Decision : Upheld
Decision date : 02 Jan 2020
The Ombudsman's final decision:
Summary: The Ombudsmen found fault by the Council and Trust with regards to the care and support they provided to a woman with ongoing health needs following her discharge from hospital. The Council and Trust will apologise to the woman’s daughter and pay a financial remedy in recognition of the impact of these events on her.
- The complainant, who I will call Miss H, is complaining about the care and treatment provided to her late mother, Ms G, by London Borough of Croydon (the Council) and Croydon Health Services NHS Trust (the Trust). Miss H complains that:
- The Council and Trust did not properly assess Ms G before discharging her from hospital. Miss H says this meant the Council discharged Ms G to unsuitable accommodation that did not meet her needs;
- The Council delayed unreasonably in arranging an assessment for Ms G by a community social worker following her discharge from hospital; and
- The Trust delayed in referring Ms G for assessment by a specialist sleep disorders clinic at another Trust.
What I have investigated
- Ms G was discharged to temporary accommodation. Miss H’s complaint relates in part to the suitability of this accommodation.
- If a council is satisfied someone is eligible, homeless, in priority need and unintentionally homeless it will owe them the main homelessness duty. Generally, the council carries out the duty by arranging temporary accommodation until it makes a suitable offer of social housing or private rented accommodation.
- The law says councils must ensure all accommodation provided to homeless applicants is suitable for the needs of the applicant and members of his or her household. This duty applies to interim accommodation and accommodation provided under the main homelessness duty.
- If a local authority has accepted the main housing duty, the applicant has review and appeal rights regarding the suitability of any accommodation it offers to fulfil that duty. For this reason, the Ombudsmen will not ordinarily consider a complaint about the suitability of accommodation as they would expect the person to use their review and appeal rights.
- However, the Ombudsmen must first consider whether it is reasonable to expect a person to use, or have used, their right to a review and appeal.
- In my view, it would not have been reasonable to expect Ms G to seek a review of the suitability of her accommodation given that her focus and that of her family was on her significant health problems at that time.
- On this basis, I have decided to consider Miss H’s complaint about the suitability of the accommodation offered to Ms G.
The Ombudsmen’s role and powers
- 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).
- 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.
- 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)
How I considered this complaint
- In reaching this final decision, I considered information provided by Miss H and discussed the complaint with her. I also considered information provided by the Council and Trust. Furthermore, I considered comments from all parties on my draft decision statement.
What I found
Relevant guidance and legislation
Housing Act 1996
- Part 7 of the Housing Act 1996 and the Homelessness Code of Guidance for Local Authorities (the Code) set out councils’ powers and duties to people who are homeless or threatened with homelessness.
- Section 17.5 of the Code says local authorities “will need to consider carefully the suitability of accommodation for applicants whose household has particular medical and/or physical health needs.”
Local accommodation options
- The Council operates some Extra Care Housing units (ECH – also sometimes called special sheltered accommodation) within the borough. These units consist of self-contained flats with access to 24-hour care and support services.
- The Council also offers sheltered accommodation. Sheltered accommodation units are self-contained properties with access to an officer who provides support. This can include assistance with day-to-day activities as well as help and advice.
- Ms G was living with one of her daughters and her family. She was admitted to hospital in March 2018 suffering from shortness of breath and a cough.
- Investigations found Ms G had chronic scarring to her lungs caused by an earlier course of radiotherapy to treat cancer. In addition, clinicians determined Ms G may be experiencing disordered sleep breathing that was contributing to her general breathlessness.
- A respiratory clinician said Ms G would require long term oxygen therapy for a minimum of 16 hours per day.
- The clinical team established that, due to Ms G’s increased health needs, she would be unable to return to live with her daughter. As a result, the Trust referred Ms G to the Council for assessment.
- A social worker initially visited Ms G in April 2018 to assess her social care needs. She found Ms G had no eligible care and support needs. However, she found Ms G was at risk of homelessness and referred her to the Council’s housing team. Ms G was placed on the waiting list for sheltered accommodation.
- Miss H was dissatisfied with the social worker’s assessment. The Council reallocated Ms G’s case to another social worker to complete a reassessment.
- The social worker completed his assessment in May 2018. He found a package of daily reablement care visits could support Ms G to regain her independence.
- On 23 May 2018, the Council offered Ms G temporary accommodation on the first floor of a property with a lift. Ms G accepted this offer. An Occupational Therapist (OT) assessed the property and found it would be suitable for Ms G with some additional equipment.
- The Trust discharged Ms G to her temporary accommodation on 30 May 2018. She received three daily reablement care visits and additional support from a charity.
- Ms G was under the care of the Living Independently For Everyone (LIFE) team. This is a multidisciplinary team comprised of health and social care professionals.
- On 26 June 2018, an OT from the LIFE team reviewed Ms G. She found Ms G felt the property was not suitable for her. The OT established the reablement service and charity support was due to end. She recommended a social worker visit Ms G to discuss rehousing options.
- A social worker referred Ms G for EHC accommodation on 24 July 2018.
- On 2 August 2018, Miss H advised the Council that Ms G’s cancer had returned and had spread to other parts of her body.
- Ms G was admitted to hospital on 8 August 2018. She died on 13 August 2018.
- Miss H complained the Council and Trust failed to properly assess Ms G before discharging her from hospital. Miss H says Ms G needed EHC accommodation but was instead discharged to an unsuitable temporary property.
- The Council said Ms G’s case was discussed at two multidisciplinary discharge meetings. The Council said Ms G was on the waiting list for sheltered accommodation and that professionals agreed this would be sufficient to meet her needs.
- The case records show a social worker assessed Ms G on 12 April 2018. She visited Ms G again on 18 April 2018. They discussed Ms G’s accommodation situation and the social worker noted Ms G was hoping for a ground floor flat. The social worker noted Ms G “does not like the idea of having carers because she is a ‘young woman’”. The social worker found Ms G could mobilise short distances independently and could wash and dress herself without support. She concluded that Ms G had no care and support needs.
- The social worker referred Ms G to the housing team, which placed Ms G on the waiting list for sheltered accommodation.
- On 10 May 2018, the case was allocated to another social worker. This officer visited Ms G on the hospital ward that morning. Ms G explained that she was keen to be discharged to suitable accommodation. The social worker also noted Ms G’s view that “once discharged, she will only require the Reablement [package of care] for a short period of time while she progresses with her rehabilitation.”
- The professionals involved in Ms G’s care discussed her needs further at a discharge meeting later that day. Miss H attended this. Miss H expressed concerns about the original social worker’s assessment, as well as the recommendation for sheltered housing (rather than ECH). The meeting heard the new social worker would complete a reassessment of Ms G’s needs.
- The social worker completed the reassessment on 17 May 2018. He noted Ms G “reports to being independent with her [activities of daily living] but believes that she will benefit from a Reablement [package of care] as she fatigues when completing these tasks as a result of her shortness of breath and having to rely on oxygen.”
- The social worker noted he would refer Ms G to a charity for support with shopping and cleaning. He also noted the charity could provide a befriending service to prevent Ms G becoming isolated. Furthermore, the social worker identified that Ms G would need some additional equipment. This included a pendant alarm as Ms G would be at risk of falls due to fatigue and the need to carry oxygen with her. The social worker concluded Ms G could be safely discharged to sheltered accommodation with the necessary support. He noted the LIFE team would then review Ms G to see whether she needed long-term support.
- On 25 May 2018, a further discharge meeting was held. Ms G and Miss H were both present. The meeting heard that Ms G had been offered, and accepted, temporary accommodation pending sheltered accommodation becoming available. The notes of the meeting record that “[t]he Medical and Therapeutic Teams believe that [Ms G] does not require a special sheltered accommodation in order to manage her care needs. She has already applied for sheltered accommodation, which should be suitable to her needs.”
- Ms G was discharged to her temporary accommodation on 30 May 2018.
- The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties with regards to social care. The provisions of the Care Act are expanded upon in the accompanying guidance. This is called the Care and support statutory guidance (the statutory guidance).
- The Act places a duty on local authorities to promote the wellbeing of services users in their area. The concept of wellbeing is a broad one. It requires a local authority to consider a service user’s physical and mental health, their social and economic wellbeing and the suitability of their living accommodation.
- The statutory guidance emphasises the importance of ensuring that the service user’s views are reflected when completing an assessment of their needs.
- Furthermore, Section 1.20 of the statutory guidance says that “[w]ellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting people to live as independently as possible for as long as possible.”
- The social worker’s assessment of May 2018 represented a thorough consideration of Ms G’s needs. The assessment identified that Ms G could complete most activities of daily living (such as washing and dressing) but that she would need some support due to the fatigue caused by her breathing difficulties. The social worker arranged a package of reablement care and additional support from a charity.
- The care records suggest Ms G was keen to return to the community and hoped she would only require support on a short-term basis. In my view, it was appropriate for the social worker to focus on supporting Ms G to regain her independence in the community with a short-term package of care in the first instance.
- The multidisciplinary team appears to have agreed that Ms G did not require ECH accommodation at that time and that, if properly supported, her needs could be met in sheltered accommodation.
- It is not for the Ombudsmen to decide how much care and support a person should receive. Rather, this is a matter of judgement for the professionals involved. I am satisfied the Council’s decision took account of Ms G’s needs and was made in accordance with the Act. I find no fault by the Council in this regard, albeit I appreciate Miss H disagreed with the social worker’s conclusions.
- However, I do have concerns about the suitability of the temporary accommodation to which Ms G was discharged.
- On 15 May 2018, a housing officer advised the social worker that the emergency accommodation team had identified potential temporary accommodation for Ms G. The housing officer noted this would not be suitable as the flat was on the first floor and “[t]he manager had concerns in regards to [Ms G] walking down stairs if there was an emergency.” The housing officer said she would update the social worker once a ground floor property became available.
- On 23 May 2018, the Council offered Ms G temporary accommodation. Ms G subsequently accepted the placement. This was another first floor flat.
- An OT assessed the property on 25 May 2018. She noted the property had a lift for use by residents and would be suitable for Ms G.
- A further multidisciplinary meeting considered the matter further on 25 May 2018. The notes record that the OT “reports that it is a 1st floor studio type flat which is accessed via a lift, approximately 10-15 meters from [Ms G’s] flat. This is ideal as she is used to mobilising longer distances in hospital.” The meeting also heard that a social worker would refer Ms G for a pendant alarm due to her increased risk of falls.
- Ms G was discharged to the temporary accommodation on 30 May 2018.
- On 18 June 2018, Miss H contacted the social worker to report that Ms G could not have a pendant alarm. This was because the alarm required a landline to be fitted and the property would not allow this. The social worker contacted the alarm team to confirm this and advised Miss H to contact that team to discuss alternative options.
- On 29 June 2018, an officer from the alarm company called Miss H. However, she was unable to make contact. I found no evidence of any further attempts to contact Miss H.
- When the Council first identified possible temporary accommodation for Ms G, a housing officer felt it would be unsuitable. This was because the suggested flat was on the first floor and it was felt Ms G would struggle to walk down the stairs in the event of an emergency due to her breathing difficulties. The housing officer felt a ground floor property would be suitable.
- Nevertheless, the Council subsequently offered Ms G another first floor property. The LIFE OT assessment noted the property had a lift. It also considered the property’s alarm system. The OT noted that the “[r]eceptionist reports that individual flat fire alarms sound and alert an alarm system downstairs – reception then investigates. If reception doesn’t answer, fire brigade are automatically alerted and attend the scene.”
- I found no evidence to suggest the OT gave any consideration to how Ms G would leave the building in the event of an emergency, when the lift would not have been operational. This would have required Ms G to walk down the stairs. It is unclear, therefore, why the Council considered this property to be any more suitable for Ms G than the previous property given her ongoing breathing difficulties.
- The social worker’s assessment of May 2018 found Ms G to be at risk of falls as a result of her increased fatigue and need to carry oxygen with her. The social worker identified that Ms G would require a pendant alarm “to guard against the risk of falls”. Despite this, the Council failed to identify prior to Ms G’s discharge that it was not possible to install a pendant alarm in the proposed property.
- Furthermore, when Miss H raised this as an issue, the Council made only limited efforts to contact her to discuss possible alternatives.
- Ms G had significant physical health problems that reduced her mobility and placed her at risk of fatigue and falls. As a result, the Council had a duty under the Act and accompanying Code to carefully consider the suitability of any accommodation it offered her. In my view, the evidence shows the Council failed to carry out a robust assessment of suitability in this case. This was fault.
- It is clear from the records and correspondence that both Ms G and Miss H were concerned the property was unsuitable and this caused them unnecessary distress.
Assessment in the community
- Miss H complains that the Council failed to arrange for Ms G’s needs to be reviewed by a community social worker following her discharge from hospital.
- The case notes show Ms G was discharged from hospital on 30 May 2018 with a six-week package of reablement care and additional support from a charity. The social worker’s assessment of May 2018 noted that this arrangement “will be reviewed before the end of the period to ascertain whether she requires long term support.”
- The social worker subsequently passed Ms G’s case to the LIFE team. He told Miss H a member of the team would contact her as soon as the case had been allocated to a community social worker.
- In the meantime, Miss H was referred to the Council’s Immediate Response Team (IRT) for a carer’s assessment.
- On 27 June 2018, an OT from the LIFE team visited Ms G to review her care. She noted Ms G’s concern that the temporary accommodation was unsuitable and her anxiety about the ongoing situation. The OT noted that Ms G “reported that [the charity] were previously doing her shopping. Patient informed that she has been told that this service will stop after 4 weeks i.e. this week. She is going to need help with shopping.” The OT noted Miss H had her own family commitments and would be unable to assist Ms G. The OT concluded Ms G should be reviewed by a social worker to consider re-housing options.
- On 16 July 2018, an officer from the IRT spoke to Miss H. She noted Ms G was likely to need daily care visits on an ongoing basis. The officer emailed the LIFE team the following day to ask that Ms G be referred for ECH.
- The IRT officer does not appear to have received a response from the LIFE team. She subsequently made the referral herself on 24 July 2018.
- On 26 July 2018, the IRT officer advised Miss H that the LIFE OT would be in contact soon to review Ms G’s needs. The IRT officer explained that she had referred Ms G for ECH and requested allocation of a social worker to support this process.
- Ms G’s GP contacted the Council the following day to report that her temporary accommodation was unsuitable and to request a move for her to EHC.
- The Council allocated Ms G’s case to a social worker on 31 July 2018. The social worker visited Ms G to complete a social care needs assessment on 6 August 2018.
- Ms G was admitted to hospital on 8 August 2018. She remained there until her death on 13 August 2018.
- Ms G’s reablement care package was due to end on 11 July 2018. The records show an OT from the LIFE team reviewed Ms G (on 29 June 2018) before the package ended to see how she was coping. The OT identified Ms G would continue to need care visits, as well as input from a social worker to discuss housing options.
- The Council should have arranged for a social worker to carry out a reassessment of Ms G’s needs at this stage. This is because the evidence strongly suggested her progress in the community had been limited and that she would need care on an ongoing basis. Despite this, the Council did not allocate the case to a social worker until 31 July 2018. This was over a month after the LIFE OT review had identified the need for social worker involvement. This in turn delayed the ECH referral. Indeed, the case records indicate the Council only made the referral on 24 July 2018 as a result of Miss H’s persistence.
- In my view, the Council delayed unreasonably in arranging a reassessment of Ms G’s needs in the community. It also delayed in referring her for ECH. This was fault.
- I am unable to say whether an earlier ECH referral would have made a significant difference in Ms G’s case. This is because she likely would have faced a wait for a suitable available place in any case.
- However, this lack of support understandably caused Ms G distress and put Miss H to avoidable time and trouble.
- Miss H complained that the Trust failed to make a referral for Ms G to a specialist sleep disorders clinic at another Trust.
- The clinical records show the respiratory consultant who was responsible for Ms G’s care in hospital determined that she should be referred to the sleep disorders clinic for assessment.
- The discharge planning meeting on 10 May 2018 discussed the referral. The notes of the meeting show the Trust’s respiratory team felt Ms G may benefit from a Bilevel Positive Airway Pressure (or BiPAP) machine. This is a machine to provide improved ventilation at nights for patients suffering from sleep breathing disorders
- The meeting notes record “[o]ther tests were done to investigate [carbon dioxide] retention – suggested disordered sleep breathing – may need BiPAP at night, a referral has been sent to [the sleep disorders clinic] for urgent BiPAP assessment as [an outpatient].”
- The next discharge meeting on 25 May 2018 also discussed the matter. A Trust consultant told the meeting that “the referral for BiPAP still stands…this has the potential to reduce her intake and reliance on oxygen, with a resulting improvement in functional capabilities.”
- I found no evidence in the clinical records to suggest the Trust made this referral. Indeed, it was only when Miss H chased the matter with the Trust in late June and early July 2018 that the Trust made a referral. This was fault by the Trust.
- It is difficult to determine the impact this had on Ms G’s care. There are two main reasons for this.
- First, it is unclear how long it would have taken the sleep disorders clinic to assess Ms G even if a referral had been made in May 2018. My understanding is that the clinic has a target response time of two to four weeks for urgent referrals. This suggests Ms G might have been assessed by mid-June 2018. However, there is no way of knowing whether the clinic would have been able to see Ms G within its target timescale.
- Second, I am unable to say whether an assessment would have concluded that Ms G did require a BiPAP machine.
- For these reasons, I cannot reach a robust view on whether the Trust’s failure to make the referral had a significant impact on Ms G’s care.
- Nevertheless, I recognise this fault caused Miss H unnecessary distress and uncertainty.
- Within one month of my final decision statement, the Council will write to Miss H to:
- Apologise for its failure to carry out a robust assessment of the suitability of Ms G’s temporary accommodation that took into account her health problems.
- Apologise for its delay in arranging a reassessment of Ms G’s needs in the community.
- Apologise for its delay in making a referral for Ms G for ECH once it became clear she would require ongoing care.
- The Council will also pay Miss H £200 in recognition of the distress this caused her, as well as the time and trouble she was put to in attempting to secure the necessary support for Ms G.
- Within two months of my final decision statement, the Council will also write to the Ombudsmen to:
- Explain what action it will take to ensure there is a robust process in place for assessing the suitability of accommodation for service users with specific health needs.
- Explain what action it will take to ensure there is a robust process in place that allows for timely assessment and review of service users’ needs in the community.
- Within one month of my final decision statement, the Trust will write to Miss H to:
- Apologise for its failure to refer Ms G to a specialist sleep disorders clinic when this was identified as a need in May 2018.
- The Trust will also pay Miss H £100 in recognition of the distress and uncertainty this caused her.
- Within one month of my final decision statement, the Trust will also write to the Ombudsmen to:
- Explain what action it will take to ensure there is a clear process in place for making, and following up, referrals to allied health services.
- I found fault by both the Council and Trust with regards to the care and support they provided to Ms G.
- In my view, the actions the Council and Trust have agreed to undertake represent a reasonable and proportionate remedy for the injustice caused to Miss H by this fault.
- I have now completed my investigation on this basis.
Investigator's decision on behalf of the Ombudsman