London Borough of Bromley (22 001 435)

Category : Adult care services > Assessment and care plan

Decision : Not upheld

Decision date : 22 Mar 2023

The Ombudsman's final decision:

Summary: Miss A complained her assigned care coordinator at the Trust failed to arrange changes to her flat and failed to arrange suitable treatment for her. We found no fault with the Trust’s actions. Arranging repairs to Miss A’s property was not the Trust’s responsibility and the treatment unit was closed due to the COVID-19 pandemic.

The complaint

  1. Miss A told professionals at Oxleas NHS Foundation Trust (the Trust) in February 2020 she felt her obsessive-compulsive disorder was getting worse. Since then, she feels she has not received the help she needs from her care-coordinator. Miss A complains the care coordinator did not
    • liaise with London Borough of Bromley Council (the Council) to arrange changes to her flat
    • recognise a professional, clinical opinion for the treatment she needs and arrange suitable treatment in a recognised facility.
  2. Miss A made a complaint in October 2020 but believes none of the issues have been resolved. She feels abandoned by professionals who are not helping her get treatment.
  3. The Council and NHS South East London Integrated Care Board (the ICB) are responsible for her aftercare. This is because Miss A was detained under Section 3 of the MHA more than once in 2020. Miss A says the delays in arranging an effective treatment package mean her condition is continually worsening and affects her daily life. She feels the professionals involved in her care are not recognising the detrimental effect trying to get treatment is having on her mental wellbeing.
  4. Miss A would like to receive the treatment she needs to stop her disorder behaviour so she can move forward with her life. She believes this needs to be in an inpatient facility.

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The Ombudsmen’s role and powers

  1. The Ombudsmen have the power to jointly consider complaints about health and social care. A single team considers complaints acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
  2. 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)
  3. 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. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as Housing Associations. (Local Government Act 1974, sections 25 and 34A, as amended)
  5. The Ombudsmen cannot question whether a decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the organisation reached the decision. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
  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

  1. I considered the complaint Miss A made to the Ombudsmen and information she provided by email. I considered the information the Council, the Trust and the ICB provided in response to my enquiries. I also considered the information her representative provided in response to my draft decision.
  2. I shared a confidential draft with Miss A, her representative, the Council, the Trust and the ICB to explain my provisional findings and invited their comments on them. I considered their comments before making a final decision.

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What I found

Background

  1. Miss A has a complex diagnosis of various anxiety and obsessive-compulsive disorders (OCD), she has been under the care of the Trust since 2017.
  2. The Mental Health Act 1983 (the MHA 1983) sets out when a person can by law be admitted, detained, and treated in hospital against their wishes. Under the MHA 1983, when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. This is sometimes called ‘being sectioned’.
  3. A person can be detained in hospital under section 2 of the Act for assessment and for treatment after the assessment. A person can be kept in hospital under section 2 for a maximum of 28 days. Before the person is discharged, a social care assessment should take place to see if they have any social care needs the council should meet. Section 3 is to provide treatment and detention can last for a maximum of six months. As with section 2, before discharge, a social care assessment should be done.
  4. S117 of the MHA imposes a duty on health and social services to meet the health and or social care needs arising from, or related to, the persons mental disorder. This is known as s117 aftercare. S117 aftercare services must:
    • meet a need arising from or related to the mental disorder for which the person was detailed; and
    • have the purpose of reducing the risk of the person’s mental condition worsening and the person returning to hospital for the treatment for the mental disorder.
  5. Section 33.7 of the Mental Health Act Code of Practice 2015 states Councils and CCGs (since replaced by ICBs) should “maintain a records of people for whom they provide or commission aftercare and what aftercare services are provided.”
  6. The ICB shares a statutory duty with the Council to provide, or arrange, s117 aftercare services for eligible service users in the area. The ICB confirmed during my investigation it holds a register.
  7. Miss A was under section 3 of the MHA twice in 2017 and in 2020, she received Section 117 aftercare.
  8. This investigation has considered events which took place from February 2020 until May 2021.

Complaint the Trust did not liaise with the Council to arrange changes to her flat

  1. Miss A explained from February 2020 she experienced new physical symptoms caused by her disorder. This meant she could no longer do some tasks around her home, and she needed adaptations. She told her care coordinator she needed changes to her front door and the communal doors because she couldn’t open them independently anymore. This meant she could not enter or exit her property without help. She also needed changes to her bathroom. Miss A complains her care coordinator did not help her with the changes and left her struggling in her own home.
  2. Miss A has a tenancy for a Housing Association property, and it is the Housing Association who are responsible for any maintenance or adaptations to her property. I cannot look into the actions of the Housing Association. Miss A is aware she can make a separate complaint to the Housing Ombudsman about this and has told me she has done this before. This investigation can only consider how the Trust and the Council dealt with Miss A’s requests and if they acted appropriately.
  3. I have reviewed the documents provided by both the Council and the Trust. The evidence shows following a discussion with Miss A, the care coordinator contacted the Council about her needs. The Council then contacted the Housing Association and provided a schedule of works for adaptations to her property. The care coordinator followed this up during May, June and October.
  4. The Council had further discussions with the Housing Association in December and was told the Housing Association has no funding available for the requested adaptations. The Council then suggested alternative works. It followed this up with the Housing Association in February and April 2021.
  5. The Care and Statutory Support Guidance says “local authorities should also have regard to how needs may be met beyond the provision, or arrangement, of services by the authority”.
  6. Miss A explained she could no longer enter or exit her home independently as she could not use the doors, this is an injustice to her. However, the Trust and Council were not responsible for the changes needed to her home. The organisations had to speak to the Housing Association who could approve the works. I have seen evidence Miss A’s care coordinator from the Trust told the Council of the adaptations Miss A needed, and the Council then referred that information to the Housing Association.
  7. I have seen evidence of continued discussion between the Council and the Housing Association about the requested changes, after the Trust made the Council aware of the need. The length of time this work took to be completed is not within the remit of this investigation and I cannot attribute this to fault by either the Council or the Trust.

Complaint the Trust has not accepted a clinical opinion and provided suitable treatment for her disorder

  1. Miss A complains despite knowing what treatment she needed, her care coordinator did not act to ensure she received this treatment quickly. Miss A saw a professional who told the Trust the treatment plan she needed; an inpatient stay with 24-hour support. Miss A feels the Trust did not accept this opinion as it did not take action to get her a place in a facility, instead proposing other less suitable alternatives. She feels the delays caused unnecessary stress and allowed her condition to worsen.
  2. Miss A’s records show between February 2020 and May 2021 there was contact between the Council, the Trust, and the Police. The contacts show concerns for Miss A’s wellbeing as she was telling professionals she was suicidal and on one occasion told a police officer she was going to throw herself in front of a train. Professionals kept in contact with Miss A and agreed when they would contact her and how. There is also evidence they were overseeing her contact and were advising her what to do if she felt she may hurt herself.
  3. In February 2020, professionals agreed Miss A needed to go to hospital as she was at high risk of self-harm but there were no beds available. Her care coordinator agreed to check on her until they could find a bed. On 14 February, Miss A was admitted to hospital informally.
  4. Before Miss A left hospital, the Council agreed to increase her support. Care workers would visit for four hours a week. Miss A left hospital on 19 March. On 23 March, Miss A told her care coordinator she needed to go back into hospital as she was suicidal and couldn’t cope. There were no beds available, so her care coordinator told her to go to her local accident and emergency department (A&E) if she felt she was going to hurt herself. Miss A went to A&E later the same evening. Her care coordinator reviewed her the next day and all agreed Miss A needed to cope at home and going to hospital should not be automatic. The notes show Miss A agreed to regular reviews and contact, and to try to cope at home. Miss A went back into hospital on 27 March and went home on 9 April with an increased care package to 5.5 hours.
  5. In early May 2020, Miss A reported she was unhappy with the company providing the care workers and told her care coordinator a care worker was rude to her. The Council agreed to change the company providing the care workers.
  6. In June 2020, a psychologist referred Miss A to the Trust’s Anxiety Disorders Residential Unit (ADRU) for an inpatient stay. In July 2020, the CCG (now ICB) approved funding for Miss A’s treatment at the ADRU however due to the COVID-19 pandemic, the unit was closed and not due to re-open until January 2021. Despite funding in place, Miss A could not start treatment.
  7. In July 2020 Miss A asked for increased support and she then received 6.5 hours a week. While it waited for the unit to re-open, the Trust’s ADRU assessed Miss A and found she was not suitable for treatment with them because she needed a placement with 24-hour support and the ADRU could not provide that. The unit sent her care coordinator a report in September 2020 which explained this. In a telephone call on 29 September, Miss A told her care coordinator she needed extra care hours, she did not agree the care she was receiving was helping and complained the Trust had been negligent in its care of her before ending the call. The care coordinator tried to call her back and she did not answer.
  8. The ADRU discharged Miss A in October 2020 as it was not suitable to meet her needs. It recommended the Trust make a referral to two alternative hospitals for intensive inpatient psychotherapy.
  9. In early November 2020, the Trust agreed to assign a new care coordinator as Miss A was no longer engaging with her previous one. The notes show there was continuing discussions about the care Miss A was receiving and all professionals agreed it would not be helpful to Miss A to increase her care package. On 9 November, the police used their powers to detain Miss A as she told them she was suicidal. She was then detained under section 2 of the Mental Health Act 1983.
  10. At the end of November, the Trust assigned a new care coordinator to Miss A. It also asked another hospital about its waiting time for admission. The unit was closed and not due to re-open until July 2021, after which the wait time was four to six months. Miss A remained under section 2.
  11. On 7 December, the Trust withdrew section 2. Miss A stayed in hospital under section 3. In January 2021, the waiting list for the other hospital had increased to seven to eight months. Miss A stayed under section 3 until early February 2021, when on an overnight stay at home she caught COVID-19 and was released from section 3.
  12. The Trust looked for treatment alternatives for Miss A and discussed these with Miss A on 18 March. Her notes show she agreed to a referral to another unit.
  13. The Trust referred Miss A to another Trust, who saw her with her sister on 9 April. At this appointment, professionals discussed Miss A’s symptoms and what treatment she needed. The unit explained it could not provide suitable treatment due to the complexities of Miss A’s condition and closed the referral. This meant the only choice was to wait for a bed to become available in either of the other two hospitals.
  14. In May 2021 the Trust spoke to another hospital who advised it had still not reopened, and the wait time was over one year. Miss A went to A&E for an unrelated physical issue at the end of May 2021. The doctor who spoke to her was concerned because she said she wanted to hurt herself. When her care coordinator arrived at A&E speak to her, Miss A said she did not want to discuss her mental health and the only thing which would help was an inpatient stay for intensive psychotherapy.
  15. Section 75(5) of the Care Act 2014 makes it clear after-care services must meet a need arising from or related to the person's mental disorder. Additionally, the purpose of these services must be to reduce the risk of deterioration in the person's mental condition and, accordingly, to reduce the risk of the person's re-admission to hospital for treatment for mental disorder. The Care Act also requires Local Authorities, NHS Commissioners and providers to work together to provide person-centred care and support.
  16. Miss A’s records show professionals were working together to provide a suitable treatment option for Miss A, but unfortunately due to the impact of the COVID-19 pandemic, the treatment she needed was not available, so professionals needed to find another way to help her until it became available.
  17. The National Institute of Clinical Excellence (NICE) provides guidelines for the treatment of OCD. It recommends “adults with OCD with severe functional impairment [as in Miss A’s case] should be offered combined treatment with an SSRI and CBT.” Cognitive Behavioural Therapy (CBT) is a talking therapy which can help manage problems by changing the way the patient thinks. Selective serotonin reuptake inhibitor (SSRI’s) are a type of antidepressant medication.
  18. Miss A’s record show she had 12 sessions of CBT in 2020, but this was not enough to help her. Professionals agreed she needed an inpatient stay to help her, but this was not available.
  19. In its complaint response, the Trust accepted there were delays due to the impact of the COVID-19 pandemic. It also agreed lack of face-to-face contact was unhelpful in crisis and when delivering therapy.
  20. Miss A says her condition worsened while she was waiting for the Trust to action the inpatient stay for her, and she was sectioned.
  21. While I can understand why Miss A thought the Trust was not taking action, I have seen evidence the delays in arranging an inpatient stay for her were outside of the Trust’s control. The unit Miss A wanted to go to, and which was most appropriate was closed due to the COVID-19 pandemic, and then there was a long waiting list. The Trust made referrals to appropriate units in the period under investigation, and when it found they were closed or not suitable for Miss A’s condition, it tried to find another option for her. The care coordinator provided support to Miss A and when the relationship broke down, the Trust allocated her a new one.
  22. In summary, I have seen evidence the Trust did what it could to support Miss A while it waited for a suitable treatment option to become available. The delays in the unit being closed and the long waiting list were outside of its control and it took appropriate action to try and find an alternative option for Miss A. I can find no indication of fault.

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Final decision

  1. I do not uphold Miss A’s complaint. I found no fault with the actions of the Council, the Trust and the ICB.

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Investigator's decision on behalf of the Ombudsman

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