Norfolk & Suffolk NHS Foundation Trust (18 002 602a)

Category : Health > Mental health services

Decision : Upheld

Decision date : 08 Aug 2019

The Ombudsman's final decision:

Summary: The complainant, Mr X, complained about the way the Council and Trust assessed his physical and mental health needs in 2014. The Ombudsmen found the Trust acted with fault in not properly assessing Mr X especially his concerns over his medication when he was discharged from its care. The Trust promptly acknowledged this and has already reimbursed the complainant £375 for his costs incurred in seeking a private doctor to review his medication. However, the Ombudsmen also later found the complainant suffered uncertainty as to whether his personal budget would have increased but for the fault. He also suffered a lost opportunity to challenge the assessment as it was not provided to him at the time. And the Trust continued to fail to deal with his complaint properly. The Trust has now agreed to the Ombudsmen’s recommendations to pay Mr X an additional £750 to remedy Mr X’s uncertainty, lost opportunity and time and trouble taken to complain.

The complaint

  1. In summary, Mr X complains about various aspects related to his care needs planning and medication concerns in 2014/15. Specifically, he says an eligibility decision was changed without his knowledge. He believes this led to his discharge from the community mental health team. He also says he suffered a significant injustice due to the poor assessment as, when the assessment was properly carried out the next year by the Council, his personal budget was increased by over £2000.

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The Ombudsmen’s role and powers

  1. 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)
  2. 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).
  3. 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.
  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. I have considered the information Mr X has provided in writing. I have spoken to his wife about his complaint (at his request). I have read the Council and Trust responses to his complaint including its responses to my enquiries. I have shared my draft decision with Mr X and read his detailed response. I also made further enquiries to the Trust after receiving Mr X’s response to the draft.

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What I found

Relevant guidance and governance

  1. At the time of the events which are the subject of this complaint, councils determined eligibility for care services by reference to the 2003 Department of Health Fair Access to Care Services (FACS) guidance. FACS established an eligibility framework graded in to four bands; critical, substantial, moderate and low.
  1. Norfolk and Suffolk Foundation Trust and Norfolk County Council had a s75 partnership agreement (under the National Health Service Act 2006). This was to provide health and social care services for adults with mental health problems. At the time of complaint events raised to us, the Trust exercised council functions as well as exercising NHS functions.
  2. The above agreement ended in October 2014 and responsibility for social care was passed back to the Council.

The complainant and his complaint

  1. Mr X has several physical and a mental health medical conditions for which he received services from the Trust.
  2. In 2014 he says he signed an assessment of his needs which rated his care needs as ‘substantial’.
  3. After he was discharged from the Trust, he requested his medical records. He says he was surprised to note that some of his needs had been changed to ‘moderate’.
  4. Mr X complained to the Trust promptly, in 2015, to query what happened. He raised other concerns saying the information in the assessment documents did not match his recollection of what was discussed.
  5. Mr X believes his needs were minimised to justify discharging him. He is particularly concerned with the Trust’s failure to properly consider his concerns about his medication. He says the medication caused him to gain weight significantly which affected his health.

The Trust and Council response

  1. In response to my enquiries on this complaint, the Council said the Trust was responsible for Mr X’s care and support at the time of the events complained about.
  2. Turning to the Trust, I note it had already admitted several instances of fault in its complaint’s response to Mr X.
  3. It said it did fail to provide copies of the assessment/care plan. It enclosed copies with a complaint response. It admitted Mr X and his wife (as his carer) were not asked to sign the documents. However, it found these administrative oversights had not affected its decisions. It illustrated this by highlighting that Mr X’s Personal Budget was not adversely affected.
  4. With respect to Mr X’s concerns about his medication it said queries could be referred to the Trust’s pharmacy team, Mr X’s GP or checked online. It said it saw no reasons to review his medication.
  5. This was despite Mr X saying the medication had caused significant weight gain contributing to his sleep apnoea and exhaustion. Mr X told me he was forced to arrange a medication review via a private psychiatrist. This resulted in other medication being prescribed by Mr X’s GP. Mr X says he has lost a lot of the excess weight and his physical health has improved. Mr X provided me with an invoice showing the private psychiatrist charged £375.00.
  6. In my enquiries to the Trust I asked if it could reconsider the medication issue. I also asked the Trust to comment on Mr X’s remaining concerns about the assessment paperwork.
  7. In addition, I asked the Trust to review the complaints handling as it appears to show a less than robust response to Mr X’s complaint in 2015. For example, the complaints investigator in 2015 appears to justify the lack of Mr X’s signature on the care planning documents by writing that “signatures are not able to be given or are not appropriate to be sought in the planning process”. Signatures should always be sought, where possible, to signify consent to the assessment process. I also find the tone of some of the Trust’s responses to Mr X to be less than professional and condescending in parts.
  8. The Council agreed to my suggestion in my enquiries letter that it should cover the cost of the private consultation. It arranged to send Mr X a cheque to cover this amount.
  9. It also said its complaints handling had much improved. It said it had implemented complaints handling for all staff involved in investigating complaints. It acknowledges the responses sent to Mr X were not of a standard it now strives to achieve. It advises that it checks the quality of its complaint responses with a group involving service users, carers, staff and representatives from independent groups such as Healthwatch.
  10. When I received the Trust’s response, I sent Mr X a draft decision saying it appeared his injustice had now been remedied. I said it was unlikely I would have achieved anything further given that his personal budget had remained unaffected by the fault.
  11. Mr X responded to my draft decision in some detail. He advised the assessment carried out properly the following year increased his personal budget by over £2000 despite there being no material change in his physical and mental health from 2014. He asked me to take this in to account before reaching any final decision.
  12. I made a further enquiry to the Trust.
  13. I asked it to consider that its failure to provide Mr X with a copy of the assessment meant he lost the opportunity to challenge the decisions made. I said there was uncertainty as to whether Mr X’s personal budget would have been increased but for the fault. I informed the Trust that when the Council assessed Mr X the following year it increased his personal budget by over £2000.
  14. I also said that while Mr X has confirmed receiving the payment to cover the cost of the private consultation it was sent without any covering letter or accompanying apology. And that this did not equate with a satisfactory complaint remedy or improved complaints handling as previously claimed by the Trust.

Analysis

  1. The Trust has agreed a financial remedy to Mr X of £500 to reflect the uncertainty and lost opportunity caused to Mr X regarding whether he would have been awarded an increased personal budget but for the fault. Plus, an additional £250 for the flawed complaint handling that has put Mr X to avoidable time and trouble in raising his complaint.
  2. My final decision is the Trust has adequately remedied Mr X’s complaint by agreeing to remedy the injustice arising from the faulty assessment.

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Agreed Recommendations

  1. The Trust has agreed to the Ombudsmen’s recommendations and within six weeks of the final decision it will:
  • Pay Mr X a token amount of £750 to acknowledge the uncertainty, lost opportunity and time and trouble taken to complain. It will also send him a letter of apology.

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Final decision

  1. The Trust acted with fault in not properly assessing Mr X especially his concerns about his medication when he was discharged from its care. The Trust also failed to deal with his complaint properly from 2014.
  2. The resulting injustice to Mr X was uncertainty as to whether his personal budget would have increased but for the fault. He also suffered a lost opportunity to challenge the assessment. And he was put to avoidable time and trouble in pursuing his complaint.
  3. The Trust agrees to the Ombudsmen’s recommendations to remedy Mr X, by £750, for the uncertainty, lost opportunity and time and trouble taken to complain (to add to the £375.00 already provided). It will also send an apology to Mr X.
  4. The Trust’s action provide an appropriate remedy for Mr X’s injustice. I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman

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