The Ombudsman's final decision:
Summary: We found faults by a Council and an NHS Trust resulted in delays in providing support for an individual who had recently been diagnosed with Autism. The organisations have already accepted some faults and taken action to improve the services provided to those diagnosed with Autism. However, the injustice to the complainant was not fully addressed. The organisations have agreed to apologise and pay the complainant £500 to recognise the distress caused by the faults.
- Mr B complains about failings by Lancashire County Council (the Council) and Lancashire and South Cumbria NHS Foundation Trust (the Trust) after he was diagnosed with Autism in January 2018. He complains the Trust discharged him from mental health services before the Council had assessed his needs and put support in place. Mr B says the Council failed to assess his needs until December 2018 because it said his needs were for mental health support. The Trust would not provide support as it considered his needs were due to his Autism. He says the Trust ignored his reports of feeling suicidal when it did assess him in March 2018.
- Mr B also complains the Council wrongly recorded that he was a threat to himself and others and used this as an excuse not to complete an assessment. It also wrongly recorded that he declined support. He says the Council refused to investigate this and told him it was a data issue.
- Mr B says the faults have resulted in a lack of support for over a year, during which he made what he considers a preventable suicide attempt. He says the lack of support and untrue information the Council recorded about him caused him unnecessary distress. Mr B wants the ‘malicious’ information removed and compensation for the distress all the faults have caused him.
The Ombudsmen’s role and powers
- 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).
- 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.
- 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)
How I considered this complaint
- In reaching my decision, I took account of the information Mr B provided to the Ombudsmen in writing and verbally. I also made enquiries of all the Council and the Trust and took account of the documents and comments they provided, including relevant health and social care records. Mr B and the organisations have seen a draft of my decision statement and I have considered their comments.
What I found
Legal and administrative context
- Section 75 of the NHS Act 2006 allows NHS organisations and councils to arrange to delegate their functions to one another. Under these agreements, NHS organisations can take on the provision of social work services which are normally the responsibility of councils. The NHS and councils remain liable for the exercise of their own functions.
- The Ombudsmen will consider, in a complaint involving the NHS and the council, whether there are formal or informal arrangements between the two bodies and the nature of those arrangements. Where the NHS and council work together under partnership arrangements and the distinction between roles and responsibilities is unclear, the Ombudsmen will not spend disproportionate time deciding individual responsibility. In these situations, if the Ombudsmen find fault they will attribute it to the partnership as a whole and expect each body to contribute to any proposed remedies.
- In this case, the Trust managed mental health social workers between January and April 2018. After this they were managed by the Council.
- Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment of any adult who appears to need care and support. They must assess anyone, regardless of their finances or whether the council thinks they have eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must involve the individual and where appropriate their carer or any other person they might want to be involved.
- An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Councils should let the individual know of the proposed timescale for when their assessment will be conducted and keep the person informed throughout the assessment process.
- A local authority may carry out a needs or carer’s assessment jointly with another body carrying out any other assessment in relation to the person concerned, provided that person agrees. In doing so, the authority may integrate or align assessment processes to better fit around the needs of the individual. An integrated approach may involve working together with relevant professionals on a single assessment. It may also include putting processes in place to ensure that the person is referred for other assessments.
- Where more than one agency is assessing a person, they should all work closely together to prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing. Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high quality, coordinated assessment. (Care and Support Statutory Guidance 2014)
- In 2017 Mr B says he was struggling with his mental health and underwent a period of assessment with the mental health service. This resulted in a diagnosis in January 2018 that he was autistic. Mr B said his consultant psychiatrist told him the mental health service would discharge him, but not until adult social care had put support in place for him. Mr B says when the mental health service discharged him no support was available to him.
- Mr B says over the next few months he felt helpless and suicidal. In March his GP requested a mental health assessment from the Trust. This happened around a month later. Mr B says that during the assessment he discussed his suicidal thoughts and the detailed plans he had made to carry this out.
- Mr B says he asked his MP for help as the Council would not carry out a needs assessment. He says the MP asked the Council to complete a needs assessment. The Council received the referral in June 2018, but it could not allocate a social worker straight away.
- In November 2018 Mr B said he was struggling to cope and could not get help from the Council or the Trust. He says one day he walked to the side of a railway line with some camping equipment and was thinking of ending his life. He said the police arrived and searched his bag and found a camping knife and arrested him.
- In December 2018 a Council officer contacted Mr B to discuss arranging an assessment. Following this call the Council recorded that Mr B was a risk to himself and others because of threatening behaviour. The Council officer spoke with their manager and decided that visits to Mr B should be accompanied. Mr B says the council used this as a reason not to complete an assessment.
- Mr B says the Council said his needs were not related to his Autism and he had mental health issues that needed addressing. However, he says the mental health team said he still needed a Care Act needs assessment from the Council to meet his needs following his Autism diagnosis.
- In January 2019, the Council considered completing a care needs assessment but because he was due to be seen by the mental health team at the Trust, the Council did not progress the assessment.
- In spring 2019 the court confirmed there was no evidence Mr B had committed an offence when he had a knife in public, as was alleged in late 2018. The court found he had good reason to have a knife with him at the time.
- The Council allocated Mr B a social worker in June 2019 and started a care assessment. However, this did not progress because at the beginning of July 2019 the records note Mr B felt unable to continue with the assessment because if contained the disputed information added following a conversation with the Council in December 2018. The assessment was eventually completed in October 2019 after Mr B’s solicitor had become involved.
- Mr B complained to the Trust and the Council about the problems completing an assessment following his Autism diagnosis. He also complained that wrong information was recorded in his records about his mental health and about him being a risk to others.
- The Trust agreed to change some information in his records because it agreed it was based on wrong information provided to the mental health team. The Council’s complaint response said it did not consider the records relating to Mr B being a risk to himself and others was inaccurate. As such, it said it was not possible to change the records.
- In October 2019, after Mr B complained to the Ombudsman so outside of the period covered by this investigation, Mr B’s solicitor wrote to the Council to ask it to complete the needs assessment. The Council agreed.
- Mr B complains the Trust discharged him from mental health services before the Council had assessed his needs and put support in place. He says the Trust also ignored his reports of feeling suicidal when it did assess him. Mr B says the Council failed to assess his needs until December 2018 because it said his needs were for mental health support.
- In January 2018 the Trust considered Mr B’s depression was secondary to his Autism. It therefore discharged Mr B from mental health services and referred him to Autism Spectrum Disorder (ASD) services and social care for support. It was appropriate the Trust referred Mr B for support for his autism, however, until a handover was complete, the mental health team should have continued to provide support.
- The records show Mr B did contact the Trust for mental health support and its staff spoke to him by telephone on a number of occasions. However, he found more formal support difficult to access.
- When Mr B had a mental health crisis in early 2018, the Trust did not consider Mr B needed support from the mental health team. The Trust said the information the Council gave it was not accurate, in that it did not fully explain the issues Mr B was experiencing. It said if it received a full account, it may have offered Mr B an assessment and been able to provide him with more tailored support.
- It seems the links between the Trust and the Council at the time were not joined‑up and services for ASD support were not well established. The evidence suggests Mr B fell between services for mental health and social care/ASD support. The Trust’s complaint responses accept it should not have discharged Mr B from its mental health team before a proper handover had taken place. This was fault.
- Mr B subsequently asked his GP to refer him back into mental health services on 4 April 2018 due to problems with low mood and concerns that Mr B had disclosed making plans to end his life. The GP asked the Trust to treat the referral as urgent. The Trust did not arrange an appointment with the Specialist Triage Assessment and Referral Team (START) until 2 May 2018. This was outside its 10 working day service standard. The Trust acknowledged this fault and apologised to Mr B for the distress the delays caused.
- The Care Act entitled Mr B to an assessment following his diagnosis of autism. There is little evidence of this process starting before June 2018. After this, there were delays by the Council allocating Mr B's case for an assessment. The records show Mr B contacted the Council several times to chase the referral, but the first discussions around this with Mr B and the Council happened in December 2018.
- Statutory guidance says the timescale for completing the assessment should be ‘appropriate and reasonable’ and take into account the urgency of needs. There is no evidence the Council considered the urgency of Mr B’s needs and I do not consider the delay in starting the assessment was reasonable. Although the Trust eventually provided some support for Mr B’s mental health needs, he did not receive assessment or support from the specialist ASD service for over a year after his autism diagnosis. This is fault.
- It also took a year from the GP’s referral for the Council to carry out a social care needs assessment in June 2018 until the assessment was started but then stopped at Mr B’s request in July 2019.
- The faults with the lack of a timely handover from the mental health team to the ASD service and the subsequent delay in arranging Mr B’s assessment combined to cause him distress. The records and Mr B’s own account show he reported experiencing increased anxiety and a deterioration in his mental health throughout 2018. He reported feeling suicidal on more than one occasion and made detailed plans to end his own life. I cannot say earlier intervention would have prevented these feelings or thoughts, but it is clear the difficulties in accessing support from the Trust and the Council had a significant effect on Mr B’s mental well-being.
- The Trust has already accepted it should not have discharged Mr B and that it should have supported him better until a handover to ASD services was completed. It has since agreed that in future the mental health team will review each case to ensure people have appropriate support in place during handover.
- The Trust has also apologised to Mr B for not arranging mental health support sooner and that it missed an opportunity to prevent further deterioration in Mr B’s wellbeing.
- The Council has advised the Ombudsmen that the Mental Health Social Work team is now under its management. This means records about Learning Disabilities and Autism and Mental Health Services are more readily accessible. This should mean the Council can provide a more seamless service with opportunities for a joint assessment and a shared management approach.
- I consider the Trust has acknowledged its fault and acted to improve its service. The Council has also accepted faults in its service and has since acted to improve its service for individuals receiving an Autism diagnosis.
- Given the time that has passed and the changes to the services since the events complained about happened, I am satisfied the Trust and the Council have addressed the issues with the service failure in this case. However, I do not consider Mr B has received a proper remedy for the injustice he has experienced.
- Mr B has since received an assessment and support from the Trust and the Council. His experience cannot be changed, but the seriousness of the situation Mr B found himself in without adequate support for a number of months should be recognised. I consider the injustice was a result of a combination of faults by the Trust and the Council. I therefore recommended further actions to address the distress this caused Mr B.
Accuracy of records
- Mr B complains the Council falsely recorded that he was a threat to himself and others and used this as an excuse not to complete an assessment. He said it was not correct that he declined support. He says the Council did not investigate his concerns about false information and considered this a data issue.
- The record of a discussion between a Council officer and Mr B in December 2018 referred to the police incident and an upcoming Court case. The Council officer noted that Mr B said the police found him with a penknife and had threatened to harm someone. The Council officer recorded that Mr B said this was the second time he had been in court for such an incident. The Council officer also noted that Mr B presented as ‘very angry and frustrated’ and used expletives. However, the records do note Mr B ‘continuously apologised’ for his language.
- The Council’s record of the discussion, made at the time, clearly differs to Mr B’s recollection. The differences are largely about the Council officer’s perception of Mr B’s aggressiveness and understanding behind the reasons for Mr B’s arrest. I cannot say exactly what Mr B said during the telephone call, but it is possible the Council officer misinterpreted or misunderstood this. However, based on their understanding, they had to make a decision about any potential risks to anyone carrying out an assessment. The police had charged Mr B for an offence involving having a knife in a public place. It was not until March 2019, the court found Mr B not guilty.
- The Council officer discussed this situation with a manager, which seems sensible. They decided that because of safety concerns, any visits should not be done alone. The Council officer noted a joint visit would be arranged in the New Year. It is understandable Mr B was unhappy with the decision and the Council’s perception that he was a ‘danger’ to others. However, based on the Council’s understanding at that time, I cannot criticise its decision to exercise caution. This was a professional judgement and I do not find fault by the Council.
- With regards to Mr B’s wish to have information removed from his records, the Council considered the record to be an accurate record of the discussions. The Council also explained that its view was that the records indicate the level of distress Mr B was experiencing. As noted above, there is no independent evidence to show exactly what was discussed.
- The Council officer recorded their account and considered these to be a true record of the discussion. I do not find fault with the Council’s decision not to remove the record. However, I have found fault with the way the Council handled Mr B’s complaint. It is evident Mr B tried to raise concerns about the records a number of times but did not feel he was being listened to. Given Mr B’s clear disagreement with what was recorded and the distress this was causing him, I consider it was fault by the Council not to address his concerns and discuss offering Mr B the opportunity to add an addendum to his record. This would have given him the opportunity to detail what he disagreed with and/or the reasons why and this could then be viewed alongside the existing record by anyone viewing his records in future.
- The following actions have been agreed to remedy the injustice caused by the faults identified:
- The Council will apologise for the distress caused to Mr B by the delays in arranging an assessment of needs following his autism diagnosis and referral to its service.
- The Trust and the Council will each pay Mr B £250 in recognition of the distress caused to him by the delays in assessment and lack of support following his autism diagnosis until receiving his needs assessment in early 2019 until his needs assessment was paused in July 2019, at Mr B’s request.
- The Council will apologise to Mr B for the distress caused by faults in not adequately addressing concerns with his records and consider allowing him to add an addendum to his records to explain why he disagrees with any entries.
- I found faults by the Trust and the Council left Mr B without adequate support for a prolonged period after he had been diagnosed with Autism. The Trust has already acknowledged this and apologised, but I do not consider this fully acknowledged the impact. The Trust and the Council have agreed actions to address the injustice to Mr B.
- I also found the Council was at fault in not addressing perceived inaccuracies in the records about Mr B’s risk to others. This caused him distress as he considered it would have an impact on the services available to him and how others would judge him. In the interests of fairness, I have recommended the Council considers working with Mr B so he can add an addendum to his records setting out his disagreements with what has been recorded.
- Given the Trust and the Council have agreed to my recommendations, I have completed my investigation.
Investigator’s final decision on behalf of the Ombudsmen
Investigator's decision on behalf of the Ombudsman