Summary: Mr X complained the Council’s care coordinator failed to act in his best interests and it has failed to adequately investigate his complaint, causing distress. We find the Council at fault because it delayed responding to Mr X’s request for a new care coordinator, but we are satisfied its apology is an adequate remedy.

The complaint

1. Mr X complains about the care coordinator he was allocated by the Council. He says:
• She refused to provide him with her contact details and did not respond to all calls and emails;
• She pressured him into paying a council tax bill;
• She did not support him in finding new accommodation or in applying for charity funding to furnish this;
• She refused to help him collect his ID documents from his previous home.
2. Mr X also complains the Council failed to adequately investigate his complaint. As a result of the care coordinator’s actions Mr X has said he has incurred extra, avoidable costs. He says this has caused him considerable distress and he is now under a Community Treatment Order as a result.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. If we are satisfied with an organisation’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

5. I considered all the complaint information Mr X has provided. I also considered information received from the Council.
6. Mr X and the Council had an opportunity to respond to a draft decision, and I considered any comments before making a final decision.

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What I found

Legal background

7. Section 2 of the Mental Health Act 1983 (the Act) explains a person can be admitted to a hospital and detained there against their wishes while they are assessed to decide whether they are suffering with a mental disorder or for the protection of themselves or others. Section 3 of the Act explains a person can then be admitted to a hospital and detained there against their wishes to receive treatment.
8. Section 131 of the Act emphasises the freedom for patients to be admitted without any formal restrictions. This section also allows for patients to remain in hospital after they have stopped being detained under another section of the Act.
9. A person who has been detained for treatment under Section 3 may be discharged back into the community under a Community Treatment Order (“CTO”). A CTO is designed to help people to maintain stable mental health outside hospital and promote recovery and a care coordinator should help manage this.
10. A CTO includes conditions with which the person is required to comply. These should be put in place to help the person to stay well and protect themselves and others from harm. The conditions may include where the person will live or where they will get treatment.
11. Failure to comply with the conditions attached to the CTO may result in the recall of the person to hospital. The Code of Practice that accompanies the Act explains that this would be a decision for the responsible clinician and a person can be taken back into hospital for 72 hours while they decide what should happen next.
12. A person can challenge a CTO if they do not think they should be on one and can apply for legal aid to pay for a solicitor to help with this if necessary. If a person needs help to understand their rights or they are unhappy with the conditions of their CTO, they have the right to see an Independent Mental Health Advocate (IMHA).

What happened

13. On 11 November 2021, Mr X was admitted to hospital under Section 2 of the Act as he was suffering with Paranoid Schizophrenia. On 19 November the Council appointed Ms Y to act as his care coordinator.
14. Mr X’s wife, Mrs X called the hospital on 28 November. They took a message and agreed to have Ms Y call her back.
15. Ms Y returned Mrs X’s call the following day. She introduced herself as Mr X’s care coordinator and explained how she would be supporting Mr X and the family as a whole. During the call, Mrs X said Mr X had an outstanding council tax bill.
16. On 30 November, Ms Y contacted the hospital to discuss Mr X’s care and treatment plan.
17. On 1 December, Mr X called the Council’s Community Mental Health Team to talk to Ms Y, but she was unavailable and called him back the following day. Mr X asked Ms Y to get his car logbook and car keys from Mrs X but then not to contact her again as they had separated. Ms Y agreed to discuss this further with Mr X once he was nearing a discharge from the hospital.
18. On 6 December, Mr X left the hospital to retrieve his car keys and car logbook himself. Following a confrontation with Mrs X, the police returned Mr X to the hospital.
19. On 7 December, Mr X was further detained under Section 3 of the Act. On this day, Mr X called out to Ms Y to discuss his council tax bill. Mr X explained he was unwilling to pay the full council tax bill as he and Mrs X were jointly liable, and he did not intend to return to their home. Mr X told Ms Y he was only willing to pay 50% of the bill, which amounted to £250. Notes from the call do not suggest Ms Y made any attempt to pressure Mr X into paying.
20. Mr X and Ms Y spoke by phone again on 13 December. Mr X told Ms Y he had paid half of the outstanding council tax bill, but he would not pay any more. Following this call, Mr X emailed Ms Y to apologise for the call cutting off, thank her for her advice and promise to be more patient with her in future.
21. On 14 December, Ms Y attended the hospital to discuss Mr X’s treatment with him and the medical professionals who were responsible for his care. They also discussed the incident of 6 December. Mr X explained he was trying to retrieve his ID documentation but acknowledged he should have consulted with someone before doing this. Mr X explained he did not want to return to his family home and had been considering other housing options, including social housing or a new mortgage. The hospital social worker agreed they would help Mr X with any housing applications while he was there but any mortgage application would need to wait until he was discharged.
22. On 15 December, Mr X emailed Ms Y to let her know he had concerns about their relationship. He explained he felt she should be taking more of a role in helping him to find housing and the care he had been receiving. Mr X said he did not trust Ms Y was working in his best interests and asked her to pass his case to someone else. Ms Y acknowledged this email the same day.
23. On 16 December Mr X emailed the Council to let it know he had secured a viewing of a privately rented accommodation and asking them to make a request for the hospital to allow him to leave for this. The Council sent Mr X’s email to the hospital for consideration.
24. On 3 January 2022, Mr X emailed Ms Y asking her to apply for charity grants on his behalf to help him with the costs of furnishing his house. Ms Y responded the following day to explain any applications needed Mr X to personally provide personal information and suggested that, as he was an inpatient, the hospital’s social worker may be best placed to support him in providing that information. Ms Y explained that once Mr X was discharged into the community it would be easier for her to help him. Ms Y also asked Mr X to let her know once he had signed his tenancy so she could begin helping with applications for funding to support his move.
25. On 7 January Mr X signed a lease for a private tenancy, which would begin on 12 January. The hospital emailed Ms Y on 11 January to explain that once Mr X was discharged she would need to check on him after 72 hours and then at least weekly. They explained he would likely need to be assisted to collect items from his family home and that he should not drive for three months.
26. Mr X was discharged from hospital on 13 January for an approved initial period of two week’s leave supported by a CTO.
27. On 14 January Ms Y called Mr X to check on him following his discharge from hospital. Mr X explained he was happy with his accommodation though it had no furniture. Mr X explained he had enquired about a bed that cost around £1,000 and he had applied for credit to cover this. Ms Y discussed cheaper alternatives, but Mr X declined these. Mr X told Ms Y that his daughter would be helping him to retrieve his belongings from the family home and his wife was aware of this. Mr X asked Ms Y to help him apply for funding to furnish his new home. Ms Y explained she was about to take annual leave but could help him on her return if needed. She also pointed out that if the items Mr X wanted were too expensive, they may not be approved by charities. During this call, Mr X told Ms Y he had no intention to stop driving despite the orders from the hospital.
28. After the call with Mr X, Ms Y called to update the hospital. She explained Mr X’s accommodation may not yet be set up for living as there is no furniture or bed. She also asked if anyone had told Mr X he should not be driving and let them know she would be on annual leave the following week but that someone would visit Mr X in her absence.
29. Following her return from annual leave, Ms Y called Mr X on 25 January. Mr X confirmed he was well and had no concerns. Mr X explained he had not yet received a bed, but this would be delivered in March. Mr X said he was fine to sleep on the floor until then and refused to consider temporary alternatives. Ms Y asked if they could meet but Mr X declined this saying there was no reason. Ms Y explained that as Mr X had been discharged on CTO it was important he engage with support services. Mr X told Ms Y he did not need any support but he was happy to engage with services and had been meeting with mental health nurses every night to take his medication. Mr X confirmed he was aware there would be a CTO meeting on 27 January.
30. On 27 January, the hospital medical professionals held a CTO review meeting with Mr X and with Ms Y present by phone. They discussed what had worked well since Mr X had left the hospital and explained he would need to continue to engage with the CTO going forward.
31. Ms Y called Mr X on 28 January to check on his welfare. Telephone notes from this call show Mr X responded aggressively and told Ms Y she was treating him like a child. Mr X made cultural references and explained Ms Y should be treating him with more respect. Ms Y redirected the conversation to the terms of the CTO. Mr X said he felt this encroached on his freedom, but he was willing to comply.
32. Mr X complained to the Council on 28 January saying he did not believe Ms Y was acting in his best interests. Mr X explained:
• He no longer felt able to work with Ms Y and cited cultural reasons;
• He had to actively seek out Ms Y and her contact details once she was appointed as his care coordinator and she had not made enough efforts to keep in contact with him;
• He felt Ms Y had pressured him into paying a council tax bill;
• Ms Y had refused to help him with his applications for financial support from charities when he was moving into a new property, meaning he had to take loans to furnish it. Mr X also said she had maliciously reported that he was sleeping on the floor while his home was unfurnished to prolong his stay at the hospital;
• Ms Y had refused to help him recover his ID documents and car keys from Mrs X, meaning Mr X had to try to do this himself;
• Ms Y had hung up on him during a telephone conversation and had not responded to all of his emails;
• Ms Y had not helped Mr X’s attempts to secure accommodation which meant he had to stay in hospital for longer than necessary;
• He had tried several times to reach Ms Y’s manager but they never returned his calls.
33. On 4 February, the Council assigned Mr X a new care coordinator.
34. The Council responded to Mr X’s complaint on 2 March explaining:
• Ms Y had only spoke to Mrs X on the phone, once. Mrs X had said there was a council tax debt that Mr X was jointly liable for and Ms Y agreed to pass this message on but did not discuss Mr X’s care or treatment. Ms Y denies pressuring Mr X to pay £500 towards a council tax bill or saying she could not work with him if he did not. However, she agrees she did say it would be the right thing to do to pay his part of the debt if he has the money to;
• Ms Y agreed it was difficult to develop a good relationship with Mr X. Specifically because Mr X brought up her cultural background and said she should have respect for him and treat him a certain way. Once the Council received Mr X’s complaint and had spoken to Ms Y, it agreed to change his care coordinator. However, it agreed Ms Y could have considered if it was appropriate for a new care coordinator to be assigned sooner and apologised for this;
• Ms Y did not support Mr X’s application for charity financial support but explained why this was at the time. Although Mr X’s request for assistance was reasonable, Ms Y could not provide the necessary support while he was in hospital and while she did not have clear details of where he was moving to. Ms Y directed Mr X to the hospital’s social worker but said she could help further once a lease was signed;
• Ms Y does not recall terminating a call with Mr X but accepts this may have happened. There was one email Ms Y did not respond to while she was off work, but Mr X made no other attempts to contact the Council for answers at that time;
• It was satisfied Ms Y did not make efforts to sabotage Mr X’s discharge from hospital;
• It did not believe Ms Y had refused to help Mr X get his ID documents. She was concerned he wanted to get his car keys and car logbook when she was aware he had a potential driving offence that he would not discuss;
• It is unclear who Mr X was contacting when trying to reach Ms Y’s manager. No relevant parties had messages asking for contact. It apologised if anything was missed but explained there are no records to support this.
35. Mr X responded to the Council that same day asking it to review his complaint as he disagreed with the findings. The Council responded on 17 March to explain it had nothing further to add but explained Mr X could contact the Ombudsman if he remained unhappy.
36. Mr X referred his complaint to the Ombudsman in March 2022.
37. In response to our enquiries, the Council provided us with Mr X’s case notes and explained:
• The Council’s usual policy is for care coordinator to provide the mental health team’s generic email and phone numbers for any contact, it does not encourage the use of personal contact details. The reason being that it is not always possible for care coordinator to respond to calls or emails immediately and this means any urgent queries can be picked up by the team. Mr X has been known to the Council’s mental health team since 2017, is familiar with this process and never had issues reaching out to Ms Y;
• It is usual for hospital social workers to provide close support to inpatients for matters such as housing applications as they are physically closer to them. Mr X’s hospital placement was out of the Council’s area, so this was even more apparent in his case. Notes from the meeting on 14 December show the hospital social worker was helping Mr X in this area. There is no evidence Mr X then asked Ms Y to become further involved;
• Its care coordinators use a strengths-based approach which means supporting clients to be independent and work to their own capabilities. Mr X independently made arrangements for himself and updated Ms Y on these in a way that had not caused concern so there was no reason to step in;
• Mr X had complained Ms Y did not respond to an email he sent her on 3 January, which was a bank holiday, but he discussed this with the Council the following day;
• Mr X has now withdrawn all active complaints he had with the Council. However, before he did so the Council feels it carried out a thorough investigation and provided a comprehensive response. While it noted there were some learning points, it did not find any fault on the key points Mr X had raised.

Analysis

38. When considering complaints, if there is a conflict of testimony or evidence, we make findings based on the balance of probabilities. This means weighing up the available relevant evidence and basing our findings on what we think was more likely to have happened. Sometimes it is not possible to come to a finding, even on the balance of probabilities, where there is no independent evidence and both sides have differing views on the same events.

Lack of contact details

39. The Council has confirmed it encourages its care coordinators not to provide personal contact details and to direct patients to the generic team phone number and emails address. While I appreciate this may seem impersonal, the Council has explained the reason is to ensure urgent queries are not missed when care coordinators are occupied elsewhere. I do not find fault with Ms Y for not providing Mr X with her personal contact details.

Council tax bill

40. Mr X has said Ms Y coerced him to pay a council tax bill he feels he was not liable for. Ms Y says she did not coerce Mr X, she just passed on a message from Mrs X and he made his own decision to pay 50% of the bill. This is reflected in the notes Ms Y took at the time.
41. It is not possible for me to say whose recollection is accurate here, however Ms Y’s notes from the time seem fairly comprehensive and suggest Mr X made the decision to pay the council tax independently, informing Ms Y after this had already been done.
42. It is clear Ms Y and Mr X had a conversation about the council tax but, I do not find there is sufficient evidence to find Ms Y was at fault.

Assistance to apply for accommodation and furniture

43. The notes show Mr X asked Ms Y to help him with applications for accommodation and for charity help to furnish this. Ms Y agreed she could assist Mr X but he may be better placed using the hospital’s social worker as they were in closer contact. Notes also show the hospital social worker agreed to help Mr X and he was satisfied with this. Once Mr X was in his property, he told Ms Y he had already sought credit and ordered furniture and declined her offers to help him source temporary furniture while he was awaiting delivery.
44. My view is there is no fault with Ms Y’s actions here. I would not expect her to interfere with a process that was being assisted by the hospital social worker and she appears to have made attempts to assist Mr X following his discharge.

Collection of ID documents

45. The notes show Mr X asked Ms Y to help him retrieve his car keys and car logbook, as well as his ID documentation from the home he had shared with his wife. The notes show Ms Y agreed this is something she could consider but suggested they wait until nearer Mr X’s discharge from hospital, and he was agreeable to this. However, Mr X then left the hospital to retrieve these documents himself.
46. I do not find fault with Ms Y here. There is no evidence to show she refused to help Mr X, just that they agreed to do this later.

Failure to work in Mr X’s best interests

47. In his complaint to the Council, Mr X explained he did not believe Ms Y was working in his best interests, but I have seen no evidence to support this.
48. The case notes I have reviewed seem to show Ms Y was in regular contact with Mr X and responded promptly to his calls and emails. It is clear the relationship between Mr X and Ms Y grew fraught but I have not seen anything to suggest Ms Y was not working in Mr X’s best interests.
49. Mr X’s CTO was a condition of his discharge from hospital and not something Ms Y was responsible for putting in place. I do not find Ms Y at fault for Mr X being on a CTO.
50. Notes from 15 December suggest Mr X had asked for a new care coordinator to be assigned but I cannot see evidence Ms Y acted on this request. It was not until Mr X’s complaint of 28 January that the Council considered a new care coordinator.
51. I find fault with the Council for not acting on Mr X’s request sooner and this would have caused some distress to Mr X. However, he did continue to work with Ms Y and ask her for help. Mr X did not pursue his request for a new care coordinator until his complaint of 28 January. The Council has already apologised for not exploring the possibility of assigning a new care coordinator and I think this is suitable to recognise the impact of the fault.

Complaint handling

52. Mr X submitted his complaint to the Council on 28 January and it responded in full five weeks later. My view is the Council’s response was comprehensive and fully gave its view on the points Mr X had raised. I do not find fault with how the Council responded to Mr X’s complaint.
53. Mr X asked for the Council to review his complaint but gave no specific reasons for disagreeing. The Council responded within two weeks to explain he could bring his complaint to the Ombudsman if he remained unhappy. I find no fault with the Council here. It responded promptly to Mr X and had no further points to consider.
54. Mr X has said there were multiple attempts to speak to Ms Y’s manager that went unanswered, but I have not seen any evidence of this and the notes suggest Mr X was in constant contact with the Council. I do not find the Council at fault here.

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Final decision

55. I do not find fault with Ms Y’s actions or how the Council responded to Mr X’s complaint. I find the Council at fault for not acting sooner when Mr X requested a new care coordinator, but my view is the Council’s apology is sufficient to remedy the injustice caused.
56. The Council has accepted my findings and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman