Summary: The Council and Trust have already acknowledged they failed to assess Mr F as a carer and failed to provide him with support. The Council has accepted our recommendation to provide an apology. The Trust has accepted our recommendation to issue staff guidance. The Ombudsmen have therefore completed their investigation.

The complaint

1. The complainant, whom I have called Mrs D, complains on behalf of her father, Mr F about the actions of the Council and the Trust. Mrs D complains that:
• between November 2015 and January 2017, the Council and Trust failed to assess Mr F’s needs as a carer and failed to provide adequate support to him, causing him avoidable distress; and
• the Council and Trust’s response to her complaint does not show that the two organisations have taken enough action to prevent similar problems from happening to others.
2. As an outcome from her complaint to the Ombudsmen, Mrs D wants to:
• see evidence of robust action taken to prevent this from happening again; and
• know the organisations are monitoring the effectiveness of this action.

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The Ombudsmen’s role and powers

3. 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)
4. The Ombudsmen cannot investigate late complaints unless they decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to the Ombudsmen about something an organisation has done. (Local Government Act 1974, sections 26B and 34D, as amended, and Health Service Commissioners Act 1993, section 9(4).)
5. 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. 
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. Mrs D’s complaint is late because she was aware of the matters she complains about from November 2015 and throughout 2016 but she did not complain to the Ombudsmen until July 2018, more than 12 months later. We have exercised our discretion to investigate the complaint from November 2015 to January 2017 when the concerns stopped, because we considered that:
• Mrs D has provided good reasons for why she did not complain to us sooner;
• there was a public interest in investigating the action taken by the Council and Trust in response to Mrs D’s complaint, to consider whether this was likely to prevent similar problems recurring; and
• it was likely that we would be able to get the evidence needed for a fair investigation.
8. I have considered matters affecting Mrs F as part of a separate complaint. This complaint focuses on matters affecting Mr F as her carer.
9. I have considered information Mrs D has provided in writing and by telephone. I have also considered documentary records and written comments provided by the Council and Trust in response to our enquiries.
10. Mrs D, the Council and the Trust have had an opportunity to comment on a draft version of this decision.

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What I found

11. Mr F lived with his wife Mrs F. Mr F has a long-standing brain injury following an accident. Their daughter, Mrs D, says this affected his emotional responses as well as his ability to make rational decisions.
12. Around 2010, Mrs F was diagnosed with Alzheimer’s disease, a type of dementia. Mr F became her carer. Mrs F received a small amount of privately funded care in her own home. This included some weekly personal care and cleaning every other week. She also attended a day centre twice a week. However, Mr F had day-to-day responsibility for her personal care, medication, keeping her company and making sure she was safe. Mrs F’s behaviour could at times be challenging. Mr F found it particularly difficult to cope with her mistaken beliefs and hallucinations relating to him.
13. Mrs F received mental health care from the Community Mental Health Team (CMHT). The CMHT provides mental health care support from professionals in the community. This usually includes social workers, community psychiatric nurses, psychologists and psychiatrists. In Mrs F’s case, the CMHT also provided her with social care services under an agreement with the Council.
14. From 2015, Mr F, his daughters and others involved in Mrs F’s care started raising concerns about Mr F’s ability to cope with caring for Mrs F.
15. In January 2017, Mrs F entered a residential care home for respite, but this became a permanent placement. She was settled and well cared for there. She died peacefully in her sleep in the care home in April 2017.
16. Mrs D says that Mr F did not receive support in his own right while he was caring for Mrs F, meaning he was unable to cope and felt distressed.
17. Mrs D complained to the Council and Trust about what happened. She was not satisfied that their response addresses her concerns. She also considered the organisations did not provide enough evidence of service improvements that would prevent similar problems happening to others.

Relevant law and guidance

18. Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment (Care Act 2014, section 10). Carers’ assessments must seek to find out the carer’s needs for support, and the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult. The carer may refuse an assessment.
19. Where the local authority is carrying out a carer’s assessment, it must consider the carer’s potential future needs for support. This must include a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

My analysis

20. There is no record of the Council (or Trust on the Council’s behalf) offering to assess Mr F as his wife’s carer between November 2015 and January 2017. This is despite the Council receiving 11 concerns about Mr F not coping with caring for Mrs F.
21. In response to our enquiries, the Council has accepted it should have ensured the Trust undertook a carer’s assessment of Mr F or a review of any earlier carer’s assessments. Failure to do so was contrary to the Care Act 2014 and fault.
22. Mr F could have refused a carer’s assessment if he had capacity to do so. The available information indicates that Mr F:
• had capacity to refuse an assessment of his needs as a carer;
• was very reluctant to engage in any sort of assessment that might result in costs to him; and
• by 2016, had lost faith in the CMHT and was reluctant to engage with them further.
23. However, he did at times accept help and support that would make his role as a carer easier. Records of Mr F’s contact with the Council and Trust’s CMHT at the time indicate Mr F at times felt distraught and unable to cope. So, it is possible that he would have accepted a carer’s assessment review and support as a carer. Failure to offer Mr F a carer’s assessment or a review of any assessments done before November 2015 resulted in a missed opportunity to support Mr F as a carer.
24. When the Trust originally investigated Mrs D’s complaint, it produced an investigation report which identified what went wrong and what the Council and Trust aimed to do to prevent similar problems.
25. The Council and Trust have provided information to show they have taken significant steps to learn from Mrs D’s complaint about lack of social care support to Mr F as a carer. We have also made recommendations for further service improvements as part of our consideration of a related complaint. We will not duplicate these here.
26. As part of the local complaint response to Mrs D, the Council and Trust held a telephone conference call with Mrs D during which they discussed the result and recommendations of their investigation. The minutes of that conference are a note of the main points discussed, not a word-for-word record. The minutes say that:
• Mrs F’s community psychiatric nurse (CPN) considered Mrs F was the CMHT’s patient, so did not get involved with concerns about Mr F’s own mental health; and
• the Trust concluded it would expect staff to view a family as a whole and support them to access services in their own right as appropriate.
27. The Trust has not provided evidence that it now has guidance which explains how staff should do this, when they have concerns about the mental health of patients’ family members. I have made recommendations to address this, which the Trust has accepted.

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Agreed actions

28. The Council is ultimately accountable for Mr F’s carer’s assessment. Within a month of my final decision, the Council will write to Mr F with a meaningful acknowledgement of and apology for what went wrong.
29. Within three months of my final decision, the Trust will issue guidance to explain how staff should support patients’ family members to access mental health services.

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Final decision

30. The Council and Trust have already acknowledged they were at fault in failing to ensure a current carer’s assessment for Mr F. The Council has accepted our recommendation to apologise to Mr F. The Trust has accepted our recommendation to issue staff guidance. The Ombudsmen have therefore completed their investigation.

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Investigator's decision on behalf of the Ombudsman