Summary: The Ombudsmen will not investigate Miss X’s complaint. Miss X’s complaint about her daughters 2013 admission to Cambridge and Peterborough NHS Foundation Trust is late. Also, the Ombudsmen cannot investigate the delayed discharge of Miss X’s daughter. Miss X should have appealed to the Mental Health Tribunal if she felt St Andrew’s Hospital should have discharged her daughter from section 3 of the Mental Health Act.

The complaint

1. Miss X complains that Cambridgeshire and Peterborough NHS Foundation Trust (the Trust) should not have admitted her daughter, Y, to hospital in 2013. That admission was not in Y’s best interests and the Trust did not provide Miss X with information to provide informed consent for the psychiatric admission.
2. Miss X also complains that Cambridgeshire County Council (the Council) and the Trust’s Community Mental Health Team (CMHT) jointly delayed discharging her daughter, Y, from St Andrews Hospital (St Andrews) until September 2020. Y was detained under section 3 of the Mental Health Act at St Andrews.
3. Miss X says Y lost her freedom and became institutionalised at St Andrews. Miss X says it has been stressful and exhausting. She also suffered a financial impact visiting Northampton from Cambridge to see Y. Miss X also says she has not been able to move from part-time to full-time work due to the delay.
4. Miss X would like the organisations to recognise their failings and make changes to avoid similar fault happening to others. She would also like a financial payment to recognise the injustice they have both suffered.

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The Ombudsmen’s role and powers

5. 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))
6. We have the power to start or discontinue an investigation into a complaint within our jurisdiction. We may decide not to start or continue with an investigation if we think the issues could reasonably be, or have been, raised within a court of law. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)

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How I considered this complaint

7. I have considered information Miss X has provided in writing and by telephone. Miss X had an opportunity to comment on my draft decision.

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What I found

The 2013 hospital admission

8. The Trust did not consider this part of Miss X’s complaint because she did not complain within 12 months of the incident. The Trust also reviewed the clinical records from that time. It could not say what information it provided to Miss X when it admitted Y.
9. Miss X said the Trust should have considered her complaint despite it being late.
10. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 state that NHS organisations should investigate complaints made within 12 months of the incident, or within 12 months of the person becoming aware that the incident occurred.
11. I asked Miss X why she took seven years to complain about the 2013 hospital admission. She said felt her complaint only became valid overtime and has never been one to complain. She also said she is a single parent with a child at home, so did not always have time to write a complaint.
12. I consider Miss X was aware in 2013 the Trust should not have admitted her daughter for a psychiatric assessment. I am not persuaded Miss X has provided an exceptional reason on why she took seven years to complain about the 2013 hospital admission. Therefore, I will not investigate this complaint.

The delayed discharge after April 2018

Background

13. Y took an overdose in 2015. Y stayed at different mental health hospitals until early 2017, when she moved to St Andrews. St Andrews provided care and treatment to Y under section 3 of the Mental Health Act. It managed Y under the Care Programme Approach with support from the Council and sometimes the Trust’s CMHT.
14. All parties planned to discharge Y to a residential placement when she no longer needed treatment under section 3. The Council was responsible for identifying suitable placements which could meet Y’s needs nearer Cambridge. The CMHT supported the discharge back to Cambridge.
15. In May 2018 and July 2019, a Mental Health Tribunal (the Tribunal) decided Y should not be discharged from section 3 at St Andrews. She should remain in hospital for medical treatment.
16. In July 2020, the Tribunal ordered St Andrews to discharge Y from section 3 to a residential placement by September 2020, which it did.

Analysis

17. Section 3 of the Mental Health Act is for providing treatment. Detention under section 3 empowers doctors to detain a patient for a maximum of six months. The detention under section 3 can be renewed for another six months. People who are discharged from section 3 will not have to pay for any aftercare they will need. This is called section 117 aftercare.
18. The Care Programme Approach (CPA) is the process by which mental health services assess a patient’s needs, plan how to meet them and ensure they are met. Under Refocusing the Care Programme Approach (Department of Health, 2008), people under CPA should have a comprehensive assessment of their health and social care needs.
19. I will not consider Miss X’s complaint that St Andrews, the Council, and the Trust delayed discharging Y.
20. While the Council was searching for a residential placement in 2018 and 2019, the Tribunal clearly felt Y was not ready to be discharged from section 3. Because the Tribunal decided Y should not have been discharged from section 3 before September 2020, I cannot say the organisations delayed discharging Y before then.
21. Miss X and Y had the opportunity to appeal the Tribunal decisions in 2018 and 2019. I asked Miss X why she did not appeal. She said the Council was always close to finding a suitable residential placement for Y, which never came about. I understand that must have been difficult. However, if Miss X felt her daughter should have been discharged from section 3, then she should have appealed the Tribunal decision.
22. Miss X also told me she is unhappy about the discharge arrangements after July 2020. Also, the support at Y’s current placement does not meet her complex section 117 aftercare needs. I cannot consider events after July 2020, as Miss X has not yet complained about those issues to the relevant organisations. Miss X will need to do that first before the Ombudsmen can consider her complaints.

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Final decision

23. I consider Miss X’s complaint about the 2013 hospital admission is late. Also, Miss X should have appealed the Tribunal decisions in 2018 and 2019 if she felt her daughter should have been discharged from detention under section 3 of the Mental Health Act.

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Investigator's decision on behalf of the Ombudsman