Summary: Mrs X complained the Council did not properly support her and her family when her late husband was discharged from hospital. There was no fault by the Council.

The complaint

1. Mrs X complained the Council failed to support her and her family when her late husband, Mr X, was discharged from hospital in January 2020. She said the Council did not complete a care needs assessment with her husband and it did not properly consider her husband’s deterioration in health. She also said the Council did not consider the impact of Mr X’s ill health on the family. Mrs X said the Council’s actions have caused her upset and have frustrated her. She would like the Council to review its procedures to ensure service users and their families are appropriately supported after hospital discharges.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I considered the information provided by Mrs X and the Council.
5. Mrs X and the Council had the opportunity to comment on the draft version of this decision. I considered their comments before making a final decision.

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What I found

Legal and administrative background

Care needs assessment

6. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Mental Capacity Act

7. 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 themselves.

Mental capacity assessment

8. A person must be presumed to have capacity to make a decision unless it is established that he or she lacks capacity. A person should not be treated as unable to make a decision:
• because he or she makes an unwise decision;
• based simply on their age, their appearance, assumptions about their condition, or any aspect of their behaviour; or
• before all practicable steps to help the person to do so have been taken without success.
9. An assessment of someone’s capacity is specific to the decision to be made at a particular time. When assessing somebody’s capacity, the assessor needs to find out:
• Does the person have a general understanding of what decision they need to make and why they need to make it?
• Does the person have a general understanding of the likely effects of making, or not making, this decision?
• Is the person able to understand, retain, use, and weigh up the information relevant to this decision?
• Can the person communicate their decision?

What happened

10. Mr X was admitted to hospital in December 2019 with an infection and subsequent delirium. At the time, Mr X’s GP suspected Mr X may have dementia but there was no official diagnosis. Mr X’s GP had referred him to a specialist dementia team but he had not been seen prior to his admission to the hospital.
11. Mr X was due to be discharged back to his home where he lived with Mrs X. However, Mrs X and the family were concerned about Mr X’s behaviour. They said his behaviour had been increasingly challenging over the past two years. Mrs X said he had been verbally abusive towards her and the family and he had threatened to physically harm her. The family also raised their concerns about Mr X’s capacity to make decisions. They wanted Mr X to be discharged into a care home for an assessment of dementia and for their safety. Mr X however had strongly expressed he wanted to return to his home.
12. During Mr X’s stay at the hospital, the Council’s social work team spoke with him and observed him. The social work team noted no concerns about Mr X’s capacity and that he could engage in conversations and provide accurate information about himself. At the beginning of January 2020, the Council conducted a mental capacity assessment with Mr X, specifically about his capacity to decide where to live on discharge from the hospital. The assessment concluded that Mr X had the capacity to decide where he wanted to go for care and treatment after discharge from the hospital.
13. Following on from this, a discharge planning meeting took place at the hospital which Mrs X and her family also attended. It noted Mr X was quite independent with his daily tasks, there were no problems with his recent behaviour and there was no evidence of any mental disorder. It noted Mr X’s behaviour on admission was linked to his delirium which had now settled.
14. Mrs X was unhappy with the decision to discharge her husband home. The Council offered to conduct a domestic abuse risk assessment with Mrs X and it offered to refer her to a domestic abuse service as she had concerns for her safety if Mr X returned home. The Council also offered to conduct a carer’s assessment with Mrs X. Mrs X declined the further support because she wanted to first see how things were when her husband returned home. The Council advised Mrs X to contact the police if Mr X became threatening or violent.
15. Mr X was discharged home towards the end of January 2020 with a package of intensive short-term home care so the Council could assess Mr X’s needs. A home care agency provided care and support to Mr X for a week and during this time, it completed a care needs assessment with Mr X. The assessment recorded Mr X did not require further care and support. The agency’s records showed towards the end of the week, Mr X and Mrs X were managing without support. The agency signed off Mr X as independent.
16. A month after the agency had discharged Mr X from its care, it carried out a follow-up call and spoke with Mr and Mrs X. The agency noted Mr X was independent and managing daily living tasks. Following on from this call, the Council had no further input with Mr X as he had been signed off by the agency with no concerns. The Council said Mrs X and the family were aware that they could contact the Council for further support if they required it.
17. The Council had no further contact with Mr X and his family until August 2020 when Mr X was admitted to hospital following a domestic abuse incident with Mrs X. Mr X’s GP contacted the Council and asked it to conduct a new care needs assessment with Mr X. However, the Council was not able to complete the new assessment because Mr X was subsequently discharged to an NHS funded care home where he died in October 2020.
18. Mrs X complained to the Council and said it did not complete a care needs assessment with her husband and the Council did not call her after the agency had discharged her husband from its care. Mrs X said she received no support from the Council regarding the risk of domestic abuse and the Council did not listen to her concerns about her husband being discharged to their home.
19. The Council responded to Mrs X but did not uphold her complaint. It said the agency did complete a care needs assessment with her husband and the Council offered further support to Mrs X in relation to domestic abuse and a carer’s assessment, both which Mrs X declined. The Council explained to Mrs X that it had carried out a mental capacity assessment and found Mr X had capacity to decide where he wanted to be discharged to after hospital. It said it had no legal authority to place her husband into a care home, against his wishes. It said it advised Mrs X to contact the police if she felt threatened by her husband. The Council recognised a follow-up call from the Council could have made the family feel more supported.
20. Mrs X and her family remained unhappy and complained to us.

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Findings

21. Mrs X questioned if the Council completed a care needs assessment with her husband. The evidence shows the home care agency, on the Council’s behalf, completed a care needs assessment with Mr X. The agency worked with the Council and the hospital regarding Mr X’s care and treatment. I find no fault with the Council.
22. Mrs X said the Council did not contact her after the agency had discharged her husband from its care. The care needs assessment and the agency’s care logs noted Mr X had no unmet care needs, he was independent and managing with his wife. The agency conducted a follow-up call a month after it discharged Mr X from its care and it spoke with Mrs X as well as Mr X. Mrs X did not raise any concerns with the agency. It noted Mr X was independent and managing. The agency informed the Council of this and the Council had no further involvement with Mr X as there were no concerns. The Council said Mrs X and her family were aware they could contact the Council if they required further support. There is no evidence Mrs X and her family contacted the Council after the agency discharged Mr X. Although the Council noted it could have carried out a follow-up call itself after Mr X had been discharged, I find no fault with the Council. From the information it had, the Council had no concerns with Mr X and his care and support needs.
23. Mrs X said she received no support in relation to the concerns about domestic abuse she had raised with the Council. The Council was aware Mrs X had concerns about her husband’s behaviour and her worry about her husband returning home. It offered to carry out a domestic abuse risk assessment and to refer Mrs X to a domestic abuse service for support. The Council also offered to conduct a carer’s assessment. The notes record Mrs X declined all support offered. The Council advised Mrs X to contact the police if she felt threatened by her husband. I find no fault with the Council. The Council had to respect Mrs X’s decision to refuse further support and it appropriately directed her to other support services.
24. Mrs X said she did not want her husband to be discharged home. She said the Council did not listen to her concerns about her husband’s behaviour. The Council was aware of her concerns and it did carry out a mental capacity assessment with her husband. The assessment concluded Mr X had capacity to decide where he wanted to live after discharge. Mr X wanted to return to their home. The Council could not legally discharge Mr X into a care home against his wishes. There were also no concerns with Mr X’s behaviour during his stay at the hospital. I find no fault with the Council.

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Final decision

25. I have now completed my investigation. The Council was not at fault.

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Investigator's decision on behalf of the Ombudsman