Mid Essex Hospital Services NHS Trust (17 016 547a)

Category : Health > Hospital acute services

Decision : Upheld

Decision date : 13 Aug 2019

The Ombudsman's final decision:

Summary: The Ombudsmen have found fault by a Council and two NHS Trusts with hospital discharge planning. This meant a patient’s discharge from hospital was delayed unnecessarily. The Ombudsmen also found fault by a Council with its best interest decision process. The Council has already acknowledged this and taken action to address the failings. The faults caused the complainant distress and inconvenience. The Ombudsmen have recommended the organisations apologise and pay the complainant a total of £400 in recognition of the injustice caused by the faults.

The complaint

  1. Mr F complains about Essex County Council (the Council), Mid Essex Hospital Services NHS Trust (the Trust), Essex Partnership University Foundation Trust (the Partnership Trust), Mid Essex Clinical Commissioning Group (the CCG) and Aspen Grange Care Home (the Home).
  2. In particular, he complains about Mrs T’s discharges from hospital in February and April 2017 and best interest decisions around these. He is unhappy with the care Mrs T received at Longfield Care Home and Aspen Grange Care Home.
  3. Mr F also complains the Council delayed investigating safeguarding concerns he raised about poor care and possible abuse of Mrs T. He says the coordinated complaint response from the Council, Trust and CCG was delayed, incomplete, and offered an inadequate remedy.

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The Ombudsmen’s role and powers

  1. 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).
  2. 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.
  3. When investigating complaints, if there is a conflict of evidence, the Ombudsmen may make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
  4. 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

  1. In reaching this decision, I took account of the information Mr F provided to the Ombudsmen. I made enquiries of the Council, the Trust, the Partnership Trust, the CCG and the Home, and took account of the documents and comments they provided, including relevant medical and care records for Mrs T. All parties also had an opportunity to comment on the draft decision.

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What I found

Legal and administrative context

Mental Capacity Act

  1. 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.
  2. 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.

Best Interest Decisions

  1. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be done, or made, in that person’s best interests. Section 4 of the Act provides a checklist of steps that decision-makers must follow to determine what is in a person’s best interests. The decision-maker must also consider if there is a less restrictive option available that can achieve the same outcome.
  2. If there is a conflict about what is in a person’s best interests, and all attempts to resolve the dispute have failed, the Court of Protection might be asked to decide what is in the person’s best interests.

Safeguarding procedures

  1. The Council’s Safeguarding Adults procedures are based on guidance from Essex Safeguarding Adults Board. The adult safeguarding procedures do not set definitive timescales, but works to target timescales. Initial information gathering/initial risk assessment should be done within 24-hours of being received into social care. A decision on whether to progress to enquiry should be made within 48‑hours of the concern being received or justify and document reasons why this is unachievable.
  2. For cases progressing to an enquiry, the target time for main enquiries to be completed within 20 working days of the enquiry commencing. If this is not achieved the reasons why should be documented. Where possible enquiries should be completed within 28 working days and not more than 3 months of the enquiry commencing unless there are unavoidable delays.

Continuing Healthcare and Funded Nursing Care

  1. Continuing Healthcare (CHC) is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. The Department of Health’s National Framework for NHS Continuing Healthcare and NHS‑funded Nursing Care (November 2012 (Revised)) (the National Framework) is the key guidance about Continuing Healthcare.
  2. NHS-funded nursing care (FNC) is the funding provided by the NHS to residential nursing homes that also provide care by registered nurses. FNC funding is set at a weekly rate.
  3. A person’s local Clinical Commissioning Group (CCG) is responsible for assessing their eligibility for CHC or FNC and providing the funding. CCGs sometimes commission other NHS organisations to carry out the assessments on their behalf.
  4. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist. If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. This assessment is completed using a decision support tool (DST). The DST is a record of the relevant evidence and decision-making. The DST should be completed within 28 days of the CHC Checklist unless there are ‘valid and unavoidable’ reasons for it taking longer.
  5. The DST makes a recommendation about whether a person is eligible for CHC or for NHS-funded nursing care, which is set at a weekly rate. The relevant CCG will then make a final decision which must uphold the recommendation of the DST in all but exceptional circumstances.
  6. The National Framework states where an individual is ready to be safely discharged from hospital it is important that this should happen without delay. The assessment process for NHS Continuing Healthcare should not be allowed to delay hospital discharge.

Complaint handling

  1. Under The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the ‘Complaints Regulations’) there is a duty to investigate complaints properly and in a way that will resolve them efficiently. There is also a duty to cooperate when a complaint is made to one organisation and contains material relevant to the other. In these circumstances, the responsible bodies must co-operate in handling the complaint. This includes duties to: establish who will lead the process; share relevant information; and provide the complainant with a coordinated response.
  2. When acknowledging a complaint, the organisation must offer to discuss with the complainant how long its investigation is likely to take and when it is likely to send a written response.
  3. During the investigation, the organisation must keep the complainant informed, as far as reasonably practicable, as to the progress of the investigation. A written response must be sent as soon as reasonably practicable after completing the investigation. If the complainant is not sent a written response within six months, the responsible organisation must notify the complainant in writing and explain the reasons why.

Background

  1. At the time of the events complained about (February 2017) Mrs T was aged 95 and living independently. She was admitted to hospital on 6 February 2017 following a fall at home. She had multiple medical diagnoses including diabetes, dementia and heart attack. The Trust recorded Mrs T was a falls risk.
  2. On 16 February 2017 the Trust, the Council and Mrs T’s daughter and son-in-law attended a best interest meeting. Prior to this meeting Mr F had spoken to the social worker to say he wanted Mrs T to move into his home. The social worker agreed to present these views at the best interest meeting. The meeting concluded it was in Mrs T’s best interests to be discharged to a care home.
  3. The Council identified Longfield Care Home as a suitable placement. Longfield Care Home assessed Mrs T on 21 February 2017 and advised it could meet her needs and it was happy to accept Mrs T.
  4. The hospital discharged Mrs T on 24 February 2017.
  5. Mrs T was readmitted to hospital later the same day after she had a fall at Longfield Care Home. Mr F says a manager of Longfield Care Home told him they were not aware Mrs T was at ‘significant risk of falling’.
  6. The Trust completed a CHC checklist on 15 March and a DST on 21 March. Mrs T’s daughter was present for the completion of the DST. This concluded Mrs T did not meet the criteria for CHC funding, but she did qualify for FNC.
  7. The Trust referred Mrs T to social care on 17 March 2017. The Council completed a social care assessment on 23 March 2017.
  8. The Council identified the Home as a potential placement for Mrs T. The Trust discharged Mrs T to the Home on 5 April 2017.
  9. On 4 May 2017 Mr F visited Mrs T at the Home. He had been out of the country on holiday prior to this. Mr F told the Home he was going to take Mrs T out for the day. He did not bring her back to the Home and instead took her to his home in Yorkshire. The Home reported this to the police and the safeguarding team at the Council.
  10. On 12 May 2017 Mr F wrote to the Home as he was concerned about a number of ‘inappropriate’ remarks Mrs T had made since she had been at his home. The Home responded in a letter dated 1 June 2017. It said it was not aware of Mrs T making inappropriate remarks when she resided at the Home.
  11. Mr F sent a further letter to the Home on 16 June. He said he wished to make a formal complaint about how his concerns were responded to and about additional issues he said he had raised previously with the CQC.
  12. The Home sent Mr F a letter dated 26 June in response. It addressed issues about its handling of Mr F’s concerns and asked Mr F to forward his further concern, as it had not seen the letter he sent to the CQC.
  13. Mr F sent another letter to the Home on 27 June. He raised concerns about staff shouting at other residents and said the staff did not tell them about Mrs T’s dietary needs before they took her out, despite telling them they were taking her for fish and chips. Mr F also complained about a faulty door in Mrs T’s room, a bruise on Mrs T’s arm, and that a nurse told him if Mrs T had something sweet, they would just give her extra diabetes medication.
  14. Mr F sent a complaint letter to the Council on 28 June about Mrs T’s hospital discharges in February and April 2017. In particular he noted concerns about the best interest meeting. He also enclosed a copy of the complaint he made to the Home.
  15. The Council wrote to Mr F on 14 July 2017. It said it had raised a safeguarding concern against the Home and it would respond to his other complaints within 28 days.
  16. Mr F wrote to the Home on 2 August to say he wished to await the outcome of the Council’s safeguarding investigation before pursuing his complaint further with the Home.
  17. Mr F wrote to the Council on 1 September to complain he had not had any updates about his complaint for nearly a month.
  18. The Council wrote to Mr F on 4 September. It explained that as he had asked the Council to contact the CCG on his behalf, it had done this but was awaiting a response. It apologised for not updating him sooner.
  19. Mr F wrote to the Council again on 18 October to complain about the lack of updates.
  20. The Council sent an update the following day and advised it was waiting the Trust’s response, which it understood would be completed by the end of October.
  21. On 24 November the Council sent a letter to Mr F confirming the outcome of a safeguarding enquiry about Mrs T’s stay at the Home. The Council stated that the outcome of their investigation was ‘inconclusive as no evidence of abuse was identified’.
  22. Mr F wrote to the Council on 4 December to ask for an update on his complaint response.
  23. The Council apologised to Mr F for the delay in a letter dated 7 December and said he should receive a response within the next week.
  24. The Council sent its complaint response letter on 13 December and enclosed a response letter from the Trust (dated 20 October 2017). It acknowledged failings with the best interest process and representing Mr F’s views. The Council also said it had asked for concerns about Longfield Care Home to be looked into to establish if there were safeguarding concerns. The Council said its Director of Local Delivery would provide a personal apology and offered to pay Mr F £150 ‘in recognition of the frustration and distress [Mr F] experienced’.
  25. On 10 January 2018 Mr F wrote to the Council to advise he was taking his complaint to the Ombudsman. He sent his complaint to the Ombudsman on 16 January.
  26. Mrs T died on 12 September 2018.

Analysis

Discharge on 24 February 2017

  1. Mr F complains the Council used flawed mental capacity assessment and best interest processes to decide that Mrs T should be discharged from hospital to Longfield Care Home rather than to Mr F’s home.
  2. The records show the Council discussed discharge arrangements with Mrs T and her family. Mrs T had previously expressed her wish to return home. However, the Council had concerns that she would not be able to manage and would be at risk of harm. The Council considered Mrs T lacked the ability to understand the risks and started a mental capacity assessment. The records show Mrs T was unable to answer basic questions about where she was or how she felt. The assessment was not completed as Mrs T became upset, but the Council concluded Mrs T lacked the mental capacity to understand decisions about her discharge from hospital. It spoke to Mrs T’s family, including Mr F, about the discharge destination and arranged a best interest meeting.
  3. The records show the Council considered the family’s views, including whether she should move to live with Mr F. The records also note that everyone agreed it was in Mrs T’s best interests to be discharged to a temporary residential placement. The Council planned to review this in 4-6 weeks and make a more permanent decision.
  4. Mr F disputes that he agreed to even a temporary placement in a residential home. Faced with two conflicting accounts, I have been unable to take a view on what Mr F said or why the Council believed he agreed to a temporary placement to assess Mrs T before making a decision about her long-term accommodation. However, this does not affect my view that the Council considered the various views of Mrs T’s family, including Mr F’s offer to move Mrs T into his home.
  5. The Council acted in accordance with the MCA in considering Mrs T’s mental capacity to make a decision about her discharge, but this could not be completed. The Council should have considered delaying the decision until Mrs T was in a more settled environment. Its complaint response acknowledged this fault and with the recording of the mental capacity assessment. However, the records show the Council did consider different options about the best interest decision.
  6. The Council has accepted fault with its communication about the best interests decision and next steps. However, as the placement was a temporary arrangement, I do not consider the faults with recording and communication resulted in an injustice to Mrs T. The plan to review in 4-6 weeks, in theory, gave all parties the opportunity to properly consider more permanent arrangements outside of the hospital environment. However, I consider the faults did cause an injustice to Mr F, which the Council has recognised.

Longfield Care Home

  1. Mr F complains the Council failed to ensure Longfield Care Home properly assessed Mrs T’s falls risk. He says the manager at Longfield Care Home told him they were not aware Mrs T was high risk of falling. Mr F says the failings led to Mrs T’s fall and readmission to hospital later the same day.
  2. Longfield Care Home dispute it told Mr Fit was not aware Mrs T was at risk of falling. The records show Longfield Care Home completed a pre-admission assessment on 21 February 2017. These clearly show Longfield Care Home were aware of Mrs T’s previous falls and her need for assistance with mobility. There is no evidence to corroborate exactly what was said, but given the information in the records, this supports Longfield Care Home’s position. It may be there was a misunderstanding when this was communicated. Based on the evidence available, I have not found fault against the Council about this.
  3. Longfield Care Home’s policy is to complete risk assessments and care plans within 24 hours of admission. The records show this had started but at the time of Mrs T’s fall (around 3.5 hours after admission) this was not yet complete. Longfield Care Home started a care plan and a falls risk assessment which noted Mrs T ‘will need full assistance when standing and mobilising’. The records show the falls risk assessment provisionally scored Mrs T as ‘medium risk’ of falls. In response to the Ombudsmen’s enquiries Longfield Care Home has acknowledged this risk assessment was incorrectly completed.
  4. Longfield Care Home’s initial assessment noted Mrs T’s history of falls when she lived alone were mostly at night-time and she had not fallen while in hospital. It planned to manage Mrs T’s falls risk initially (and prior to the care plan being fully completed) using a falls sensor mat by her bed, use of a walking frame and supervision from a staff member when walking. Longfield Care Home’s decision that 1:1 care was not indicated at that stage was therefore evidence based.
  5. Although Longfield Care Home’s care planning for Mrs T was not completed, this does note her history of falls and that she remains at ‘high risk of falling’. It also noted Mrs T needed to be reminded to use her walking frame as she sometime forgets due to short-term memory impairment.
  6. While it is likely Mrs T’s falls risk score should have been rated differently, I cannot speculate as to whether this assessment would have been reviewed and/or corrected when Mrs T’s care plan was completed. In any event, given Mrs T was not assessed as needing 1:1 care, I cannot say the initial error on the falls risk assessment affected Mrs T’s care.
  7. The records show Mrs T fell whilst trying to walk without her walking frame and cut her head. Care planning was still being completed, which was in line with Longfield Care Home’s policy. I have seen no evidence the care was substandard or contributed to Mrs T’s fall. I therefore have not found fault by the Council in relation to this aspect of the complaint.

Delayed discharge on 5 April 2017

  1. Mr F complains the Council, the Trust and the CCG delayed assessing Mrs T between February and April 2017. He says this meant Mrs T spent approximately six-weeks in hospital when she was medically fit for discharge.
  2. The nursing records show Mrs T was medically fit for discharge on 26 February. A social worker saw her that day and noted Longfield Care Home would visit to reassess her the following day. Longfield Care Home did not consider it could meet Mrs T’s needs.
  3. The records on 28 February show the plan was to arrange a CHC checklist. This was completed on 15 March and indicated the need for a full DST. The records between 28 February and 15 March show the checklist ‘was being chased’.
  4. An integrated discharge team coordinates the discharge arrangements at the Trust. This is a multidisciplinary team between the Trust, the Council and Partnership Trust. This team have responsibility for coordinating the discharge arrangements, including CHC checklists and arranging assessments. However, the Trust still has responsibility to ensure the safe discharge of a patient from its care. The Trust should have referred Mrs T to social care as soon as discharge planning started. This was not done until 17 March, almost three weeks after Mrs T was medically fit for discharge. This is fault and contributed to the delayed discharge.
  5. The Partnership Trust told the Ombudsmen the IDT received a referral for a CHC checklist on 4 March 2017. It said this was not allocated to the Partnership Trust’s staff to complete until 14 March. It said the Trust’s IDT screen the referral before allocating it. The Trust’s response to the Ombudsmen’s enquiries said it had ‘transferred responsibility’ for the patient’s discharge to the Partnership Trust. It also said referral to social services would be completed by Council staff. The Council’s complaint response said it could not progress sourcing a home placement until the DST was completed. However, it did acknowledge fault with multi‑agency working and agreed delays were excessive.
  6. Under the National Framework discharge should not be delayed because of a DST. This was fault, which the Council has already acknowledged. This contributed to the delays in Mrs T’s discharge from hospital. The Council said it is working towards completion of DSTs after a patient has been discharged from hospital, but this was not regular practice at the time of Mrs T’s admission.
  7. There is conflicting information in the responses from the organisations. There is a lack of clarity about their collective responsibilities within the IDT. I consider there were failings in the communication between the Trust, the Council and the Partnership Trust in relation to Mrs T’s discharge arrangements. This is fault and contributed to the delay in Mrs T’s discharge.
  8. I consider there are a number of factors that contributed to the delay in Mrs T’s discharge from hospital. The arrangements are multidisciplinary and the responsibility is therefore a joint one. I have therefore made my recommendations to all three organisations as I consider they all had a role in Mrs T’s hospital discharge. The CCG dealt with the CHC within the timeframes set out in the National Framework and as noted above, this was not a reason for delaying Mrs T’s hospital discharge.

Discharge to Aspen Grange Care Home

  1. Mr F complains the Council wrongly decided Mrs T should be discharged to the Home rather than to Mr F’s home. He says the Council failed to properly consider his views and Mrs T’s best interests in reaching this decision.
  2. The Council did not complete a MCA assessment or arrange a best interests meeting to consider whether Mrs T’s placement at the Home was the most appropriate discharge destination. This was fault. The Council has acknowledged this in its complaint response.
  3. Mental capacity is specific in time and place. The lack of any assessment about the discharge decision means is not possible to say whether Mrs T had any capacity to understand her discharge options. If she did not have capacity as appears to have been presumed, there was a failure to complete a best interest decision. Mr F wanted Mrs T to move in with him. He had told the Council about this previously, but there is no evidence this was properly considered.
  4. I note Mrs T’s daughter was involved in discussions about the discharge arrangements. Unfortunately the lack of documentation about Mrs T’s mental capacity and best interests decision means it is difficult to say what the outcome would have been had the Council followed the correct process, or if the Council considered a further temporary arrangement given Mrs T was in a hospital setting and Mr F was out of the country. However, while Mr F made his disagreements known afterwards, there is no evidence Mrs T suffered any harm from her placement.
  5. The Council has taken action to address systemic issues by ensuring staff in the hospital assessment team have received up to date Mental Capacity assessment training. It said randomised audits will also be completed to ensure decisions are recorded correctly. I consider this addresses the faults identified in this issue about the MCA process. However, the flawed process, uncertainty and lack of input into the decision has clearly caused Mr F distress.

Care at Aspen Grange Care Home

  1. Mr F complains about poor care provided by the Home to his mother between 5 April and 4 May 2017. In particular he raised concerns about not being told that Mrs T was on a texture D diet (pre-mashed food) when he discussed taking Mrs T out for fish and chips; staff regularly gave Mrs T cake and biscuits, putting her at risk of choking; Mrs T had a bruise on her arm; and nursing staff said ‘if [Mrs T] has something sweet, just give her an extra [diabetes tablet]; we often do that’.
  2. The records show the Home completed a detailed care plan when Mrs T first moved to the Home. This covered all Mrs T’s health and social care needs, including her medical history, mobility and nutritional requirements. The care plan noted Mrs T needed a diet of thickened fluids and soft or mashed foods. It also noted she should avoid high amounts of sugar in food and drink due to having diabetes. The Home noted Mrs T’s lack of capacity to understand the care plan due to her dementia and the notes show Mrs T’s ‘next of kin’ was consulted and agreed with the plan.
  3. The Home’s contemporaneous records from 4 May show Mr F had visited to take Mrs T out. There is no mention of any discussions between Mr F and staff about specific plans for the day or dietary requirements. This is not to say a discussion took place, but there was no record of this at the time. The Home’s staff have since made statements which stated they do not recall having any such conversation with Mr F, but it is acknowledged the nursing staff were busy at the time with the medication round. The Home said staff spoke to Mr F soon after Mrs T moved into the Home and discussed diet. The staff member recalled Mr F asking if a soft diet was ‘mush’. However, I have not seen anything in the records to corroborate this discussion.
  4. Mrs T’s nutritional requirements predated her move to the Home. The Home’s assessment was a continuation of previous assessments by Speech and Language Therapy professionals. There would be no cause to discuss this with Mr F unless he had specifically raised this. There is a difference of recollections about any such discussions and no evidence to corroborate what was said. It is therefore difficult for me to reach a view, even on the balance of probabilities given the lack of evidence.
  5. With regards to whether the Home put Mrs T at risk of choking with an inappropriate diet, the records show Mrs T was noted to require a soft diet. There is a comprehensive record of Mrs T’s food and fluid intake and this shows no issues with her diet. The Home has clarified the cakes and biscuits Mr F referred to were ‘soft’ and its clinicians closely monitored and supervised Mrs T. I consider the Home managed Mrs T’s nutrition in line with her assessed needs and she did not have any problems with food intake or choking. I therefore find no fault in this regard.
  6. With regards to Mr F’s comment that the Home told him to give Mrs T extra diabetes medication to counter increased sugar intake from birthday cake, the nurse denied this happened or that this was usual practice. Her statement says she would never give this advice as a registered nurse and diabetic herself. I have not seen anything in the records to indicate this was something that happened routinely.
  7. As the medication was prescribed and not ‘as needed’, additional medication would need to be given by a doctor. There is no indication that this happened. Again, there is a lack of evidence about the discussion and a difference in recollections. However, based on the nurse’s statement and the records, I consider, on the balance of probabilities, it is unlikely the nurse said they would give extra medication to counter consumption of birthday cake. I cannot say why there was a misunderstanding and do not find fault by the Home in this regard.
  8. The bruise on Mrs T’s arm that Mr F raised concerns about was noted in the records on 3 May 2017 at 23:10. The record notes two bruises on Mrs T’s arm – one small and one larger in colour. A body map was completed. The Home say as Mr F removed Mrs T from the Home the following morning it was unable to investigate the cause further. However, it did ask staff about this but they could not be certain how or why the bruising happened. Given the time elapsed, further investigation is unlikely to provide any additional information to determine what caused the bruising or whether this was preventable. The records show moving and handling assessments were completed appropriately at the Home and the daily records do not indicate there were any incidents in the preceding days. I have therefore not found fault by the Home.

Safeguarding investigation

  1. Mr F complains the Council delayed investigating the safeguarding concerns Mr F raised about poor care and possible abuse of Mrs T at the Home. He says his family are left with the uncertainty of not knowing whether a more timely safeguarding investigation would have been able to reach conclusions about the allegations of abuse.
  2. Mr F initially raised his concerns as complaints directly with the Home. It investigated and responded to these through its complaints procedure. This was entirely appropriate. Mr F subsequently sent a complaint letter to the Council, dated 28 June 2017. These were not raised as safeguarding concerns. However, the Council decided the issues appeared serious enough to warrant a safeguarding enquiry. It wrote to Mr F on 14 July to tell him about this.
  3. The safeguarding records state the decision to progress to an enquiry was made on 27 July. It shows enquiries were made to the Home and records were reviewed, but no evidence of neglect was found. The Council sent Mr F an outcome letter on 24 November 2017.
  4. There is a delay between 14 July and 27 July for the enquiry to progress. This is not in line with the local policy. The time taken to close the enquiry is also outside the target timescale. I have not seen evidence in the safeguarding or complaints information the Council has provided that indicates Mr F was kept updated about delays.
  5. Although the local safeguarding policies do not specify definitive timescales, the time taken at each stage in this case are far enough outside the target timescales, and without adequate communication about the reasons why, to be fault. However, there is no evidence Mrs T or any other individuals were at risk. Mrs T was living in Mr F’s home and there was a lack of evidence to substantiate the concerns. I do not consider investigation by the Council a couple of weeks sooner would have meant it could have reached definitive conclusions about the alleged abuse.

Complaint handling

  1. Mr F complains the coordinated complaint response from the Council, Trust and CCG was poor because it was delayed, incomplete, and offered an inadequate remedy.
  2. The substance of the complaints has been dealt with above. In terms of the coordination of the response, the Council took the lead. The Council had agreed to keep Mr F updated, but this only happened after Mr F chased this up himself.
  3. The Council’s acknowledgement letter said it would respond in writing within 28 days from 10 July 2017. Although this was not done, the Council contacted Mr F on 9 August and agreed to extend the time limit. It is unclear what these were extended to, but Mr F says he agreed on the understanding he would be kept updated regularly. It was also agreed at this time to expand the complaint to include the CCG/Trust. This was good practice and in accordance with the Complaint Regulations.
  4. The Trust sent its response to the Council on or around 20 October. However, the Council did not respond or provide Mr F with any updates until December. As the lead organisation for the complaint, the Council was responsible for coordinating the complaint, including updates. I do not consider it acted in accordance with the Complaint Regulations in keeping Mr F informed as to the progress of the investigation or sharing the response ‘as soon as reasonably practicable after completing the investigation’. This is fault.
  5. The Council has acknowledged fault with its complaint handling and apologised to Mr F for the frustration and distress. Given the injustice was relatively minor and Mr F received a joint response within six months of making the complaint, I consider this provides an appropriate and proportionate outcome to this aspect of the complaint.

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Recommendations

  1. I acknowledge the Council has offered to apologise and pay £150, but Mr F did not want to accept this prior to the Ombudsmen’s consideration of his complaint.
      1. The Council should apologise to Mr F for the distress and inconvenience caused by the faults identified with the MCA assessment and best interest process when Mrs T was discharged from hospital in February 2017.
      2. The Council should apologise to Mr F for the distress that resulted from its failure to consider a MCA assessment/best interest process during Mrs T’s discharge planning in April 2017.
      3. The Council should pay Mr F £100 in recognition of the distress that resulted from its failure to consider a MCA assessment/best interest process during Mrs T’s discharge planning in April 2017.
      4. The Council, the Trust and the Partnership Trust should apologise to Mr F for the distress caused by failings within the IDT and CHC assessment which led to Mrs F’s discharge being delayed.
      5. The Council, the Trust and the Partnership Trust should pay Mr F a total of £300 (split between the organisations) in recognition of the distress and inconvenience caused by the faults leading to a delayed discharge.
      6. The Council, the Trust and the Partnership Trust should review their respective responsibilities in the IDT and ensure all relevant staff are aware of their roles within this team to prevent delays in future discharge planning. This should pay particular attention to referral to social care, arranging CHC checklists and assessments and best interest decisions.
  2. Recommendations a) – e) should be completed within one month of the date of the Ombudsmen’s final decision statement. Recommendation f) should be completed within three months of the date of the Ombudsmen’s final decision statement.
  3. Recommendations d) and e) have been made jointly to the organisations as the discharge arrangements are a joint responsibility and it is failings in collaborative working that has led to the fault and injustices.

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Final decision

  1. There was fault by the Council with its MCA and best interest decision process on two separate hospital discharges. The Council has taken appropriate action to address this, but I have recommended it apologises to Mr F for the distress and inconvenience caused by the fault identified.
  2. The Council, the Trust and the Partnership Trust, as part of the IDT, were at fault in discharge planning. This delayed Mrs T’s discharge from hospital and caused Mr F distress and inconvenience. I have made recommendations to the organisations to apologise to Mr F for the injustice and to address discharge planning by the IDT.
  3. There was fault by the Council with the time taken for a safeguarding investigation, but this did not lead to an injustice to Mrs T or Mr F.
  4. There was fault with the complaint handing by the Council. However, this has already been acknowledged and it has apologised to Mr F. As the injustice was relatively minor, I consider this was an appropriate and proportionate outcome to this part of the complaint.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman

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