20. On 28 January, following hip surgery, Mrs Y was transferred to a rehabilitation bed at Mexborough Montagu Hospital for further rehabilitation.
21. Mrs Y’s discharge was handled by the hospital’s Integrated Discharge Team (IDT). This is a team of health and social care staff who assess patients with complex discharges and work together with professionals such as Occupational Therapists (OTs) to arrange appropriate discharge plans.
22. On 7 February, a social worker attempted to complete a mental capacity assessment in relation to Mrs Y’s capacity to decide her discharge arrangements. Mrs Y was confused and did not have her glasses and hearing aids available. It was agreed to repeat the assessment in a week to see if the confusion would resolve.
23. Following the mental capacity assessment, Mrs Y’s daughter was contacted to discuss her mother’s confusion. She had not seen Mrs Y since her admission due to COVID-19. Her daughter felt the high level of Mrs Y’s confusion was not usual for her and said her mother had capacity prior to admission. The Council records note that Mrs Y’s daughter was advised the assessment would be repeated a week later.
24. On 17 February, a joint mental capacity assessment was carried out by the social worker and a Trust employed OT who had been providing therapy to Mrs Y on the ward. The outcome was that Mrs Y did not have capacity to decide her discharge arrangements. Shortly after, the OT completed further assessments with Mrs Y, which indicated problems in all areas of thinking and reasoning. Mrs Y continued be confused on the ward and the nursing staff raised concerns.
25. On 23 February, a discharge planning meeting was held between various professionals and three members of Mrs Y’s family who were all health and welfare attorneys on her behalf. The professionals explained that Mrs Y was displaying significant cognitive difficulties which caused high risk of falls requiring 24-hour care. The family were upset and concerned by the information, which they said did not match the Mrs Y they knew. The family asked for Mrs Y to be discharged home, in line with her previous wishes. The Council meeting minutes record that the family was advised the Council did not fund 24-hour care at home and this would need to be funded privately by the family. A short term 24-hour care home placement was suggested, which the family strongly objected to.
26. On 1 March, a further discharge planning and Best Interests meeting took place. This was attended by various professionals, including the social worker, the OT and ward nurses. Mrs Y’s family also attended. Mrs Y continued to be confused, need constant supervision due to falls risks and help with frequent toileting including overnight. Mrs Y’s family repeated their wish for the option of 24-hour care at home to be explored. The social worker advised that this was not an option as the Council would not fund it and the family could not afford to do so. The family were given two options. Firstly, Mrs Y moves into her daughter’s home with three daily care visits with the family supervising and assisting with toileting in between. The family felt unable to assist with toileting for dignity reasons. The second option was a 24-hour short term care home placement, which the family was strongly opposed to. No agreement was reached.
27. In March 2022, Mr X complained. The discharge process was paused while further work was carried out and a new social worker was allocated.
28. In April 2022, a mental capacity assessment was completed by an independent social worker. Mr X attended to support Mrs Y. The assessment found Mrs Y was able to make some decisions about her daily care, however concluded that she lacked capacity to make decisions about her discharge arrangements.
29. In May 2022, a home visit was carried out with Mrs Y to assess her. Initially Mrs Y did not recognise her home, although she was moving around well. However, following a nap, Mrs Y became less co-ordinated. The OT decided that her ability to move was variable and she remained a high falls risk. A further discharge meeting was held and, while the family still strongly wished for Mrs Y to return home with 24-hour care in place, they agreed to a short term care home placement.
30. On 1 June 2022, Mrs Y was discharged to a care home. Further capacity assessments took place, and while there was some improvement to Mrs Y’s cognition within the care home, she was still found to lack capacity to decide her care and residency arrangements due to limited insight into risks. In July 2023, Mrs Y’s care home placement became permanent.

Analysis

Mental Capacity Assessments

31. Mr X complains that the mental capacity assessments were not carried out properly for several reasons, which I will now address in turn.

Glasses and hearing aids

32. Firstly, Mr X complains that Mrs Y was not wearing her glasses or hearing aids during the assessments, which impacted on her ability to understand the questions being asked. The Council has confirmed that Mrs Y was not wearing her glasses and hearing aids for the first mental capacity assessment. This assessment was not completed. It was decided to delay the decision and repeat the assessment again in a week, to give time to see if Mrs Y’s confusion might resolve. This is in line with the Mental Capacity Act 2005 (The MCA). The Council records note the social worker also asked the family to bring in Mrs Y’s glasses and hearing aids. The family provided these and explained that Mrs Y did not like to wear her hearing aids.
33. Mrs Y had both her glasses and hearing aids available for the second mental capacity assessment, which was conducted jointly with the social worker and the OT. The Council’s records note that Mrs Y agreed to wear her glasses and commented that she could see better. It is also recorded that Mrs Y was encouraged to wear her hearing aids, however she refused. Continued encouragement was causing Mrs Y to become distressed and the assessors did not consider it appropriate to pursue this with her further.
34. The assessors could not make Mrs Y wear her hearing aids if she did not want to. The records shows that the professionals did consider the impact of this refusal on their ability to carry out the assessment. It is noted that Mrs Y was taken to a quiet room, where the assessors spoke loudly and clearly and repeated questions when necessary. They noted that Mrs Y was able to respond appropriately and repeat information back and they were satisfied that she could hear them adequately to carry out the assessment. It was also noted that Mrs Y was able to communicate and joke with the staff on the much noisier ward, without her hearing aids. I am satisfied that the assessors properly considered the impact of Mrs Y declining to wear her hearing aids and I have not seen any evidence that this impacted on her ability to engage properly with the assessment.

Hospital environment and infections

35. Mr X further complains that hospitals are the wrong place to assess capacity. He says the impact of the hospital environment, long term lack of sleep on the ward and delirium from recurrent Urinary Tract Infections (UTIs), lack of vitamin B12 and COVID-19 on Mrs Y’s capacity were not properly taken into account.
36. It is recognised that long term care decisions should not be made in an acute hospital setting. However, it was necessary to have some formal insight into Mrs Y’s mental capacity regarding her discharge arrangements. Practically, that assessment would therefore need to take place prior to discharge, often in a hospital environment. That said, the option of a home visit earlier in the discharge process could have given valuable additional insight into how Mrs Y managed in her home environment too. I will address this in full later.
37. Each mental capacity assessment relates to a person’s capacity to make a specific decision at the time it needs to be made. The assessments would have been specifically about Mrs Y’s ability to decide her discharge arrangements at that particular time. While a person’s capacity may be temporarily impaired, for example due to illness, it is not always possible to delay a decision. Hospital discharge is a time sensitive matter and it is generally accepted that patients who are medically fit for discharge benefit from a timely discharge.
38. Mrs Y was being discharged to a Discharge to Assess pathway where a full assessment of her capacity and needs was to be carried out in relation to her long term care needs. The IDT had made a referral to the Older Person’s Mental Health Team for further capacity and cognitive assessments to be completed in the community. The records also note that Mrs Y’s capacity was fluctuating, the confusion had the potential to resolve and her cognition should be reviewed again after discharge.
39. I also note that the assessors took steps to mitigate the hospital environment as much as possible for the assessment. Mrs Y was given a nutrient drink that morning, at her family’s request, as they felt she improved after these. She was assessed in the morning, when the ward staff reported she was most alert. She was also taken to a quiet room where she could hear easier and there were fewer distractions.
40. I accept that the hospital environment, lack of sleep on the ward and infections are factors that likely had some impact on Mrs Y’s capacity. Indeed, there was some improvement in Mrs Y’s cognition when she moved into the care home and settled into a better sleep pattern. However, I have not seen any evidence to suggest that these were the sole reason for her confusion and cognitive problems. Further assessments after discharge continued to find that Mrs Y lacked capacity around her residency arrangements and care needs.
41. I appreciate that Mrs Y had recurrent UTIs, which can cause delirium. The Trust told me that concerns about Mrs Y’s frequent toileting were raised on 13 February 2022 and a doctor reviewed her bloods and a recent culture and took the view that it was unlikely that a UTI was present. The Trust says there is nothing in the medical records to indicate that a UTI was present during the mental capacity assessment on 17 February and no further concerns were raised about her toileting between 13 and 20 February. A few days after the mental capacity assessment, Mrs Y tested positive for a UTI which was treated with antibiotics. Mrs Y later tested positive for both a UTI and COVID-19 on 3 March 2022, three weeks after her mental capacity assessments. While I acknowledge that both these infections can contribute to delirium, I have not seen any evidence to confirm that Mrs Y had an active UTI or COVID-19 during her mental capacity assessments. Further, Mrs Y would not have had these infections constantly throughout her admission, yet the ward staff reported ongoing daily confusion and cognitive concerns. Therefore, while infections may have had some impact on Mrs Y’s cognition, it does not appear to be the primary cause and I have seen nothing to confirm these impacted on her formal capacity assessments.

Family not invited to mental capacity assessments

42. Mr X complains that family members were not invited to support Mrs Y at her mental capacity assessments, particularly as they were appointed health and welfare attorneys. In response to my enquiries, the Council and the Trust to me that family members, even those who are attorneys, are not routinely invited to mental capacity assessments to avoid any undue influence on the process by the presence of family members.
43. There is no requirement in the MCA for family members or attorneys to be present at a mental capacity assessment. The Code of Practice says ‘sometimes having a relative or friends nearby can provide helpful support and reduce anxiety. However, some people might find it intrusive, and it could increase their anxiety or affect their ability to make a free choice.’ The Council records note Mrs Y’s family felt unable to accept an offer to visit Mrs Y in hospital in February 2022, due to COVID-19, although Mr X disputes this. Mrs Y also became distressed by their presence at virtual meetings. I further note that, following his request, Mr X attended the last mental capacity assessment in April 2022. I have not found fault on this point.

Discharged Mrs Y with COVID-19

44. Mr X complains that Mrs Y was going to be discharged to a care home while she tested positive for COVID-19.
45. During a Best Interest meeting on 8 March 2022, there was a discussion between the family and the social worker about Mrs Y having recently tested positive for COVID-19. This included whether this would delay Mrs Y’s discharge. I acknowledge that Mrs Y’s family found the conversation frustrating. I also note the transcript shows that the meeting concluded that Mrs Y would not be discharged to a care home until 10 days after her positive test. In the end, Mrs Y was not discharged until May 2022.
46. The Trust explained to me that Mrs Y was regularly tested on the ward for COVID-19. She tested positive on 3 March, and again on 13 March. Following that, she did not test positive again.
47. Mrs Y was tested for COVID-19 on 31 May 2022, the day before discharge. She did not test positive. Mrs Y was discharged significantly after the ten-day isolation period had passed. There is no evidence to suggest that she was discharged to a care home while she was testing positive for COVID-19, therefore I have not found fault on this point.

Best Interests Meetings

48. Mr X complains about the way the Best Interests meetings were conducted and says that the wishes and views of Mrs Y and her family were not taken into account. I will address each one in turn.

Social worker comments about dementia

49. Mr X complains that, during a Best Interests meeting, the social worker shared her view that Mrs Y had mild dementia. Mr X says the social worker was not qualified to make such a statement.
50. I have reviewed the minutes and transcripts from the Best Interests and discharge planning meetings. I can see that Mrs Y’s capacity was discussed and it was recognised that the ward staff had raised concerns about Mrs Y’s cognition and that her medical records had queried possible dementia. The family’s input that Mrs Y previously had several tests for dementia and nothing had been formally diagnosed is also recorded. I note Mr X’s concerns about the accuracy of the minutes, however most of the records are automated transcripts of the meetings.
51. I have not found a record which confirms the social worker stating a view that Mrs Y had mild dementia. I acknowledge that is the family’s recollection of the conversation, however without an independent record to confirm this, I am unable to make a finding on this point.
52. I note that all written assessments and care plans state that Mrs Y had no formal diagnosis of cognitive impairment and the discharge planning was made based on this information.

Financial questions

53. Mr X complains that the family were asked about Mrs Y’s financial circumstances right at the start of the meeting and before the discharge options had been properly discussed. The family found this upsetting and made them feel the decision was ‘all about money’.
54. Having reviewed the transcripts and meeting minutes, I can see that, during the 8 March meeting, the family stated their preferred option on 24-hour care at home at the start of the meeting. The social worker responded that the Council would not fund this and it would need to be privately funded. This led to some discussion around Mrs Y’s finances.
55. Financial assessments are a part of discharge planning and it is important to have clear conversations about this, to ensure that all parties are aware of the financial implications of discharge options. However, care options should first be explored to see how best to meet a person’s needs, then finances considered. The Council has acknowledged that it would have been unhelpful to discuss this first and apologised.

Social worker’s views only

56. Mr X complains that the social worker’s views dominated the early discharge planning meetings and the other professionals did not say enough. I have not found evidence to support this. I have reviewed the meeting minutes and transcripts which record various professionals including the OT, physiotherapist and ward nurses sharing their professional opinions. It is clear that all professionals had an opportunity to speak and collectively agreed that Mrs Y required 24-hour care to remain safe.

Mrs Y’s views

57. Mr X complains that Mrs Y’s views and wishes were not taken into account. The meeting minutes, transcript and discharge planning documents I have seen all include that Mrs Y valued independence and held a long standing view that she did not wish to move into a care home. She continued to express this view during her hospital admission. Although Mrs Y was clear in her wish to return home, she was found to lack capacity regarding her discharge plans as she was unable to fully understand the risks.
58. That said, the ward reported that Mrs Y was enjoying company and did not like being alone overnight. While this did not match with her previous views, it was considered that she may benefit from a more social environment now. A person’s needs and wishes can change over time. Making a Best Interests decision can involve a delicate balance of respecting a person’s previous wishes along with their current preferences.
59. As I have already addressed above, I consider that all reasonable steps were taken to ensure Mrs Y could engage with the capacity assessment process. Mrs Y was also invited along to the discharge planning meetings, although unfortunately was unable to stay as she became distressed when seeing her family virtually.
60. I am satisfied that Mrs Y’s views and wishes were clearly gathered and known to the professional team. As I will address later, I do not consider that sufficient action was taken to properly explore the option of fulfilling her wishes to return home.

The family’s views

61. Like Mrs Y, the family held strong views about her return home and did not wish for her to move into a care home. As her health and welfare attorneys, they sought to uphold her long standing view on the matter. While initially struggling to understand the rapid change in Mrs Y since her admission, the family accepted that Mrs Y likely needed 24 hours care to remain safe. All family members were in agreement that their strong preference was for 24-hour care to be provided within Mrs Y’s own home and not via a care home placement.
62. The family’s views were recorded within the discharge planning, mental capacity assessment and best interest decision documents. Their views were also discussed at every meeting. As above, the professionals gathered and were clear on the family’s position, but not enough was done to properly explore this option.

The option to return home with 24-hour care

63. Mr X complains that the option to discharge Mrs Y home with 24-hour care was not properly explored before a discharge decision was made. The family felt this option was quickly dismissed for financial reasons without proper consideration first. Mr X says the family felt bullied and railroaded into accepting a short-term care home placement, without sufficient information about all options to make the decision.
64. During the complaint handling, both the Trust and the Council recognised that the option for Mrs Y to return home had not been properly explored during initial discharge planning. For example, no home visit was planned. It was only after Mr X complained that this option was considered further, including completing a home visit. As a result, the family did not have sufficient information to make an informed decision about discharge options. This is fault. Both organisations have apologised.
65. Initially the social worker had told the family that there were only two discharge options to decide between: moving into the family home with care visits or a care home placement. She said this was because the Council would not fund 24-hour care at home and the family was unable to fund this privately. The family replied that the option of 24-hour care at home needed to be fully explored before any decision was reached, regardless of funding.
66. There was also discussion around whether Mrs Y was suitable for a step down rehabilitation placement. This is a short term community placement to help a person improve their strength and functional skills prior to returning home. However, it was decided that this was not the right placement for Mrs Y as is was unlikely to offer adequate supervision to manage her falls risk. Mrs Y was also struggling to engage with therapy exercises at the time, due to her cognitive problems.
67. The Best Interests decision documents completed on 8 March 2022 weighs up the benefits and risks of three discharge options: going home with 24-hour care, moving into a family home with daily care visits or 24-hour care in a short term care home placement. This document recognises that 24-hour care at home would meet Mrs Y’s wishes but fails to consider that this would also be the least restrictive 24-hour care option. This is contrary to Principle 5 of the MCA which states that ‘before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive or a person’s rights and freedom of action.’
68. Further the only risk identified in this document for 24-hour care at home was that the Council did not fund 24-hour care at home and therefore this was not a viable option. This was repeated to the family in meetings on several occasions. For this reason, this option was initially discounted by the professional team without sufficient further consideration. There is nothing in this document to suggest that Mrs Y’s needs could not be met at home with 24-hour care.
69. Following Mr X’s complaint, a new social worker was allocated and the relationship with the family improved. Further work to explore the options was carried out and the family ultimately agreed to a short term care home placement. However, the Council’s position that it did not fund 24-hour care at home was maintained.
70. An organisation should not adopt a blanket or uniform approach or policy that prevents it from considering the circumstances of a particular case. We may find fault in the actions of organisations that ‘fetter their discretion’ in this way. This applies to the Council’s blanket decision that it does not fund 24-hour care at home.
71. I acknowledge that 24-hour care at home is a costly option and that the Council is obliged to spend public money wisely. Section 10.27 of the Department of Health guidance for the Care Act 2014: ‘Care and Support Statutory Guidance 2014’ says ‘In determining how to meet needs, the local authority may also take into reasonable consideration its own finances and budgetary position, and may comply with its related public law duties. This includes the importance of ensuring that the funding available to the local authority is sufficient to meet the needs of the entire local population. The local authority may reasonably consider how to balance that requirement with the duty to meet the eligible needs of an individual in determining how an individual’s needs should be met (but not whether those needs are met). However, the local authority should not set arbitrary upper limits on the costs it is willing to pay to meet needs through certain routes – doing so would not deliver an approach that is person-centred or compatible with public law principles. The authority may take decisions on a case-by-case basis which weigh up the total costs of different potential options for meeting needs, and include the cost as a relevant factor in deciding between suitable alternative options for meeting needs. This does not mean choosing the cheapest option; but the one which delivers the outcome desired for the best value.’
72. From the evidence I have seen, I am not satisfied that the Council properly considered whether Mrs Y’s needs could be met at home with a 24-hour care package when exploring discharge options. I have seen nothing to suggest that Mrs Y’s needs could not be met at home with a 24-hour care package or that domiciliary care was considered inappropriate. The Council was agreeable for Mrs Y to potentially have unqualified family members providing supervision and support between formal care visits. Therefore, it follows that a formal 24-hour care package at home also had the potential to provide adequate supervision and support. Instead, this option was quickly dismissed by the Council, due to finances, without first establishing whether Mrs Y’s needs could be met this way.
73. The records show the family were advised at every discharge planning meeting that the Council would not fund 24-hour care at home. Initially, the family were told there were only two discharge options due to lack of funding, which did not include 24-hour care at home. Following Mr X’s concerns, further work was carried out including a home visit and the new social worker explained to the family why she felt the social aspects of a care home would benefit Mrs Y based on her behaviour on the ward. While the further work was welcomed by the family to reach a decision, the Council’s position that it did not fund 24-hour care at home was maintained.
74. A Council must consider a person’s wishes, although it is not obliged to follow them. A Council must meet their needs. The decision about how best to meet a person’s needs should take into account all relevant information including wishes, benefits and risks, least restrictive options and finances for that particular person.
75. The Council repeatedly stated its position that it does not fund 24-hour care at home. The Council failed to take a holistic approach and instead fettered its discretion by applying a blanket financial approach rather than considering each person’s needs on a case by case basis. This is contrary to the Care Act 2014 and the Guidance. This is fault.
76. As noted above, Section 10.27 of the Guidance means councils can look at the most cost effective way of meeting someone’s needs. However, they also have to consider the benefits of someone remaining in their own home, if that is what they or their family want. While this has to be balanced with the need to maintain sufficient funding for the whole area, if the benefits sufficiently merit it, there are grounds to pay a higher budget to help a person stay in their own home. Further, Section 11.2 of the Guidance says “Local authorities should not have arbitrary ceilings to personal budgets that result in people being forced to accept to move into care homes against their will”.
77. While we cannot know what the outcome of the decision would have been and whether it would have been different, the decision was not taken properly. This is fault. As a result, the family experienced significant frustration and uncertainty. The family did not feel heard. The family stated ‘for the record, we strongly object and if there was any other way of keeping Mrs Y in her own home, that will be the family’s preference and that will be Mrs Y’s preference. But we can’t do that obviously because there is no funding from the Council and we can’t fund it'. Instead the family said they felt ‘railroaded’ into a decision to place Mrs Y in a care home, against her previous wishes, without having access to all the relevant information to make an informed decision. This was distressing for them.

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Agreed actions

78. Within one month of my final decision, the Council will apologise to Mrs Y and Mr X for failures in Mrs Y’s discharge planning.
79. Within one month of my decision, the Council will pay:
• Mrs Y £250; and
• Mr X £250 in recognition of uncertainty and frustration
80. Within three months of my final decision, the Council will review its policies to ensure that all requests for 24-hour care at home are properly considered on a case by case basis, in line with Section 10.27 of the Guidance. The Council will also ensure that all staff are aware of any changes arising from this.

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Final decision

81. I found the Council failed to take a holistic approach to Mrs Y’s discharge planning. The Council did not properly consider whether Mrs Y’s needs could be met with 24-hour care at home, instead applying a blanket financial decision contrary to the relevant legislation. This meant Mrs Y’s family did not have all the relevant information to make an informed decision about her discharge. This also caused significant frustration and uncertainty for Mr X.
82. I have not found fault in relation to Mrs Y’s mental capacity assessments were carried out. I have now completed my investigation.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman