North Tyneside Metropolitan Borough Council (23 008 046)
Category : Adult care services > Assessment and care plan
Decision : Upheld
Decision date : 28 Mar 2024
The Ombudsman's final decision:
Summary: Ms X complains Newcastle upon Tyne City Council (NUTCC) failed to provide enough support for her late mother after she went to live with Ms X in March 2020. She also complains North Tyneside Metropolitan Borough Council (NTMBC) failed to respond to her request for support in meeting her mother’s needs when her mother wanted to move back to her own home. NUTCC accepts it should have taken responsibility for meeting Mrs Y’s needs while she was staying with her daughter. NTMBC accepts it delayed in taking action in 2021 and for the confusion it caused and has apologised. NUTCC also delayed in making a referral for a moving and handling assessment in 2021. It should apologise and make a symbolic payment to Ms X for the distress it has caused.
The complaint
- The complainant, whom I shall refer to as Ms X, complains:
- NUTCC failed to provide enough support for her late mother after she went to live with Ms X in March 2020, causing significant problems for her as she struggled to meet her mother’s needs; and
- NTMBC failed to respond to her request for support in meeting her mother’s needs when her mother wanted to move back to her own home, leaving Ms X struggling to meet her mother’s needs.
The Ombudsman’s role and powers
- 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)
- 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, sections 30(1B) and 34H(i), as amended)
- This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
What I have and have not investigated
- I have investigated events up to the point Mrs Y qualified for NHS Continuing Healthcare on 13 May 2021. I have not investigated events after that as they fall within the remit of the Parliamentary & Health Service Ombudsman, which has been dealing with a complaint from Ms X.
How I considered this complaint
- I have:
- considered the complaint and the documents provided by Ms X;
- discussed the complaint with Ms X;
- considered the comments and documents NUTCC and NTMBC have provided in response to my enquiries;
- considered the Ombudsman’s guidance on remedies; and
- invited comments on a draft of this statement from Ms X, NUTCC and NTMBC, for me to consider before making my final decision.
What I found
What happened
- Ms X lives in Newcastle. Her mother, Mrs Y, lived in North Tyneside.
2020
- Mrs Y went into hospital in February 2020 after falling and breaking her hip.
- On 18 February the ambulance service raised concerns with NTMBC about her safety at home after taking her to hospital. NTMBC contacted the hospital for updates on 19 and 21 February.
- On 26 February NUTCC received notification from the hospital that Mrs Y was being discharged to her daughter’s home, under the delayed discharge process, and needed help with washing and dressing.
- The next day the hospital told NUTCC Mrs Y was no longer being discharged to her daughter’s home but being moved to another ward. NUTCC contacted NTMBC about providing reablement care for Mrs Y and doing a carer’s assessment for Ms X. According to NUTCC’s records, NTMBC said it would get back to NUTCC. According to NTMBC’s records, NUTCC agreed to assess Mrs Y and refer her to its reablement team. NTMBC said it did not charge for reablement when Newcastle residents moved to North Tyneside. NTMBC said it would assess Mrs Y if she had long-term needs and wanted to return to her home in North Tyneside. Neither Council took any further action. Ms X says her mother wanted to return to her home as soon as she could.
- Mrs Y went to stay with her daughter when she left hospital 23 March, the start of the first COVID-19 lockdown, as she needed support.
- Mrs Y went into hospital on 12 April, having become unresponsive. When she left hospital on 17 April she returned to Ms X’s home with a ventilator, which she continued to use until she died.
- Ms X says she contacted NUTCC about providing support for her mother but was told to contact NTMBC, as her mother’s home was in its area. She says she was passed between the two councils. Neither Council made records of this contact.
- According to NTMBC’s records, it spoke to spoke to Ms X on 22 July about assessing her mother in her own home, if she could take her there, or assessing her virtually in Ms X’s home. Ms X said her mother wanted to go home as soon as possible and they would be happy to have a virtual assessment. Ms X says they were only offered a virtual assessment, which would have been difficult in her mother’s home as she did not have the internet.
- NTMBC completed a virtual assessment on 27 July. It identified the need for a period of reablement, as Ms X had been meeting her mother’s needs and she needed to start doing things for herself. Ms X said a GP had confirmed Mrs Y did not have a chest infection but had prescribed diuretics to treat fluid retention. She said her mother had been walking more but she needed to let her do more for herself.
- According to NTMBC’s records, it did a virtual assessment in Mrs Y’s home on 5 August, but Mrs Y said she did not feel ready to go home and wanted to stay with Ms X. NTMBC therefore closed her case. Ms X says NTMBC would only offer four calls a day, but she knew this would not meet her mother’s needs, as she could not manage her ventilator on her own and needed more regular support.
2021
- On 26 January NUTCC spoke to Ms X about her mother’s needs. The record of the conversation says Mrs Y did not receive physiotherapy after she left hospital in March 2020 “due to some mix up”. It says Ms X was supporting her mother with washing, dressing and meals due to poor mobility. She was also helping Mrs Y to and from the toilet.
- On 15 April NTMBC spoke to Mrs Y’s GP about completing a checklist for NHS Continuing Healthcare. The plan was for Mrs Y to return home.
- Ms X complained to her MP about the lack of support. Her MP wrote to NTMBC on 20 April, copying his letter to NUTCC. He said Mrs Y hoped to return home, but care needed to be in place for her to do so. He asked both councils to work together.
- NUTCC contacted Ms X on 21 April. Its records say Mrs Y had lived with her since leaving hospital, as she needed support with all activities of daily living and Ms X was meeting all her needs. Ms X said she could not leave her mother for any length of time (she wanted someone to sit with her mother so she could go out to do shopping). NUTCC’s records say Mrs Y’s GP was dealing with an application for NHS Continuing Healthcare. They say Mrs Y’s condition had declined and she had a ventilator due to high levels of carbon dioxide in her blood. NUTCC referred Mrs Y for physiotherapy/occupational therapy.
- NTMBC contacted Ms X on 22 April. She said NUTCC had apologised for not providing support when her mother left hospital, but had now refused to provide support so she could go out to do shopping. She said Mrs Y would prefer to return to her own home than be alone in Ms X’s home when her daughter returned to work in June. She said NUTCC had offered to assess Mrs Y and send the paperwork to NTMBC. She said the GP had confirmed her mother met the criteria for a full NHS Continuing Healthcare assessment. She said she did not think four calls a day would be enough to meet her mother’s needs. NTMBC agreed to liaise with the GP and NUTCC over the next steps.
- NUTCC assessed Mrs Y’s needs over the telephone on 22 April. The assessment said:
- Ms X, who was working from home, was meeting her mother’s need for help with activities of daily living (dressing, washing, meals, continence).
- Mrs Y needed help from one person when walking.
- Ms X was supporting her mother at night to reattach the ventilator.
- Mrs Y wanted to return to her own home.
- Mrs Y did not want to move to residential care, not even for respite care.
- Ms X had declined a package of care and would continue to meet her mother’s needs until she went back to work in June.
- Ms X’s son had provided support when shopping was needed but was currently unable to do this.
- The NHS told NTMBC it needed to do a full assessment for NHS Continuing Healthcare, but Mrs Y needed some support until it could do this. It said she had a ventilator due to respiratory failure and was staying with Ms X because she could not be left alone.
- On 23 April NTMBC told the NHS NUTCC should have assessed Mrs Y’s needs as she was staying with her daughter and did not intend to move back to North Tyneside until June. It agreed to confirm who would attend a multidisciplinary meeting. Ms X says her mother wanted to return home immediately.
- On 28 April NUTCC noted the need for and urgent moving and handling assessment. Ms X had been lifting her mother, but equipment was needed to move her safely. NUTCC’s occupational therapy team said it would take weeks to do an assessment, and suggested making a referral to the NHS’s Community Response and Rehabilitation Team.
- From 30 April NUTCC provided a sitting service for Mrs Y (3 hours a week), so Ms X could go out to shop.
- NTMBC spoke to Ms X on 7 May. Its record of the call says they had a long discussion of Mrs Y’s health needs and “underwent an assessment in order to create a CHC (NHS Continuing Healthcare) plan”.
- On 10 May 2021 NUTCC told Ms X’s MP Mrs Y was ordinarily resident in North Tyneside, as she was staying (i.e. temporarily) with her daughter in Newcastle. It said it would assess Mrs Y’s care and support needs, liaise with NTMBC and help with the NHS Continuing Healthcare process, which would happen in North Tyneside as her GP was located there.
- Both NUTCC and NTMBC took part in the NHS assessment for Continuing Healthcare on 12 May. Following the assessment NUTCC referred Mrs Y to the NHS’s Community Response and Rehabilitation Team for an urgent (12 or 13 May) moving and handling assessment.
- The NHS wrote to Mrs Y on 14 May saying she qualified for NHS Continuing Healthcare from 13 May. This meant the NHS was responsible for Mrs Y’s care from that date.
- On 18 June Mrs Y received a diagnosis of motor neurone disease.
- Ms X took her mother to her home on 20 June. She died that night.
- When NUTCC replied to Ms X’s complaint in November, it said:
- It did not receive a referral from the Ambulance Service in February 2020.
- It agreed Mrs Y’s assessment appeared to question her eligibility for NHS Continuing Healthcare and apologised for the misinformation.
- It should have accepted responsibility for meeting Mrs Y’s needs when Ms X first asked for help, regardless of any dispute it may have had with NTMBC. It apologised for telling Ms X to contact NTMBC.
- When NTMBC replied to Ms X’s complaint in November, it said:
- The Ambulance Service contacted it on 18 February 2020. On 27 February the hospital said it was discharging Mrs Y to Ms X’s home, at which point her care transferred to NUTCC.
- Mrs Y was referred back to NTMBC in April 2021. It assigned someone to work with her on 27 April. The officer contacted Ms X on 7, 14 and 19 May.
2022
- Ms X wrote to NTMBC in November 2022, as she was not happy with a joint response she had received from the NHS to her concerns.
- When NTMBC replied in December 2022, it said:
- When discussing Mrs Y’s case on 27 February 2020, NUTCC said she would be returning to Ms X ‘s home in Newcastle. It understood NUTCC was in contact with Ms X, so there had been no need for it to contact her.
- On 7 May 2021 it had offered to provide four calls a day for Mrs Y. After Mrs Y qualified for NHS Continuing Healthcare a week later, it was agreed she would need 20 hours (or more) of support a day for her to return home on 21 June.
- It apologised for the confusion, following contact from Mrs Y’s GP on 15 April 2021, over Mrs Y’s intention to move back to her own home and the delay in getting involved.
Is there evidence of fault by the Council which caused injustice?
- The Care and Support (Disputes Between Local Authorities) Regulations 2014, set out the procedures councils must follow when disputes arise regarding a person’s ordinary residence. They must first take all reasonable steps to resolve the dispute between themselves. It is critical the person does not go without the care they need while councils are in dispute. The council meeting the needs of the adult or the carer on the date the dispute arises must continue to do so until it is resolved. If no council is meeting the person’s needs, then the council where the person is living or is physically present must accept responsibility until the dispute is resolved. The council which has accepted provisional responsibility is called the ‘lead authority’.
- NUTCC accepts it should have taken responsibility for meeting Mrs Y’s needs when she was staying with her daughter. As a result of this fault, Mrs Y missed the opportunity for reablement support when she left hospital. It is not clear what the outcome would have been if Mrs Y had received that support. When NUTCC assessed Mrs Y in April 2021, the only support Ms X accepted was a sitting service so she could access the community to do shopping. NUTCC has apologised for its failings. There was some delay by NUTCC in referring Mrs Y for an urgent moving and handling assessment in 2021. It identified the need for an urgent referral to NHS’s Community Response and Rehabilitation Team on 28 April, as its own occupational therapy service could not do an assessment for weeks, but did not make the referral until 12 May. That left Ms X struggling to meet her mother’s needs without the right equipment for at least two weeks, putting them both at risk of harm. It is no longer possible to remedy any injustice to Mrs Y as she has died. However, there are grounds for NUTCC to make a further apology to Ms X and a symbolic payment to reflect the avoidable distress caused to her.
- NTMBC agreed with NUTCC that the latter would meet Mrs Y’s needs while she stayed with her daughter. It assessed Mrs Y in July 2020 on the basis that she would be returning to her own home, but she decided to remain with her daughter. It accepts it was slow to get involved after being told of Mrs Y’s intention to return home in April 2021. It appears that in offering to provide four calls a day on 7 May 2021, NTMBC was prejudging the outcome of the NHS assessment for Continuing Healthcare on 12 May 2021. This added to Ms X’s confusion over who was doing what. NTMBC has already apologised for the delay and the confusion it caused. It is unlikely the outcome would have been significantly different if there had been no delay in 2021, as NTMBC is unlikely to have been able to arrange support before Mrs Y qualified for NHS Continuing Healthcare. Whatever actions NTMBC took after 12 May to meet Mrs Y’s needs, it was acting on behalf of the NHS as the funder of her care (see paragraph 5 above).
Agreed action
- I recommended NUTCC within four weeks apologises to Ms X for the delay in referring Mrs Y for a moving and handling assessment in 2021 and pays her £300 for the distress it caused by not accepting responsibility for Mrs Y’s care sooner.
- NUTCC has agreed to do this. It should provide us with evidence it has complied with the above actions.
Final decision
- I have completed my investigation on the basis:
- there has been fault by NUTCC causing injustice which requires a remedy; and
- there has been fault by NTMBC causing injustice which has already been remedied.
Investigator's decision on behalf of the Ombudsman