Summary: The Ombudsmen do not consider there was fault in the way Lancashire County Council and Lancashire Care NHS Foundation Trust decided Mrs B’s daughter had capacity to be discharged from the community mental health team. The community mental health team also considered Mrs B’s concerns.

The complaint

1. Mrs B complains about the actions of Lancashire County Council (the Council) and Lancashire Care NHS Foundation Trust (the Trust). Specifically, the Council and Trust jointly decided to discharge her daughter, Miss C, from the Trust’s community mental health team (CMHT) in January 2019. Mrs B disagrees her daughter had capacity to discharge herself from the CMHT. Mrs B also says the CMHT ignored her concerns.
2. Mrs B says she must provide the care and support for her daughter the CMHT should be providing. This includes making sure she takes her medication, which her daughter has started to question. Mrs B is concerned her daughter will relapse, and if this happens there will be no support in place for her.
3. Mrs B would like her daughter to receive appropriate support from the CMHT.

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The Ombudsmen’s role and powers

4. 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).
5. The Ombudsmen cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7)) 
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. I have considered the complaint information Mrs B has provided to me. I have asked the Council and the Trust to comment on the complaint and provide supporting documentation. I have considered the relevant law and guidance.
8. I wrote to Mrs B and the organisations involved with a draft decision. I gave them the opportunity to provide comments before I issued the final decision.

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What I found

9. Miss C suffered with bipolar affective disorder (when someone’s mood can swing from one extreme to another).
10. In July 2018, the community mental health team (CMHT) held a review meeting with Miss C and following an examination, plans to discharge Miss C from the CMHT were discussed with her.
11. In October 2018, the CMHT held a further review meeting with Miss C. Mrs B was also present and raised concerns about Miss C’s housing situation. Miss C was again assessed. The consultant also asked Miss C’s care coordinator to address Mrs B’s housing concerns before discharging Miss C.
12. In November 2018, Miss C’s care coordinator completed an assessment of her social care needs, including her housing situation. The care coordinator agreed to provide support to Miss C to manage her needs.
13. In January 2019, with Miss C’s agreement, she was discharged from the CMHT.

Analysis

14. The National Institute for Health and Care Excellence’s (NICE) Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services (2011) guideline refers to discharge. Specifically, it says clinicians should:
• Discuss and plan discharge carefully beforehand.
• Develop a care plan with social care, which includes details of how to access services in times of crisis.
• Agree discharge plans with the service user and include plans to address problems after discharge.
• Discuss arrangements with any family or carers. Assess the service user’s financial and home situation, including their housing.
• Give service users clear information about all possible support choices.
15. 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.
16. 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. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.
17. I consider the CMHT acted within the MCA and the Code when it decided Miss C had capacity to decide to discharge from its service:
• The CMHT’s care records show CMHT staff properly considered Miss C’s specific needs and mental health when assessing her.
• The CMHT discussed the discharge with Miss C and Mrs B in the six months before January 2019. This was in line with the NICE guidelines.
• The CMHT created a discharge care plan detailed how Miss C could get support following her discharge. The care plan, which Miss C agreed with, was in line with the NICE guidelines.
18. Also, I consider the CMHT correctly addressed Mrs B’s concerns about her daughter’s housing situation. Miss C’s care coordinator assessed her house as part of a social care assessment. This assessment was in line with the NICE guidelines.
19. Whilst Mrs B feels she has to provide support for her daughter, the evidence shows that Miss C had capacity to decide to discharge from its service and that an appropriate discharge plan was put in place to enable Miss C to access the support she needs.

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Final decision

20. I do not consider there was fault in the way the CMHT decided Miss C had capacity to discharge from their service in January 2019. Also, the CMHT considered Mrs B's concerns.

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Investigator's decision on behalf of the Ombudsman