Summary: We found fault with the care provided to Mrs H by the Trust and West Northants Council when she started to display challenging behaviour due to dementia. We also found fault with the actions of the Approved Mental Health Practitioner service acting on behalf of North Northants Council as it did not properly involve Mr H in the Mental Health Act Assessment process even though he was Mrs H’s nearest relative. These organisations will apologise to Mr and Mrs H and pay them a financial remedy. They will also take action to prevent similar problems occurring in future.

The complaint

1. The complainant, who I will call Mr H, is complaining about the care and treatment provided to his wife, Mrs H, by West Northamptonshire Council (West Northants Council), North Northamptonshire Council (North Northants Council), Northamptonshire Healthcare NHS Foundation Trust (the Trust) and Woodsend Medical Practice (the Practice).
2. Mr H complains that:

• the Practice failed to arrange a mental health assessment for his wife despite being advised to do so by a hospital doctor in April 2021;
• a Trust consultant prescribed medication (including Lorazepam and Risperidone) without reviewing his wife and did not maintain proper oversight of her care. Mr H says the consultant did not see his wife in person until the Mental Health Act Assessment on 20 May 2021;
• staff at Spinneyfields Specialist Care Centre (the care home – acting on behalf of West Northants Council) were not appropriately trained to administer medication. Mr H says this meant staff failed to maintain accurate and complete medication administration records and administered more than the prescribed dose of some medications;
• when Mrs H was admitted to hospital, there were fading bruises on her hands and arms. Mr H queries whether this was evidence that care home staff forcibly restrained her in order to make her take medication;
• there is no evidence that Mrs H received treatment for her Urinary Tract Infection (UTI) in May 2021. Mr H queries whether this would have contributed to the rapid decline in her condition; and
• the professionals involved in arranging a Mental Health Act Assessment for his wife on 20 May 2021 failed to notify him an assessment was to take place and did not include him in this process even though he was her Nearest Relative and had Lasting Power of Attorney.

3. Mr H says the failure of these organisations to provide his wife with appropriate care and treatment led to her deterioration and, ultimately, detention under the Mental Health Act 1983.

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The Ombudsmen’s role and powers

4. 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 injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
5. 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.
6. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies 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

7. In making my final decision, I considered information provided by Mr H and discussed the complaint with him. In addition, I considered relevant information and records from the organisations Mr H is complaining about. This included copies of the clinical and care records. I also took account of relevant legislation and guidance.
8. Furthermore, I invited comments from all parties on my draft decision statements and considered the responses I received.

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What I found

Relevant legislation and guidance

9. Under the Mental Health Act 1983 (the MHA), when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. This is sometimes known as ‘being sectioned’.
10. Ordinarily, three professionals need to agree that the person needs to be detained in hospital. These are either an Approved Mental Health Professional (AMHP) or the nearest relative, plus a doctor who has been specially approved in MHA detentions and another doctor. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person and their nearest relative about this. Admission should be in the best interests of the person, and they should not be detained if there is a less restrictive alternative.
11. The MHA is accompanied by the Mental Health Act Code of Practice (the Code of Practice). This provides guidance for health and social care staff on how to implement the MHA in practice.

Background

12. In February 2021, Mrs H was living at home with Mr H. She was receiving support from the Trust’s Memory Monitoring Service (MMS) due to her dementia diagnosis.
13. On 19 February, a local voluntary organisation contacted North Northants Council on Mr H’s behalf. The voluntary organisation reported that Mrs H had deteriorated and that she had no insight into her condition. The voluntary organisation reported that Mr H was struggling to support Mrs H as her sole carer.
14. North Northants Council’s records show a social worker was unable to contact Mr H but left a message for him. However, Mr H says he received no such message.
15. The voluntary organisation also contacted the Trust on 1 March to report similar concerns.
16. On 23 March, Mrs H was briefly admitted to hospital following a fall at home. She was discharged home after treatment.
17. The voluntary organisation made a further referral for Mrs H to North Northants Council on 25 March. The referral reported that Mrs H required emergency respite care to allow Mr H a break from his carer duties.
18. On 4 April, Mr H contacted North Northants Council to report that Mrs H had attacked him and that he had been forced to restrain her.
19. North Northants Council arranged a respite placement for Mrs H in the care home. The placement began on 5 April.
20. The following day an MMS officer visited Mrs H at the care home. The MMS officer noted that Mrs H “appeared bright in mood and was happy and jovial”. However, she was “not orientated to day of week, month or year”.
21. The MMS officer also contacted Mr H. Mr H described some of Mrs H’s recent problematic behaviours. He reported that Mrs H had recently recovered from a UTI and had been more alert following a course of antibiotics.
22. A social worker from North Northants Council contacted the care home on 15 April to see how Mrs H was settling. A member of care home staff reported that Mrs H was “compliant with care and settled” but remained disorientated.
23. On 16 April, the social worker spoke to Mr H to discuss possible care options. This included the possibility of Mrs H remaining in a care home on a long-term basis or returning home with a package of care. Mr H agreed to discuss the options with his son.
24. On 20 April, the social worker contacted the MMS to request a review for Mrs H.
25. The social worker visited Mrs H again that day. She noted Mrs H appeared very confused, could not recall information, and had difficulty finding words. The social worker recorded that Mrs H was becoming increasingly restless and that care home staff felt her care would break down quickly if she was discharged back into the community.
26. A urine test revealed that Mrs H was suffering from a further UTI. A Practice GP prescribed antibiotics for Mrs H on 21 April.
27. An elderly care clinician from the local hospital Trust contacted Mr H on 21 April as part of the follow-up to Mrs H’s hospital admission in March. Mr H described Mrs H’s recent behaviours. The elderly care clinician wrote to the Practice to advise a mental health assessment.
28. The North Northants Council social worker spoke to Mr H again on 27 April. They agreed caring for Mrs H in the community would likely not work and that long-term residential care would be more appropriate.
29. On 28 April, a GP from the Practice reviewed Mrs H. As Mrs H’s UTI had not yet resolved, the GP prescribed a further course of antibiotics.
30. On 5 May, a senior officer at the care home contacted the MMS. She reported that Mrs H was being “verbally and physically aggressive. She has pushed staff and residents, threatened to punch.” The care home officer said Mrs H had been unsettled at night and was pacing and refusing other residents access to certain areas.
31. The MMS sought advice from a consultant psychiatrist in the Trust’s Older Persons Community Mental Health Team (OPCMHT). The consultant advised Mrs H’s GP to prescribe Lorazepam (a medication to treat anxiety and sleeping problems) on an ‘as required’ basis. The consultant also recommend that the care home commence a behaviour chart.
32. On 7 May, a nurse from the MMS contacted the care home to see how Mrs H was responding to her medication. A member of care home staff advised that Mrs H had slept well after having a dose of Lorazepam the previous evening. However, the care worker said that, when given a further dose that morning “she had slurred speech and was not making sense. She was unable to walk and needed carers to assist.” The nurse clarified that Lorazepam should only be given at night.
33. Staff from the care home continued to contact the MMS over the course of the next week to report that they were struggling to cope with Mrs H’s behaviour. The consultant psychiatrist commenced Mrs H on Risperidone (an antipsychotic medication) on 13 May.
34. On 17 May, the care home contacted North Northants Council and the Trust to report that Mrs H had been throwing knives and plates around the dining room and had twice attacked a member of staff. The care home manager said the care home was not set up to deal with this aggressive behaviour and that staff were not trained to do so.
35. On 18 May, Mrs H’s care transferred from the MMS to the OPCMHT. A Community Psychiatric Nurse (CPN) from the OPCMHT visited Mrs H at the care home to complete an assessment. The CPN recorded that Mrs H was calm and pleasant but disorientated to time and place. He noted that her speech was not relevant to what was being discussed and that she was unable to follow the flow of the conversation. The CPN concluded that Mrs H’s needs would be best met in a residential placement with appropriately trained staff.
36. The care home manager contacted the OPCMHT again on 20 May. He reported that Mrs H’s behaviour continued to deteriorate and that she was attacking other residents.
37. A CPN spoke to the duty AMHP to discuss the possibility of a Mental Health Act Assessment. The AMHP suggested a consultant visit Mrs H to see whether she would consent to a voluntary admission. I understand this visit did take place. However, I found no note of it in the clinical records.
38. The OPCMHT discussed Mrs H’s case at a team meeting and arranged for a Mental Health Act Assessment to be completed that afternoon. This assessment concluded that Mrs H should be detained under Section 2 of the MHA for further assessment.

Analysis

Practice response to hospital letter

39. Mr H complained that the Practice failed to arrange a mental health assessment for his wife despite being advised to do so by a hospital doctor in April 2021. He said that earlier mental health input might have prevented the need for Mrs H’s subsequent sectioning.
40. The letter in question was sent to the Practice by an elderly care clinician on 21 April 2021. The clinician called Mrs H at home as a follow-up to her brief hospital admission the previous month. As Mrs H was by this point in the care home, the clinician spoke to Mr H. He noted Mrs H “was having strange behaviour recently and became physically aggressive towards her husband…With her history of Alzheimer’s, [h]er symptoms suggest psychiatric illness rather than delirium but this will need an urgent assessment by community mental health team for consideration of an admission under psychs in a mental health hospital.” However, the letter was not marked as urgent by the elderly care clinician.
41. On 21 April, before having seen the letter from the elderly care clinician, a GP had a telephone consultation with the care home. The GP noted that Mrs H had a suspected urinary tract infection and prescribed antibiotics to treat this. In the meantime, care home staff took a urine sample for testing.
42. A GP visited Mrs H at the care home on 26 April. A physical examination did not reveal any significant abnormalities. The care home staff did not report any concerns about Mrs H’s behaviour. The GP concluded that Mrs H’s confusion was likely due to her infection.
43. The GP first reviewed the elderly care clinician’s letter on 27 April. The GP arranged another telephone consultation with the care home the following day. The results of the urine test confirmed that Mrs H was suffering from a urinary tract infection. The GP prescribed a further course of antibiotics and noted that Mrs H was due to be reviewed by mental health services.
44. In its comments on my first draft decision statement, the Practice said the consultant’s letter was based on information about Mrs H’s behaviour prior to her admission to the care home and the positive urine test. Furthermore, the Practice said this letter was not based on a face-to-face assessment. The Practice said the GP’s assessment was based on face-to-face and telephone consultations, as well as appropriate tests and investigations. The GP also ensured that Mrs H was receiving input from mental health services. On this basis, the GP concluded that an urgent referral was not indicated.
45. This was ultimately a matter of clinical judgement for the GP concerned. However, I consider the GP took appropriate action to investigate the source of Mrs H’s confusion. I am satisfied he also properly considered whether an urgent referral to secondary mental health services was indicated. I found no fault by the Practice in this regard.
46. Nevertheless, I found the Trust delayed inappropriately in referring Mrs H to a suitable mental health team.
47. In April 2021, Mrs H was still under the care of the MMS due to her dementia diagnosis. This was primarily a memory monitoring service rather than a secondary mental health team. Furthermore, as the Trust explained in its complaint response, the MMS was not providing a face-to-face service at that time due to the ongoing COVID-19 pandemic and the vulnerability of its service users.
48. The clinical records show that, by 5 May, Mrs H’s behaviour had begun to deteriorate significantly, and the care home was struggling to support her. Despite this, the Trust did not transfer Mrs H’s care to the OPCMHT until 18 May. This was almost two weeks after care home staff began to raise concerns. This was fault by the Trust.
49. I am unable to say whether Mrs H’s subsequent sectioning would have been avoided if even if she had received a timely mental health assessment via the OPCMHT. Nevertheless, the delay represented a missed opportunity to explore alternative treatment options. This left Mr H with uncertainty as to whether the outcome of Mrs H’s care would have been different.

Lack of review and prescribing decisions

50. Mr H said a Trust consultant prescribed medication (including Lorazepam and Risperidone) without reviewing his wife and did not maintain proper oversight of her care. Mr H says the consultant did not see his wife in person until the Mental Health Act Assessment on 20 May 2021.
51. The Trust has acknowledged that the consultant from the OPCMHT did not see Mrs H in person until 20 May, when he visited her at the care home. In its complaint response, the Trust said this was because the consultant understood Mrs H had already been reviewed by a nurse from the MMS. However, this was not the case. The Trust acknowledged that medication should not have been prescribed for Mrs H without her first having been reviewed by a member of the OPCMHT or MMS. This was fault.
52. In his complaint to the Ombudsmen, Mr H said the prescribed medication severely affected Mrs H’s cognition and ability to function and that she was unable to feed herself.
53. The British National Formulary (BNF) provides guidance for clinicians on the prescription of medications. I am satisfied the medications suggested by the consultant were prescribed in the dosages recommended by the BNF.
54. Nevertheless, the available evidence suggests there was a lack of oversight with regards to Mrs H’s care. The clinical records show that care home staff twice contacted the MMS (on 7 and 10 May) to report that Mrs H was unsteady or unable to walk and had slurred speech after taking Lorazepam. This supports Mr H’s account of his visit to see Mrs H on 7 May
55. This should have prompted the Trust to transfer Mrs H’s care to the OPCMHT so a clinician could review her in person. This would have allowed for informed adjustments to her medication. However, as I have explained above, this did not happen.
56. This was understandably distressing for Mr H, who was left in doubt as to whether Mrs H was being over-medicated.
57. I have commented on the administration of medication by the care home below.

Care home

58. Mr H complained that staff at the care home were not appropriately trained to administer medication. Mr H says this meant staff failed to maintain accurate and complete medication administration records and administered more than the prescribed dose of some medications.
59. In its complaint response, West Northants Council acknowledged that record-keeping at the care home had not been to the required standard. In particular, West Northants Council said more detailed records should have been kept for the period immediately preceding Mrs H’s admission to hospital.
60. Significant confusion developed in this case around whether care home staff were appropriately trained to administer Mrs H’s medication. This stemmed from an entry in the Trust’s clinical records. On 18 May, an OPCMHT nurse documented a conversation with the care home manager. He noted that the care home manager “explained that many of the staff do not have the skills to work with [Mrs H] effectively as [their] specialist care centre is not set up to manage people with dementia that have behavioural challenges.”
61. The evidence I have seen suggests this was a misunderstanding. There is ample evidence in the clinical records to show the care home manager was concerned about the ability of staff to cope with Mrs H’s increasingly challenging behaviour. However, in response to my enquiries, West Northants Council has confirmed that care home staff were trained to administer medication.
62. Nevertheless, I do have concerns about how care home staff administered medication in Mrs H’s case.
63. During Mrs H’s time in the care home, staff were administering the following medications:

• Lorazepam (from 6 May). This was initially to be administered in 0.5mg doses as required up to two times daily. A nurse from the MMS later advised (on 7 May) that this medication should only be administered at night; and
• Risperidone (from 13 May). This was initially to be administered in 0.5mg doses once per day at night. This was increased to two doses per day on 17 May.

64. The Trust subsequently made further changes to Mrs H’s medication on 20 May (stopping Lorazepam and introducing Clonazepam). However, Mrs H was sectioned before staff could administer the new medication.
65. In his complaint correspondence, Mr H says staff continued to administer two doses of Lorazepam (morning and evening) on most days, despite the advice from the MMS.
66. The clinical records show a care home worker contacted the MMS on 7 May as Mrs H had become drowsy and unsteady on her feet when staff administered a dose of Lorazepam that morning. A nurse from the MMS advised the care home worker to only administer Lorazepam at night.
67. Despite this, the MAR charts show care home staff continued to administer two doses, including one in the morning, on most days between 7 and 20 May. This was contrary to the specialist advice provided by the MMS and represented fault by the care home, which was acting on behalf of West Northants Council.
68. I have reviewed the daily contact records for this period. With the exception of 7 May, I was unable to find any evidence to suggest the Lorazepam medication had an excessively sedative effect on Mrs H. Indeed, these show Mrs H’s behaviour remained challenging during this period. Nevertheless, the failure of care home staff to administer medication in accordance with specialist advice placed Mrs H at risk of over-medication.
69. With regards to Mrs H’s Risperidone medication, care home staff administered this once per day as prescribed between 13 and 16 May. On 17 May, when the prescription changed, staff administered one dose. On 18 and 19 May, staff administered two doses as prescribed, with a further dose on the morning of 20 May. Mrs H was sectioned later that day.
70. I am satisfied care home staff administered Mrs H’s Risperidone medication appropriately and I find no fault in that regard.

Treatment for Urinary Tract Infection

71. Mr H said there is no evidence that Mrs H received treatment for her UTI in May 2021. Mr H queries whether this lack of treatment could have contributed to the rapid decline in her condition.
72. As I have explained above, the clinical records show a urine test taken on 20 April revealed that Mrs H was suffering from a urinary tract infection. As a result, a GP from the Practice prescribed a one-week course of antibiotics (Nitrofurantoin).
73. On 28 April, a member of care home staff spoke to a GP. She reported that Mrs H’s symptoms (such as increased confusion) had not resolved and that her urine continued to have a strong smell, which was suggestive of an infection. The GP prescribed a one-week course of an alternative antibiotic (Pivmecillinam).
74. On 5 May, a GP had a further telephone consultation with the care home. The care home revealed that Mrs H’s urine was now normal and that she was awaiting input from the Trust’s mental health services.
75. There is evidence to show the Practice did prescribe antibiotics to treat Mrs H’s infection, therefore. The care home’s Medication Administration Records (MAR) show staff administered these as prescribed. I found no fault by the Practice or West Northants Council on this point.

Mental Health Act Assessment

76. Mr H complained that the professionals involved in arranging a Mental Health Act Assessment for his wife on 20 May 2021 failed to notify him an assessment was to take place and did not include him in this process even though he was her Nearest Relative and had Lasting Power of Attorney.
77. In its response, the Trust said Mr H could have attended the assessment and apologised that this did not happen. However, the Trust said the AMHP acted appropriately by advising Mr H of the outcome of the Mental Health Act Assessment and the details of the ward to which she was to be taken.
78. The case evidence shows that, prior to Mrs H’s admission to the care home, Mr H had been her main carer. He was also her Nearest Relative for the purposes of the MHA.
79. The clinical record shows a nurse from the OPCMHT first discussed with Mr H the possibility that Mrs H may require a hospital admission on 18 May. The nurse noted that Mr H was aware of the problems the care home was experiencing with Mrs H. The nurse noted that Mr H "was open to the idea of admission if necessary but would prefer her to be in a stable care home environment.”
80. The nurse visited Mrs H at the care home later that day. He noted that Mrs H would benefit from a specialist care home placement with staff who could manage her challenging behaviour. The nurse noted that a mental health bed was not necessary at that time.
81. Section 14.53 of the Code of Practice says that “[i]f a patient wants someone else (eg a familiar person or an advocate) to be present during the assessment and any subsequent action that may be taken, then ordinarily AMHPs should assist in securing that person’s attendance, unless the urgency of the case makes it inappropriate to do so.”
82. Section 14.58 of the Code of Practice sets out that “[w]hen AMHPs make an application for admission under section 2, they must take such steps as are practicable to inform the nearest relative…that the application is to be (or has been) made and of the nearest relative’s power to discharge the patient.”
83. There is a significant dispute as to the level and nature of the contact between the AMHP service and Mr H.
84. The records of North Northants Council suggest an officer from the AMHP service contacted both the care home and Mr H between 4.15pm and 5.30pm on 20 May. The officer noted some personal and family history for Mrs H but provided no further detail about her conversation with Mr H.
85. However, Mr H remains adamant that did not receive this call. He told me the information the AMHP noted in the records was shared with her by the care home manager. Mr H said he received no contact from the AMHP service until an AMHP contacted him to tell him that the decision had been made to section Mrs H and that an ambulance was on its way to collect her. The North Northants Council records contain a brief note of this later call, which took place at approximately 7pm.
86. Based on the limited evidence available to me, I am unable to say, even on balance of probabilities, whether the earlier call took place. However, even if the call did take place, I found no evidence to suggest the AMHP explained to Mr H that a referral for a Mental Health Act Assessment had been made.
87. Furthermore, I found no evidence in the assessment documentation to suggest the attending AMHP explored with Mrs H whether she would like somebody to attend the assessment to support her. This was contrary to the Code of Practice.
88. North Northants Council has accepted that it would be considered good practice for an AMHP to consult with a person’s Nearest Relative as part of the Mental Health Act Assessment process. I can see no clear explanation for the failure to properly do so in this case. It remains my view that these omissions represented fault by North Northants Council.
89. I am unable to say whether the outcome of the assessment would have been different even if Mr H had been more involved. This is because the decision to section Mrs H was ultimately a matter of clinical judgement for the doctors involved. However, I recognise this caused Mr H distress and uncertainty.

Bruising to Mrs H

90. Mr H complained that, when Mrs H was admitted to hospital, there were fading bruises on her hands and arms. Mr H also provided me with photographs of the bruising. Mr H queries whether this was evidence that care home staff forcibly restrained her in order to make her take medication.
91. In its complaint response, West Northants Council said it found no documentation in the care home records regarding bruising. West Northants Council said Mrs H had been bathed on 20 March and that no bruising had been noted at that stage. However, it said that Mrs H had been prevented from attacking another resident at the care home later that day by two members of staff. West Northants Council acknowledged Mrs H might have sustained bruising during this incident. Nevertheless, it said that the hospital in which Mrs H was subsequently detained did not refer to bruising or raise any concerns about Mrs H’s wellbeing.
92. I have reviewed the care home records and have been unable to identify reference to any bruising.
93. The records do contain a description of the incident referred to in the West Northants Council response. A member of care home staff documented that Mrs H “attempted to attack [another resident] this morning, physically removed from room, then attacked myself and another support worker."
94. In a more detailed record, a care worker documented that Mrs H “became physically aggressive to both my colleague and I, scratching, punching and kicking…myself and colleague guided her from the room holding her hand.”
95. There is no evidence in the records to suggest Mrs H suffered any injuries during this incident. However, I am unable to rule this possibility out given the limited evidence available.
96. In the absence of any further evidence, I am unable to make a robust decision, even on balance of probabilities, as to how Mrs H sustained the bruising.

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Agreed actions

97. Within one month of my final decision statement:

• the Trust will apologise to Mr and Mrs H for its failure to transfer Mrs H’s care to the OPCMHT promptly when her behaviour became challenging so she could be assessed. The Trust will also pay Mr H £200 in recognition of the distress and uncertainty caused to him by this delay;
• West Northants Council will apologise to Mr and Mrs H for the failure of care home staff to administer Mrs H’s Lorazepam medication in accordance with specialist advice it received from a Trust nurse. West Northants Council will also pay Mr H £100 in recognition of the distress this caused; and
• North Northants Council will write to Mr and Mrs H to apologise for the failure of the AMHP to properly involve Mr H, as Mrs H’s Nearest Relative, in the Mental Health Act Assessment process. North Northants Council will also pay Mr H £200 in recognition of the distress and uncertainty this caused.

98. Within three months of my final decision statement:

• the Trust will write to the Ombudsmen to explain what action it will take to ensure there is a clear process for referring patients with challenging dementia symptoms to an appropriate team for assessment and review. This process should ensure there is appropriate clinical oversight of a patient’s care and that patients are reviewed by a member of the team in person where possible;
• West Northants Council will write to the Ombudsmen to explain what action it will take to ensure the care home has a robust protocol in place for the administration of medications. This should include a process for receiving, storing, administering and recording medications. It should also include a process for recording specialist advice; and
• North Northants Council will write to the Ombudsmen to explain what action it will take to ensure the AMHP service has a clear protocol in place for involving the Nearest Relative in the Mental Health Act Assessment process. This protocol should ensure that the Nearest Relative is provided with necessary information about their rights and responsibilities under the MHA. It should also provide guidance for staff on properly recording contacts with Nearest Relatives.

99. The organisations will provide us with evidence they have complied with the above actions.

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Final decision

100. I found fault by the Trust with regards to its delay in transferring Mrs H’s care to the OPCMHT to allow for an assessment to be completed.
101. I found fault by West Northants Council with regards to the failure of care home staff to administer medication in accordance with specialist clinical advice.
102. I found fault by North Northants Council as the AMHP acting on its behalf failed to properly involve Mr H in the Mental Health Act Assessment process, even though he was Mrs H’s Nearest Relative.
103. In my view, the actions these organisations have agreed to undertake represent a reasonable and proportionate remedy for the injustice caused to Mr and Mrs H by the fault I identified.
104. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman