Summary: Mrs C complained about care and support the Council and Trust provided to her late sister, Ms D, and about how the organisations communicated with Ms D’s family. We will not investigate Mrs C’s complaint, because it is unlikely we could add to the responses Mrs C has already received from the organisations she complains about.

The complaint

1. Mrs C complains that Gloucestershire Health and Care NHS Foundation Trust (the Trust) and Gloucestershire County Council (the Council) failed to provide adequate care and support to her late sister, Ms D. Specifically, Mrs C complains that:

• Ms D’s needs were neglected and she was not properly supported;
• risk assessments of Ms D’s home were not carried out;
• Ms D’s house was neglected while she was in hospital;
• a deep clean of Ms D’s house was not done; and
• the organisations failed to share information with her about Ms D’s care.

2. Mrs C said as a result of this, Ms D’s house was dirty and unsafe, and her health declined. Mrs C said seeing Ms D’s house in this condition, and that things were not done for Ms D as they should have been, caused distress to Ms D’s family.
3. In bringing her complaint to the Ombudsmen, Mrs C wants the Trust and Council to accept failings in Ms D’s care, and to explain what happened. Mrs C also seeks financial remedy for the distress caused to the family.

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The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
5. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we 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).
6. If it has, we 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.
7. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we would find fault, or
• it is unlikely we could add to any previous investigation by the bodies.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

8. I considered information from Mrs C, the Trust and Council.
9. I also considered the Ombudsman’s Assessment Code.
10. Mrs C had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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My assessment

11. Ms D had a diagnosis of bipolar disorder as well as physical health conditions. She lived in her own home and received support from the Trust’s Assertive Outreach Team (AOT), which provides mental health services.
12. Because of the funding arrangements for Ms D’s care, and the involvement of an Approved Mental Health Professional (AMHP), acting on behalf of the Council, I have included both the Trust and the Council in my assessment of the complaint.
13. As Mrs C has raised several issues within her complaint, I have grouped these under separate headings, below.

Care and support provided to Ms D

14. Mrs C complained Ms D’s needs were neglected, and she did not get the care and support she should have had while living at home. The Trust response set out the arrangements for Ms D’s support: she was supported by care staff who would work with the AOT if Ms D’s mental state deteriorated.
15. The Trust said there was information in the records to show the AOT worked to support Ms D and this met the expected standard. The Trust also said the care package was to support Ms D with cleaning and shopping, rather than carrying out those tasks for her, and that Ms D’s notes showed she got on well with the support package in place.
16. I recognise Mrs C disagrees with the Trust’s response on this point. The Trust’s response acknowledged discussions with her about this were limited, as Ms D did not give consent for information about her health to be shared with her family. I recognise it is difficult for Mrs C not to be given more details of what happened, but it is unlikely we would find evidence of fault by the Trust on this point if we investigated.

Risk assessments

17. Mrs C said risk assessments were not carried out on Ms D’s property, which meant Ms D’s home was unsafe and put her at risk, and caused her health to decline.
18. In responding to Mrs C’s complaint about this issue, the Trust said the AOT discussed this with Ms D on several occasions, but said it was Ms D’s wish to remain in her house. The Trust said Ms D had capacity to make this decision. The Trust apologised to Mrs C that it could not share these discussions with Mrs C at the time, and it is unlikely we could add to the Trust’s explanation on this point for Mrs C.

Complaint that Ms D’s house was neglected while she was in hospital

19. Mrs C asked who was responsible for looking after Ms D’s house while she was in hospital. She said Ms D’s house was left with rotting food and bags of rubbish. The Trust response said the AMHP, acting on behalf of the Council, told Ms D’s nearest relative when she went into hospital. This was in line with the Mental Health Act.
20. The Trust arranged an environmental health assessment of Ms D’s home while she was in hospital. It said the AOT assessed Ms D’s capacity at that time, and found she had capacity to understand her needs in her own home including keeping warm and dry.
21. The Trust said since Mrs C’s complaint, it had worked with the Council to improve services for people in similar situations to Ms D. The Council offered additional training for its staff on this issue, and Trust staff would also take part. The Trust had also discussed the issue with its own safeguarding lead to consider what else could be done to support people in this position.
22. I recognise this must have been a difficult situation for Mrs C. However, my view is the Trust and Council have taken appropriate action to improve services in this area, and it is unlikely we could add to this by investigating this part of Mrs C’s complaint.

Deep clean of Ms D’s home

23. Mrs C complained that a deep clean of Ms D’s home, while she was in hospital, did not take place. The Trust provided Mrs C with the date of the deep clean and the name of the company that carried it out. It also said there were other people at the property at the time. I recognise Mrs C’s view that the deep clean did not happen. However, it is unlikely we would find fault with the Trust or Council on this point, given the Trust has been able to reference details from the records showing a deep clean was done.

Sharing information

24. The Trust said discussions with Ms D’s family were limited as she had not given consent for information about her health to be shared with her family. However, the Trust accepted it could not find any evidence that it had specifically assessed Ms D’s capacity to consent to share information. The Trust appropriately apologised for this, and for the distress caused to Mrs C. The Trust said it would provide training for staff on capacity assessments in similar situations. As the Trust has apologised and taken action to improve services, it is unlikely we could add to this response for Mrs C.
25. Mrs C said the Trust told her it cannot discuss anything with her or give her any paperwork relating to Ms D’s care. The Trust has sent Mrs C written responses and has held a meeting with her about her concerns. I recognise it is difficult for Mrs C not to be given the more detailed explanations she is seeking about Ms D’s care and support.
26. However, it is unlikely an investigation would be able to add any further explanations for Mrs C, because any consideration by the Ombudsmen would also need to take into account the expressed wishes of Ms D. Therefore, while I recognise this is difficult for Mrs C, it is unlikely we could provide any further explanations for her in addition to those she has already received from the Trust.

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Final decision

27. We will not investigate Mrs C’s complaint about the care and support provided to Ms D. This is because it is unlikely an investigation could add to the responses she has already received.

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Investigator's decision on behalf of the Ombudsman