Summary: The Ombudsmen found no fault with the care and support provided to a young woman with complex needs by a Council, Mental Health Trust and Clinical Commissioning Group.

The complaint

1. The complainant, who I will call Miss J, is complaining about the care provided to her by South Tyneside Metropolitan Borough Council (the Council), South Tyneside Clinical Commissioning Group (the CCG) and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust (the Trust).
2. Miss J complains that The Council, Trust and CCG delayed unreasonably in arranging new accommodation for her when her previous placement served notice in August 2019. She says the professionals working with her failed to involve her in decisions around her care and accommodation and did not share information with her.

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The Ombudsmen’s role and powers

3. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused the complainant injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
4. If the Ombudsmen are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. In making this final decision, I spoke to Miss J about her complaint and considered information she provided. I examined information provided by the Council. This included Miss J’s care records. I also considered relevant law and guidance. I also invited comments on my draft decision from Miss J and the organisations she is complaining about and considered what they had to say.

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What I found

Relevant law and guidance

Mental Health Act 1983

6. Under the Mental Health Act 1983 (the Act), when someone has a mental disorder and is putting their safety, or that of someone else at risk, they can be detained in hospital against their wishes. This is sometimes known as ‘being sectioned’.
7. In 2017, Miss J was detained in hospital for treatment under Section 3 of the Act. When she was discharged, Miss J became eligible for free aftercare services under Section 117 of the Act. These are care and support services intended to meet any needs related to the person’s mental disorder and prevent the need for them to be readmitted to hospital in future.
8. Responsibility for providing Section 117 aftercare services rests with the local authority and local clinical commissioning group. The Council and CCG provide and fund these services for Miss J.

Care Act 2014

9. Sections 9 and 10 of the Care Act 2014 say councils must carry out an assessment of any adult who appears to need care and support. This assessment must look at the adult’s needs and how these needs affect their wellbeing and the outcomes they want to achieve. It must involve the individual and, where appropriate, that person’s carer or any other person they want to be involved.
10. Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high-quality joint assessment.

What happened

11. Miss J is a young woman with a mild learning disability and complex mental health needs, including low mood and anxiety. She has a history of self-harm.
12. In 2019, she was living in a residential placement for young adults (Placement 1). She was receiving intensive support from her care team at the placement. This included extensive 1:1 support and 24-hour observation, as well as, input from a psychiatrist and psychologist. In addition, Miss J had an allocated social worker who worked closely with her.
13. Miss J wanted to live independently in the community with support from a care team. Miss J’s social worker was exploring possible alternative placements.
14. In early 2019, the professionals involved in Miss J’s care were concerned that her behaviour was becoming increasingly difficult to manage. Miss J left Placement 1 alone on several occasions and was found to have harmed herself when alone.
15. In August 2019, Miss J took an overdose of medication during a visit to her family and was admitted to hospital briefly before returning to Placement 1.
16. Miss J told her social worker that she did not want to live at Placement 1 any longer. The social worker told her she was looking for other placements but had not been able to find anything suitable in the local area.
17. On 20 August 2019, Placement 1 served Miss J with notice. A manager from Placement 1 agreed staff would support Miss J to move to another placement.
18. Miss J’s behaviour continued to escalate, and she made several further attempts to harm herself, with staff from Placement 1 intervening to keep her safe. The care team increased observation levels to ensure a member of the team was with Miss J at all times.
19. In early November 2019, the social worker found a care provider (Provider A) that would be able to provide a package of care for Miss J once she moved from Placement 1.
20. In December 2019, Provider A found an Independent Support Living property that would be suitable for Miss J. However, this would not be available in time for Miss J’s planned move date in January 2020.
21. The social worker began to explore temporary placements for Miss J. She found a suitable placement in the local area (Placement 2). This was a new specialist placement for people with learning disabilities. The professionals involved in Miss J’s care agreed Provider A would support Miss J at Placement 2 with extra support from the Trust’s Assertive Outreach Team.
22. Miss J’s social worker left the Council and her case was allocated to another member of the team. In early January 2020, the new social worker found Placement 2 was not going to be ready in time for Miss J’s move from Placement 1. She found a residential placement (Placement 3) that could accept Miss J on a temporary basis.
23. Miss J visited Placement 3 on 15 January 2020. However, the professionals involved in Miss J’s care were concerned that Placement 3 did not have properly trained staff in place and would not be able to organise training in time for Miss J’s move. The social worker instead managed to secure a move for Miss J to Placement 2 slightly earlier than planned.
24. Miss J moved to Placement 2 on 17 January 2020.

What I found

Delayed move

25. Miss J complained that the Council, Trust and CCG delayed in finding her new accommodation with a care package that could meet her needs.
26. The case records show Miss J has very complex needs. Professionals felt she was at high risk of self-harm. As a result, she received extensive 1:1 support from the care team at Placement 1, as well as input from a psychiatrist and psychologist. Miss J also saw her social worker regularly.
27. Miss J was keen to move to a different placement as soon as possible. By August 2019, Placement 1 had served Miss J with notice as staff felt she was no longer willing to work with her care team.
28. On 2 September 2019, the professionals supporting Miss J attended a review meeting to discuss her care needs. Miss J also attended the meeting. The meeting considered various accommodation options. The first of these was a Shared Lives placement (a supported placement within a family home). The professionals agreed this would not be suitable for Miss J as her mental health needs meant she needed more intensive support than this sort of placement could provide. The team also spoke about the possibility of a specialist personality disorder placement. Again, they felt this would not be appropriate for Miss J due to her young age and vulnerability. The professionals decided Miss J’s needs could best be met in an Independent Supported Living placement with additional 1:1 support from a care provider seven days per week.
29. The evidence shows it was challenging for Miss J’s social worker to find a suitable placement for her due to her complex needs and the limited number of placements available in the local area.
30. Between August and early October 2019, Miss J’s social worker contacted over a dozen placements and care providers in the local area. Most of these were not suitable for someone of Miss J’s age or had no vacancies.
31. The social worker also looked at placements in other parts of the country. However, she felt these would not be suitable for Miss J as this would take her away from her family and college.
32. The case records show Miss J made several attempts to harm herself during this period. The professionals supporting Miss J felt she was at high risk and increased the level of support she was receiving at Placement 1.
33. Miss J’s challenging behaviour also made it harder to find a service provider to support her. The social worker eventually identified a suitable service provider (Provider A) in November 2019.
34. The records show Provider A found a possible Independent Supported Living placement for Miss J in December 2019. This was discussed at a multidisciplinary team meeting on 17 December 2019, which Miss J’s advocate attended. The meeting agreed an Occupational Therapist would need to assess the property to see whether it would be right for Miss J.
35. The Occupational Therapist found the property would be suitable with some minor alterations. As it would be some time before the property was ready, it was necessary for Miss J to move into a temporary placement. Miss J’s social worker found Placement 2 would be able to meet her needs, with additional support from Provider A and the Assertive Outreach Team. Miss J moved into the placement on 17 January 2020.
36. The evidence shows it took several months to find a suitable long-term placement for Miss J, along with a care provider to support her in the community.
37. The case records show Miss J’s social worker worked with other professionals (such as the care team at Placement 1 and Miss J’s psychiatrist) to ensure she had a clear picture of Miss J’s care needs. The evidence also shows the social worker worked hard to arrange suitable accommodation and a package of care for Miss J.
38. I appreciate Miss J was keen to move from Placement 1 and that this was a very worrying time for her. However, Miss J’s complex needs meant there were limited care options available in the local area. It was important for the professionals working with Miss J to be content that any accommodation and care package would allow her to live safely in the community. While this took longer than Miss J had hoped, I found no evidence of unnecessary delay by the Council, Trust or CCG. I found no fault on this point.

Communication

39. Miss J complained that the professionals working with her failed to involve her in decisions about her care and did not share information with her.
40. The case records show Miss J’s social worker met with her regularly to talk about her care. The social worker clearly noted Miss J’s views about the care and accommodation options they discussed.
41. Miss J also attended care review meetings in September, October and November 2019 to discuss her ongoing care and accommodation. The notes of these meetings show professionals spoke to Miss J about where she would like to live and what she hoped to achieve in future.
42. The records show members of Miss J’s care team at Placement 1 also spoke to her regularly about her accommodation and tried to explain that it was unlikely she would be able to move until January 2020.
43. By January 2020, the social worker was considering two possible temporary placements (Placement 2 and Placement 3) for Miss J while her new property was prepared. Both placements needed to arrange additional training for staff to ensure they could meet Miss J’s needs safely. Miss J’s social worker decided not to discuss this with Miss J until it was clear whether either placement would be able to meet her needs. In my view, this was a sensible approach and was intended to avoid raising Miss J’s hopes unnecessarily.
44. It is understandable Miss J was anxious about her care and where she would be living. The evidence I have seen suggests the professionals supporting Miss J made every effort to involve her in decisions about her care and keep her informed as the situation developed. I found no fault by the Council, Trust or CCG on this point.

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Final decision

45. I found no fault by the Council, Trust or CCG in the care they provided to Miss J. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman