Summary: There was delay in the support the Council had agreed to provide to Mr C, particularly in managing his finances. There was poor communication with Mrs B and the Council should have held a multi-disciplinary risk meeting earlier. Mrs B suffered an injustice as a result as she was often left to provide support for Mr C. The Council has agreed to apologise to Mrs B and pay her £300.

The complaint

1. Mrs B complains on behalf of Mr C, who has sadly passed away. She says the Council failed to provide the appropriate support to Mr C and its communications with her were poor.

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The Ombudsman’s role and powers

2. 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)
3. 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, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I have discussed the complaint with Mrs B. I have considered the documents that she and the Council have sent, the relevant law, guidance and policies and the Council’s response to the draft decision.

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What I found

Law, guidance and policies

Care Act 2014

5. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (updated 2017) set out the Council’s duties towards adults who require care and support.

Duty to meet eligible needs

6. Section 9 of the Care Act 2014 requires councils to carry out an assessment for any adult with an appearance of need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.

Safeguarding duty

7. Section 42 of the Care Act 2014 says a safeguarding duty applies where an adult:
• has needs for care and support,
• is experiencing, or at risk of, abuse or neglect and
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
8. If the section 42 threshold is met, then the Council must make enquiries or cause others to do so. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by whom.

Self-neglect

9. The Guidance states that neglect may include self-neglect. This often involves adults who demonstrate a lack of care for themselves and/or their environment and who refuse assistance or services. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

Mental Capacity Act 2005

10. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves.
11. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity.
12. The council must assess someone’s ability to make a decision when that person’s capacity is in doubt.
13. The five key principles in the Act are:
• Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise.
• A person must be given all practicable help before anyone treats them as not being able to make their own decisions.
• Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision.
• Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests.
• Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

Appointee and Deputy

14. If a person lacks the mental capacity to manage their financial affairs and has limited assets, an application can be made to the DWP to become the person’s appointee to manage their benefit income.
15. A deputy is appointed by the Court of Protection to manage a person’s property and financial affairs if they lack mental capacity to do so themselves.

What happened

16. Mr C was an adult man who lived alone.

July 2019 – safeguarding enquiry

17. The Council started a safeguarding enquiry after receiving safeguarding referrals in June 2019. Mr C had cognitive decline which affected his ability to live independently. Mr C was not paying his bills and had accrued significant council tax and electricity bill arrears. He was losing weight and not eating properly. There were concerns of financial abuse as another adult man, who was not related to Mr C, was living in Mr C’s home.

August 2019 – Mrs B’s concerns

18. Mrs B contacted the Council and said she had been helping Mr C but he was ‘very confused and forgetful’. Mr C had received a court summons for unpaid council tax. There was a ‘pile of paperwork’ relating to bills he had not paid. Mr C did not know how to access his state pension and only used his private pension.
19. Mrs B says that she did not hear from the Council after this and she was left to apply for attendance allowance for Mr C, to sort out his finances and car finance (he had a debt relating to the purchase of a car) and take him to doctor’s appointments.

January 2020 – outcome of the safeguarding enquiry

20. The Council held a safeguarding conference in January 2020. The notes say that Mrs B attended the conference. The Council decided to close the safeguarding enquiry as it was felt that the concerns had been addressed for the following reasons:
• The police attended Mr C’s house in December 2019 and said the house was clean and tidy and there was food in the house.
• The man who had been living in the house and possibly put Mr C at the risk of financial abuse, had moved out.
• The Council was in the process of applying for deputyship for Mr C to manage his finances.

January 2020 – Mrs B’s concerns

21. Mrs B contacted the Council. She said Mr C was getting worse and she felt that she had been left to look after him.

March 2020 – Mrs B’s concerns

22. Mrs B contacted the Council in March 2020. She said Mr C was unable to top up his electricity so he kept running out of electricity. He had no hot water, put frozen food in the fridge and was often ‘wandering’ at night. He could not manage his medication without assistance. She said she could no longer take Mr C to appointments as he forgot and would go out.
23. Mr C was frequently getting lost on the buses trying to travel to or from the local supermarket and members of the public or the police would bring him home.

March 2020 – the Council’s actions

24. Mrs B continued to email the social worker as she was worried about Mr C. Mr C did not understand the Covid restrictions and was putting himself at risk. The problems with the electricity had still not been solved.
25. The Council put in a care plan after assessing Mr C’s needs. The care workers started to provide the support in April 2020, but Mr C would rarely engage with the support and was often not in the house when the care workers arrived.

June 2020 – Mrs B’s concerns

26. Mrs B contacted the Council again as Mr C was deteriorating and the same problems were occurring. Mr C continued to run out of electricity, he did not have appropriate food and continued to leave the home and get lost. Mrs B said this was making her ‘very stressed, frustrated and angry.’
27. July 2020 The Council organised a safeguarding conference which Mrs B was invited to. Mrs B wrote a report for the conference highlighting all the problems she and Mr C had encountered, but the conference was cancelled.

August 2020 – Mrs B’s complaint

28. Mrs B contacted the Council several times in August 2020 to alert them to ongoing concerns and to complain about the Council’s lack of support to Mr C.
29. Mrs B made the following complaints:
• On 10 August 2020, she said she had received a call the previous day from the Council’s duty team to say that Mr C had no money, no electricity, no food and had not eaten for several days. The Council officer asked if Mrs B could help Mr C with some food. She said that despite Mr C ‘being in safeguarding for 18 months’ nothing much had been done. Mrs B said she had to finance Mr C’s shopping and electricity for him and said that the ongoing situation had caused her ‘tremendous stress, frustration and anxiety.’
• On 11 August 2020, she said she rang the Council’s emergency number to say that Mr C had no money and was about to run out of electricity.
• On 13 August 2020, she said that she had rung the Council that day at 9:00 am and had received no response. She rang again at 4:10 pm and was put through to an answer phone after 27 minutes. She then spoke to a person who said she was unable to help and said: ‘I give up’.
• Mrs B rang the Council again at 6:30 pm and spoke to an officer who told her Mr C’s social worker was on leave but someone else should have dealt with the matter. She said it would be escalated to the managers and someone would ring Mrs B in the morning.
30. Mrs B said Mr C had been ‘neglected and abandoned by the inefficiency and incompetence of the staff’ for 18 months. This had caused Mr C and her unmeasurable stress and anxiety.
31. Sadly, Mr C died on 20 August 2020.

March 2021 – the Council’s response

32. The Council responded to Mrs B’s complaint and said:
• There was excellent practice by the allocated worker who consistently reviewed risk, liaised with other agencies, made home visits and comprehensively documented her work.
• The social worker looked at the least restrictive options proportionate to the risk.
• The Council could have convened an Adult Risk Management meeting earlier. This would have brought people from across the service together and may have found more ways to support him.
• The application for deputyship took too long and the process of transferring responsibility was subject to significant delay which resulted in Mr C not having money for essentials.
• Mr C’s case was being used as a training case in self-neglect.
• The findings and recommendations from Mr C’s review had been presented to the Safeguarding Adults Board.
• The Council’s reviewer had looked at all the self-neglect cases to ensure that they were being appropriately addressed.

August 2021 – the Council’s second response

33. The Council said:
• It upheld the complaint about the expectations of Adult Social Care towards neighbours and friends. It said efforts to support Mr C were restricted by the corporate deputyship application and the effects of the pandemic which restricted the access to emergency cash was restricted.
• It said the majority of emergency situations were responded to in a timely manner.
• It upheld the complaint about the response from one the workers to Mrs B.
• It made no findings on Mrs B’s complaint that there were delays in the response to her complaint.
• It partially upheld the complaint about the delay in the corporate deputyship application. It said the Corporate Appointee Team was reviewing the way it managed referrals to minimise delays.
• It had put in place other emergency cash during the pandemic.

Analysis

Failure to provide support

34. I accept that cases of self-neglect are difficult for councils to address as the council has to balance the choices and rights of the individual with its legal duties towards the person.
35. I note good practice from the Council in that the Council, from the outset, understood that it had a duty to safeguard Mr C and a duty to provide services if Mr C had eligible assessed needs.
36. The Council also understood that Mr C’s mental capacity was crucial in its decision making and I note that there were several mental capacity assessments as Mr C’s capacity deteriorated.
37. The social worker put a care plan in place but Mr C did not engage with the support provided.
38. The Council also started the safeguarding process and correctly noted that it had to apply for appointeeship and deputyship to manage Mr C’s finances.
39. However, there was clear fault in the Council’s failure to progress the application for appointeeship and deputyship and the Council has not really explained why this occurred.
40. It appears to me that, if these applications had been made earlier, the Council could have avoided a lot of the problems which Mrs B described. The issues relating to the access to Mr C’s finances, Mr C’s failure to pay bills which led to court demands, the continuous lack of electricity as Mr C did not understand how to pay and top-up the meter, the lack of money to pay food could all have been addressed if the Council was in control of Mr C’s finances. Because it was not, Mrs B was often left to provide this support.
41. I also agree with the Council that it could have held an Adult Risk Management meeting earlier as a complex case like Mr C’s could have benefited from the input from different departments, particularly as it became clear that the support the Council was providing, was not fully meeting Mr C’s needs.

Communication

42. I also uphold the complaint about the poor communication with Mrs B, particularly over the four days in August 2020.
43. Mrs B had been providing a lot of support to Mr C during the previous year. She should have been able to contact the relevant professionals involved with Mr C at the Council immediately. Instead she spent three days trying to get support for Mr C and being passed around departments.

Injustice and remedy

44. Sadly, any injustice to Mr C cannot be remedied.
45. However, Mrs B has also suffered an injustice. She was trying to help Mr C and was stressed by what she perceived to be the lack of support from the Council. She also suffered stress by having to help Mr C when there was nobody to help him.
46. We expect councils to treat people fairly and with respect and not to expose the public to unnecessary distress as a result of their actions. Such injustice cannot generally be remedied by a payment, so we usually seek a symbolic amount to acknowledge the impact of the fault on the complainant. I recommend the Council pays Mrs B £300.
47. I asked Mrs B what she wanted to achieve from going to the Ombudsman. She said she wanted the Council to improve its services. I note that the Council has already put in several service improvements to address the failures that have been identified so I do not recommend any further service improvements.

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Agreed action

48. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mrs B in writing for the fault.
• Pay Mrs B £300.

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Final decision

49. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman