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Barts Health NHS Trust (19 006 787a)

Category : Health > Hospital acute services

Decision : Closed after initial enquiries

Decision date : 14 Feb 2020

The Ombudsman's final decision:

Summary: The Ombudsman will not investigate this complaint. The Council has taken reasonable steps to address Mr R’s complaint and remedy his injustice. Also, there is not a significant injustice to warrant an investigation.

The complaint

  1. Mr R complains how London Borough of Newham (the Council) handled the discharge arrangements for his elderly father, Mr S, in June and July 2019. Specifically, he says:
    • The Council’s early view that Mr S should return home with a care package was inappropriate and wasted time.
    • The Council did not fully consider all the relevant information to make that decision, such as the psychiatrist’s report and the family’s views.
    • The Council’s communication with other professionals and the family was poor.
    • The Council did not follow up Mr R’s request to have a different social worker assigned to Mr S.
  2. Mr R says the Council delayed Mr S’s discharge and caused the family distress.
  3. Mr R would like the Council to carry out service improvements to ensure these mistakes do not happen again.

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The Ombudsman’s role and powers

  1. 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’. We provide a free service, but must use public money carefully. We may decide not to start an investigation if we believe:
  • the injustice is not significant enough to justify our involvement, or
  • it is unlikely we could add to any previous investigation by the Council, or
  • it is unlikely further investigation will lead to a different outcome, (Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

  1. I have considered information Mr R has provided in writing and by telephone. I have also considered written information from the Council. I have provided Mr R with a draft version of this statement and considered his comments about it.

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What I found

Key facts

  1. Mr S is an elderly man with dementia who was living in sheltered accommodation.
  2. In mid-June 2019, a hospital admitted Mr S following an accident.
  3. A hospital social worker (the social worker) met with Mr S’s daughter a few days into Mr S’s admission. They discussed Mr S’s choices for discharge. The social worker told Mr R that Mr S could return home with a care package. Mr S’s family wanted to move Mr S to a residential care home, closer to where they lived because of his dementia. Mr R told the social worker (and the hospital staff) the family held lasting power of attorney for Mr S.
  4. The hospital held a team meeting in late June 2019. The Council completed a need assessment and decided Mr S could return home with a care package.
  5. Mr S’s family felt Mr S lacked mental capacity, so a psychiatrist and the social worker carried out mental capacity assessments. Those assessments said Mr S had fluctuating mental capacity and could not make decisions about his discharge. Following this, in early July 2019, all parties agreed Mr S should move into a residential care home near to his family.
  6. In late July 2019 the hospital discharged Mr S to a care home.
  7. In response to Mr R’s complaint, the Council said:
    • The social worker’s conversation with Mr R about discharge in mid-June 2019 was premature. The social worker had not completed a needs assessment and Mr S’s condition was poor. It apologised that the social worker’s actions fell below the expected standard.
    • It accepted the mental capacity assessments, and review of Mr S’s choices, delayed his discharge.
    • The social worker properly considered two doctor’s views when they completed the mental capacity assessment.
    • It apologised there were communication issues. The social worker should have told the hospital about Mr S’s lasting power of attorney. It also told relevant staff to share important information like this with other professionals.
    • It also apologised to Mr R for the inconvenience caused by not assigning a new social worker.
  8. The Council held a reflective learning session in November 2019. This was a robust review of Mr S’s case. The Council invited all the relevant staff members in Mr S’s case. The Council said:
    • Staff should have all the relevant information before completing any assessments or making decisions about care and support. It had spoken with the social worker about Mr S’s case.
    • It provides staff with annual and refresher training, so staff are competent with mental capacity assessments and people with power of attorney.
    • It sent an email to the hospital social work team to ensure they respond to concerns in a timely and robustly manner. Staff should follow up concerns in writing if necessary.
    • It apologised for not responding to Mr R’s request for a new social worker sooner. In future, it will escalate requests to the Service Manager who will consider and respond to requests within 48 hours.

The social worker’s early view on discharge

  1. I understand how the social worker’s comments in mid-June 2019 would have been distressing for the family. However, the Council has taken reasonable steps to put right the distress the family suffered and ensure similar fault does not happen again to others. The social worker attended the November 2019 session and has reflected on their actions. The Ombudsman must consider what material difference we can achieve by using public money to investigate. It is unlikely further investigation would achieve more for Mr R.

Delayed discharge

  1. The Council was responsible for delaying Mr S’s discharge by one week. I understand how frustrating it must have been to then wait another three weeks to find a suitable care home. However, the Council accepted it contributed to the delayed discharge and apologised. It is unlikely further investigation would achieve more for Mr R.

Capacity assessments

  1. Mr R said the social worker would not accept a doctor’s mental capacity assessment of Mr S, but agreed to carry out another one after Mr R threatened to escalate his concerns. The social worker completed the mental capacity assessment with two specialist doctors at the hospital. I have viewed a copy of that assessment, and I am unlikely to find fault with it.
  2. While I am unlikely to find fault, the Council told Mr R it offers training to any staff who want to update their knowledge on how to complete mental capacity assessments. This is good practice and should ease Mr R’s concerns on this point.

Communication

  1. The Council apologised that its communication with Mr S’s family fell below the expected standard. The Council has ensured staff understand how to communicate better with families of service users. It is unlikely further investigation would achieve more for Mr R.
  2. Mr R said the Council delayed providing a copy of Mr S’s needs assessment. That delay was fault. However, the social worker told Mr R the result of the needs assessment verbally. Therefore, Mr R was aware the hospital was going to discharge Mr S to a care home. I do not consider there is a significant injustice to Mr R to warrant an investigation.

Request to change social worker

  1. I consider the Council has apologised to Mr R for the inconvenience caused by not assigning a new social worker. I am also satisfied the Council has introduced a robust plan to ensure it considers requests sooner. It is unlikely further investigation would achieve more for Mr R.

Mr R’s response to the Council’s service improvements

  1. In late January 2020, Mr R told me the November 2019 session should have been compulsory. While the Council said the November 2019 session was invitational, I am satisfied the relevant professionals attended the November 2019 session, which included the social worker. I have not seen any evidence to doubt the social worker did not attend the session.
  2. Mr R also wanted the Council to change its policies and/or procedures to avoid similar fault reoccurring. I am satisfied the Council identified where its service amounted to fault which caused the Mr S’s family distress. However, I am satisfied the Council’s response to Mr R’s complaint has addressed the injustice the family suffered and will stop similar fault from happening again.

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Final decision

  1. I consider the Council has taken reasonable steps to address his complaint. Also, there is not significant injustice to Mr R to warrant an investigation.

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Investigator's decision on behalf of the Ombudsman

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