Summary: Mrs Y, and her grandson, Mr Z, complain about the way the Council and Trust handled their request for assistance when their daughter and mother, Mrs X, was due to return to the UK after being discharged from a mental health hospital abroad. The Ombudsman found fault causing injustice in the initial faulty advice provided to Mrs Y and Mr Z. However, the Ombudsmen are satisfied the Council and Trust’s subsequent actions remedied the impact of the injustice prior to the complaint to the Ombudsmen.

The complaint

1. Mrs Y complains about Kent County Council’s (‘the Council’) and Kent and Medway NHS and Social Care Partnership Trust’s (‘the Trust’) communications with her as she sought to bring her adult daughter, Mrs X, back to the UK. Mrs Y describes her daughter Mrs X as ‘deeply mentally ill’ and reports she had been ‘detained’ in a mental health unit abroad.
2. Mrs Y says the Trust’s confusion, delay and last-minute panic arrangements did not work and resulted in additional responsibilities and risks to Mrs X and her son Mr Z. She also says the complaint responses are incorrect and implausible.
3. Mrs X says the Council failed to exercise its responsibility of oversight.

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The Ombudsmen’s role and powers

4. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA,as amended, and Health Service Commissioners Act 1993, section 18ZA)
5. The Ombudsmen cannot decide what level of care is appropriate and adequate for any individual. This is a matter of professional judgement and a decision that the relevant responsible body has to make. Therefore, my investigation has focused on the way that the bodies made their decisions.
6. 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).
7. 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.
8. The Ombudsmen provide a free service but must use public money carefully. They may decide not to start or continue with an investigation if they believe it is unlikely, they could add to any previous investigation by the bodies. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended.
9. 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

10. I have read the complaint information Mrs Y provided to us alongside information from the Council and Trust. I have also considered the law and guidance relevant to this complaint. All parties have had an opportunity to respond to an earlier draft of this decision and I have read Mrs Y’s solicitors’ response carefully.

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What I found

AMHPs and the Mental Health Act 1983

11. An approved mental health professional (AMHP) is a mental health worker who can help assess whether a person needs to be compulsorily detained (sectioned) as part of their treatment.
12. The Mental Health Act 1983 sets out the legal powers doctors and AMHPs must use to detain people in hospital against someone’s will. (The role of the doctors is to make recommendations for an application to be assessed). The role of the AMHP is to ensure that an application to be assessed is necessary and that no ‘less restrictive’ form of intervention is used.
13. If you are detained under the Mental Health Act it is because you have been judged as needing urgent treatment for a mental health disorder and are at risk of harming yourself or others.
14. Section 13 of the Mental Health Act says (we have underlined for emphasis):

“ Duty of approved mental health professionals to make applications for admission or guardianship

If a local social services authority have reason to think that an application for admission to hospital or a guardianship application may need to be made in respect of a patient within their area, they shall make arrangements for an approved mental health professional to consider the patient’s case on their behalf.”

Background to the complaint

15. Mrs Y explains that Mrs X suffered a breakdown when living in Kent. She went missing. Another relative was advised by the British Consulate that Mrs X had been detained in a mental health unit abroad after attempting suicide and being arrested for violence.
16. Mrs X’s son, Mr Z, arranged to collect Mrs X and bring her back to the UK. He sought reassurance from the Trust it would help Mrs X when she returned. Mrs Y says she became involved as Mr Z failed to receive a satisfactory response from the Trust.
17. Mr Z and Mrs Y said Mrs X would need care and treatment via an urgent mental health assessment as soon as she returned to the UK on 3 December 2016 at Heathrow Airport. Mrs Y said otherwise Mrs X would go missing, attempt suicide and be a danger to others.
18. Mrs Y contacted the Council, Trust, the local MP, and the Police with her requests for assistance. She received a variety of responses. Overall, she says she was left with the impression that a ‘team of fully qualified professionals’ would meet and assess Mrs X as she arrived at Heathrow.
19. Mrs Y complains that Mr Z was left on his own to take Mrs X from Heathrow to a hospital bed in Kent. Mrs Y said Mrs X was resistant during the journey and Mr Z had to sedate her while being careful not to over sedate.

The complaint responses from the Council and the Trust

20. In January 2017, the Council sent its first complaint response to Mrs Y. In summary, it said it had no powers to carry out an assessment of Mrs X’s mental health at Heathrow. This was the responsibility of the local Council nearest to the airport: the London Borough of Hillingdon.
21. It explained the Council has a legal agreement with the Trust to deliver integrated services on its behalf including to people with mental health needs. And the Trust’s Approved Mental Health Professional (AMHP) service is responsible for carrying out mental health assessments. It apologised for not making this clearer before.
22. The Council said it acted on Mrs Y’s request by checking the Trust was aware of and dealing with her concerns. It understood there had been confusion initially over whether Mrs X’s mental detention would remain in place while travelling between countries. And, it said that in November 2016 the Trust did contact the local AMHP service but there was limited information and it was noted Mrs X was not in Kent. The Council said it was aware the Trust had told the MP that Mrs X would be met at Heathrow. But, it wrote, that once it was realised the authorities overseas would discharge Mrs X, the procedure in the UK was that the AMHP service local to Heathrow, from the London Borough of Hillingdon, would be called for assistance/assessment if needed.
23. The Council highlighted it was not possible to confirm that detention would happen before a mental health assessment had taken place. It said that if this has been suggested by anyone this should not have happened.
24. The Council went on to explain that - despite the promise made by the Trust to the MP - the Trust was only told on 2 December, by Hillingdon’s AMHP service, that immigration services would not be ‘pro-actively’ meeting Mrs X. So, the Trust passed on this information to Mr Z and said he should ask for help at Heathrow if needed. The Council says the Trust also liaised with Kent Police to ensure the Police at Heathrow were aware. And finally, the Trust arranged for a bed to be made available at a hospital in Kent in case Hillingdon AMHP service decided Mrs X needed to be detained.
25. The Council noted what happened at Heathrow: Mr Z called the Trust to say he would take Mrs X directly to the hospital bed in Kent where she was admitted as a voluntary patient. It noted Mrs X was willing to be admitted and this was the ‘least restrictive’ option as required by best practice.
26. The Council said it understood the late information provided to Mr Z on 2 December would have caused anxiety.
27. In May 2017, the Council responded to Mrs Y’s further points. In the main, it reiterated the procedure for someone being detained under the Mental Health Act at Heathrow after an assessment had taken place. It confirmed people could not be detained without an assessment. It added that advice given by Council staff had been given in good faith at the relevant time and it apologised there was a late change in arrangements. It said the Trust would be reviewing what happened and was better placed to respond to Mrs Y’s complaint.
28. In June 2017, the Trust sent Mrs Y a copy of its investigation. It said it had reviewed its records and interviewed relevant members of staff. It wrote that incorrect information had been provided when a member of staff promised an assessment would be arranged when Mrs X arrived at Heathrow. And it found this information was relayed to Mr Z, Mrs Y, Council staff and the MP. The Trust says as soon as it realised its error it informed Mr Z (on 2 December).
29. The Trust stressed the actions it took after correcting the initial wrong advice. It says a staff member advised Mr Z who he should contact on arrival once at Heathrow, if needed. Plus, a Trust member of staff provided him with her mobile number so he could call her at any point over the weekend (even though she was not working over the weekend). The same member of staff reserved a bed at a hospital in Kent for Mrs X. The Trust apologised for the distress and confusion. It said it appreciated this was a ‘difficult and stressful time’ for the family.
30. It also addressed Mrs Y’s concerns that the Trust did not always answer her emails. The Trust said its understanding was that ‘relevant and pertinent’ emails had received responses. It apologised for not responding to the email dated 17 November 2016 addressed to its ‘single point of access’ contact team. It wrote that Mrs Y sent ‘numerous’ emails to not only the Trust, but also the Council, Mrs Y’s GP, the Police, and the local MP. The Trust said this caused ‘some confusion’ over who the email was intended for and who should reply. It added that Mrs Y had declined its offer to discuss her emails over the telephone.
31. Overall, it stressed that Mrs X was safely admitted as a voluntary patient to the hospital. It noted no issues were reported by Mr Z to the London Borough of Hillingdon and no contact with the authorities at Heathrow was needed. It said the Trust staff had remained in contact with Mr Z during the journey.
32. The Trust also said, in such situations in future, the case would be escalated to a senior member of staff. It accepted there was a lack of clear direction in this case which created confusion, frustration, and anxiety for Mrs Y. It said it would share this learning widely within the Trust and include it in its Staff Bulletin for learning.
33. In August 2017, the Trust sent another response as Mrs Y continued to raise her concerns. The Trust apologised again. It reiterated that, from the point of view of its staff member, she had remained in contact with the Mr Z throughout the journey. It repeated its views on its responses to her numerous emails. It apologised again if not all were responded to due to the volume received.
34. In September 2017, the Trust acknowledged receipt of Mrs Y’s 36-page email repeating her complaints. It said it could not provide any more assistance and signposted her to the Ombudsmen.

The Ombudsmen’s draft decisions

35. In September 2019 we sent Mrs Y our first draft decision on her complaint. We noted the fault in the initial advice provided by the Trust (to Mrs Y’s MP) leading her to believe Mrs X would receive a mental health assessment at Heathrow. However, we found the Trust’s subsequent actions remedied the impact of the fault: the Trust liaised with the responsible social services authority for Heathrow - the London Borough of Hillingdon - and its AMHP service to advise it of Mrs X’s arrival at Heathrow. It also acted by providing the mobile number of a Trust Manager for Mr Z to call, if needed, and it reserved a bed for Mrs X in a hospital in Kent. We noted the outcome where Mrs X had been successfully admitted as a voluntary patient to the hospital in Kent. We also noted the apologies provided to Mrs Y and Mr Z for the initial misleading information. Overall, we found there was no obligation on the Trust to arrange for Mrs X to be assessed and detained at Heathrow, as requested by Mrs Y. We advised we intended to discontinue the investigation as we were unlikely to be able to add anything more to the investigations already carried out by the Trust and the Council.
36. Mrs Y’s response to the first draft decision was now provided by her solicitor who raised many wide-ranging points. We asked the Council/Trust to answer these queries and reconsidered the case. We sent Mrs Y’s solicitor a second draft decision in July 2020 with the same decision outlined in this statement and read his comments carefully.

My analysis

37. We consider it would not be proportionate to respond to every general point of concern raised by Mrs Y’s solicitor. As KCC and the Trust were not the relevant ‘local social services authority’, under s13 of the Mental Health Act, when Mrs X was physically present in the UK, at Heathrow Airport. That was the London Borough of Hillingdon who would normally hold any statutory duty to assess.
38. To recap, as we wrote in the first draft decision, there was fault in the initial advice provided by the Trust to Mrs Y’s MP that led her to believe Mrs X would receive a mental health assessment at Heathrow.
39. However, we consider the Trust’s actions remedied the impact of the initial faulty advice and no injustice arose to Mrs X. This is because, as soon as the Trust became aware it had provided the wrong advice, it alerted Mr Z and says it contacted the London Borough of Hillingdon.
40. We note the solicitor has provided a letter from the London Borough of Hillingdon stating that it failed to receive any contact from the Trust. There may be a conflict of evidence here as the Trust details several file notes recording staff contact with the London Borough of Hillingdon (albeit it accepts it should have sought written confirmation of its communications with Hillingdon). It is not necessary for us to make a finding on this issue given, any statutory duty to arrange to assess Mrs X at Heathrow remained with the London Borough of Hillingdon, and there was limited injustice arising to Mrs X and her family.
41. Further, we note the Trust provided a mobile number of a senior member of its staff and arranged to keep in touch with Mr Z over the weekend. Mrs X was safely driven by Mr Z from Heathrow to Kent to the mental health bed in Kent reserved for her by the Trust.
42. And we also note that the Trust’s actions arising from its complaints investigation. It says it will now ensure such cases are escalated to senior officers - earlier than this one was - to minimise the risk of faulty information provided at the outset. The Council has advised that the AMHP service is now back with the Council, so any similar requests would go directly to the AMHP service, rather than Mental Health services. We note the admission that the communication could have been clearer as well as the recording of information. And also that it has provided an apology to Mrs X at Mrs Y’s request. This learning, together with the apologies provided, are in line with the Ombudsmen’s guidelines on remedying complaints.
43. Mrs Y sent many emails to the Trust, Council, and other agencies. We consider it was inevitable that some of these would be missed, due to the volume, and therefore detract from achieving the answers she was seeking.
44. Mrs Y has pursued her complaint to us in detail. She continues to seek answers to issues such as the extent of the liaison carried out by the Trust with the overseas authorities, the Police in the UK, the British Consulate overseas. We see no good reason to make enquiries into these issues to reach a decision on her complaint. We fail to see what we could meaningfully achieve by investigating her outstanding queries.

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Final decison

45. We have completed our investigation and uphold Mrs Y’s complaint. There was fault by the Trust causing injustice arising from the initial faulty advice. However, the Trust’s subsequent actions provided a suitable remedy prior to the complaint to the Ombudsmen.

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Investigator's decision on behalf of the Ombudsman