Summary: Ms X complained that the organisations involved in care and support for Ms Y failed to share a crisis plan, did not recognise her symptoms or put the right support in place, and did not give enough time to remove her belongings when moving to a new care home. We found fault by the Trust for not exploring this issue further, leading to uncertainty for Ms Y and Ms X. The Trust has agreed to take action to remedy the injustice caused. We found no fault in the actions of the Care Provider, ICB, and Council.

The complaint

1. Ms X complains on behalf of her mother, Ms Y, about Section 117 aftercare arranged by Hampshire County Council (the Council) and NHS Hampshire and Isle of Wight ICB (the ICB), while Ms Y was resident at Emsworth House (the Care Home).
2. Specifically, Ms X complains:
1. Hampshire and Isle of Wight Healthcare NHS Foundation Trust (the Trust) failed to put a crisis plan in place from the start of the placement, and then delayed sharing the plan with the Care Home;
2. the Trust failed to include in the care plan, or tell the Care Home, that excessive spending was a symptom of Ms Y’s condition;
3. the Care Home did not put the right support in place regarding Ms Y’s excessive spending, and did not raise safeguarding concerns about it; and
4. the Care Home did not give Ms Y sufficient time to arrange removal of her belongings.
3. Ms X said this meant that while living at the care home, Ms Y was able to spend excessively and purchase a large number of items. She said that Ms Y did not get the care and support she needed, as her spending should have been recognised and treated as a symptom of her illness.
4. Ms X said that because of this, Ms Y experienced unnecessary distress, and incurred the cost of storing the items.
5. Ms X said there has also been an impact on her, in trying to resolve the situation, and deal with the many items that were purchased has also been very difficult and stressful for her.
6. As an outcome of her complaint, Ms X seeks an acknowledgement that things went wrong. She also wants the organisations to make service improvements, and seeks financial remedy to recognise the impact on Ms Y and herself.

Back to top

The Ombudsmen’s role and powers

7. 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).
8. 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).
9. 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.
10. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(1), as amended)

Back to top

How I considered this complaint

11. I considered evidence provided by Ms X and the organisations, as well as relevant law, policy and guidance.
12. Ms X and the organisations had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Key facts

13. Ms Y’s placement at the Care Home was jointly arranged and funded by the Council and ICB through Section 117 aftercare. During her time at the Care Home, Ms Y was reviewed by the Trust’s mental health team, including a care coordinator and consultant psychiatrist.
14. While Ms Y was at the Care Home, Ms X became concerned that Ms Y was making an excessive number of purchases. She raised her concerns about the care and support being provided to Ms Y with the Care Home and the Trust, and later made a formal complaint.
15. Ms Y was dissatisfied with the responses she received from the organisations, and complained to the Ombudsmen.

Section 117 aftercare

16. Anyone who may have a need for community care services is entitled to a social care assessment when they are discharged from hospital to establish what services they might need. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act (e.g. Section 3). Aftercare services provided in relation to the person’s mental disorder under S117 cannot be charged for. This is known as section 117 aftercare.

Mental Capacity Act 2005

17. The Mental Capacity Act 2005 (the MCA) applies to people who may lack mental capacity to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity.
18. Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.

Care Act - safeguarding

19. Section 42 of the Care Act 2014 says that a council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.

Local Authority duties

20. The Care Act requires that each local authority must:

• make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by who.
• set up a Safeguarding Adults Board (SAB).
• arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other suitable person to represent and support them.
• co-operate with each of its relevant partners (as set out in Section 6 of the Care Act) in order to protect the adult. In their turn each relevant partner must also cooperate with the local authority. (Care and Statutory Guidance 2014).

21. As Ms X has raised several issues in her complaint, I have set these out under separate headings, below.

a) complaint that the Trust failed to put a crisis plan in place from the start of the placement, and delayed sharing the plan with the Care Home

22. Ms X complained that a crisis plan should already have been in place and available to the Care Home when Ms Y first moved there, but said this was not the case.
23. The records indicate the Trust had completed a crisis plan for Ms Y, which was dated the same month that Ms Y moved into the Care Home. This set out what early warning signs of a crisis might be, but did not specify any issues relating to excessive spending.
24. In responding to Ms X’s complaint, the Trust acknowledged that the crisis and contingency plan was not provided immediately to the Care Home when Ms Y moved there. However, the Trust said the Care Home had access to Ms Y’s discharge summary and history during this time. The records indicate the Trust’s mental health team also carried out regular reviews. The Care Home was also in contact with the team soon after Ms Y had moved there, to establish whether she had any outstanding needs. A copy of the crisis plan was later shared with the Care Home.
25. Ms X raised her concerns that the Care Home not having the crisis plan from the start had an impact on the care and support provided to Ms Y. The Trust apologised to Ms X and said it would review how care and crisis plans were documented and shared, including with care providers where there is consent for this. The Trust has taken appropriate action to address the issues it identified, and therefore I have not made any further recommendations on this part of the complaint.

b) complaint that the Trust failed to include in the care plan, or tell the Care Home, that excessive spending was a symptom of Ms Y’s condition

26. Ms X said excessive spending was a symptom of Ms Y’s condition. She said that not including this as part of Ms Y’s care plan, or considering it further, meant Ms Y did not get the support she needed while she was at the Care Home.
27. The Trust acknowledged this issue was not included in Ms Y’s care plan. It said that after Ms X raised her concerns about this, the Trust reviewed Ms Y and documented that while she had capacity around her finances, she could also be vulnerable to financial exploitation.
28. In its response to Ms X’s complaint, the Trust acknowledged that it could have considered a more formal referral for assessment by the Council, and that a safeguarding referral would have been appropriate.
29. The available records do not indicate why the Trust did not consider this further, or include this issue in Ms Y’s care plan, given it had noted unresolved concerns on this point. I found fault by the Trust on this point.
30. Ms X complained that had her concerns about spending been properly considered, and included in Ms Y’s care plan, this could have been prevented.
31. I recognise Ms X’s concerns on this point, and the impact she explained this had on her and Ms Y. We are not able to say what would have happened had the Trust considered the issue further, or included it in Ms X’s care plan. I recognise this leaves Ms Y and Ms X with uncertainty about what may have happened. I have made recommendations on this point, below.
32. The Trust has made service improvements in relation to this part of the complaint, to help prevent recurrence. The Trust said it would provide staff training on assessing complex issues of financial capacity, safeguarding responsibilities, when to escalate concerns beyond health services, and family involvement in decision making. Therefore, I have not recommended any further service improvements on this point.

c) complaint that the Care Home did not put the right support in place regarding Ms Y’s excessive spending, and did not raise safeguarding concerns about it

33. The Council said that throughout her time at the Care Home, Ms Y was assessed by healthcare professionals as having capacity to make decisions about her care and wellbeing. This is supported by the information from the Trust, as referred to above. The Council said Ms Y had been reviewed by independent healthcare professionals as having capacity, and it had no reason to challenge this.
34. In its response to Ms X’s complaint, the Council said the Care Home encouraged Ms Y to make wise decisions, but acknowledged she was able to make unwise choices, as set out in the MCA. The Council said because of this, it did not restrict Ms Y’s daily living, including internet access or opening parcels.
35. The records indicate the Council and Care Home referred to the information from the Trust regarding Ms Y’s capacity around finances. The Council’s response said the Care Home supported Ms Y in line with her care plan. As noted above, I have not seen anything to indicate the Trust made a referral to the Council regarding concerns about Ms Y’s spending, or that this issue was included in her care plan. Therefore, my view is there was no fault by the Council or Care Home on this point.

d) complaint that the Care Home did not give Ms Y sufficient time to arrange removal of her belongings

36. Before Ms Y moved out of the Care Home, there was a meeting involving Ms Y, Ms X and care home staff. The notes of the meeting say that Ms X raised her concerns that Ms Y had a lot of belongings at the Care Home, and the Care Home said it would arrange to store these for up to three weeks.
37. Approximately two months after Ms Y had moved out of the Care Home, the Council wrote to request that her belongings be collected in two weeks. However, Ms X explained she did not receive a copy of the letter until three days before the date given for collection, and said she should have been sent a copy directly. Ms X said the delay meant she had only a short time to organise alternative storage and removal of Ms Y’s belongings.
38. The Council responded to Ms X’s complaint on this issue. It said it recognised there was a postage delay that meant Ms X had less notice than intended about collecting the items, and apologised for this. The Council response also said that the proposed timescale for storing Ms Y’s belongings had been discussed at the meeting. The Council said it had stored the belongings for 85 days free of charge and this had been a temporary measure.
39. I recognise Ms X said there was a delay in receiving the letter. I also recognise Ms X’s view that it was difficult and stressful to organise collection of the belongings in a short amount of time. Ms X also explained she did not receive a copy of the meeting notes. She raised concerns that the decision to provide additional storage encouraged Ms Y to make unwise choices. While a copy of the meeting notes may have helped clarify the situation for Ms X, I have not found fault by the Council on this point as the notes from the meeting indicate that additional storage, including a timescale, was discussed with Ms X at that time. I have not seen anything in the available information to indicate why the delay in Ms X receiving the letter occurred or that this was due to any fault by the Council. Therefore, I do not find fault with the Council on this point.

Back to top

Action

40. Within one month of the final decision on this complaint, the Trust has agreed to:

• Make a payment of £150 to Ms Y, to act as a symbolic recognition of the avoidable uncertainty and distress caused by the faults identified; and
• Make a payment of £150 to Ms X, to act as a symbolic recognition of the avoidable uncertainty and distress caused by the faults identified.

41. The Trust should provide us with evidence it has complied with the above actions.

Back to top

Decision

42. I find fault by the Trust causing injustice. The Trust agreed actions to remedy the injustice caused.

Back to top

Investigator's decision on behalf of the Ombudsman