Ombudsman’s investigation – York City Council – 04/B/01280 (31/1/06)

This report concerned a complaint by the son of a female patient (S) detained under s.3 Mental Health Act 1983, that York City Council (York) was unable to guarantee the provision and funding of the aftercare needed by S.  As a result of York’s actions, S’s family found a place for her in a private care home.  S was sufficiently capacitated to make a reasoned decision about her continuing care and agreed that residential care was what she wanted.  S consented to waive her own entitlement to funding of her aftercare under s117 of the Act and sold her home to fund her residential care as a private client.

Prior to S’s discharge, a meeting was held to discuss her future care needs.  York was not represented at this meeting.  It was decided by S’s Psychiatrist and hospital staff that S required an extensive home care package and hospital day visits to support her discharge.  York agreed that the home support would be provided and funded under s.117 of the Act.  Following an unsuccessful pre-discharge home visit, there was a change of plan and after discussions with S, her daughter and Psychiatrist, it was decided that a residential placement would be more appropriate.  It was hoped to find such a placement as soon as possible.  S’s Care Manager agreed that residential care was the best option.  A multi-disciplinary meeting did not take place as was usual prior to a patient’s discharge, since York felt that the post-discharge plan had already been made and did not involve Social Services.  It felt that a further assessment was unnecessary.

S’s Care Manager advised a family member that s.117 would apply to the residential placement and the family need not contribute to its cost, but the request would need to be considered by York’s Funding Panel and would be added to a waiting list until a suitable placement became available.  This could take up to 12 months.  The client’s daughter was also told that she could not expect York to fund a placement identified by her, and that the placement would have to go through the normal process. A suitable placement was found and S’s family proposed to fund the placement through the sale of her flat.  The daughter decided that it would better for S to be discharged so that she could take up the placement that she had already identified.  However, legal advice received by the Care Manager stated that York should fund the placement, but at the rate it would normally expect to pay for similar aftercare, and S or S’s family could and should make up the balance.  This advice was not passed on to S’s daughter, nor was it acted upon.

S’s daughter was told by York that if the client wished to be discharged in order to take up the residential placement, her mother would need to relinquish her future rights to funding.  Due to the detrimental effect that a prolonged stay in hospital would have on S, and the possibility that the residential place on offer might be lost if she didn’t move quickly,  the daughter felt that there was no option but to waive the right to future funding as it was in her  mother’s best interests.   S’s doctor was under the same impression i.e. that this was the only option, and that discharge from s.117 status was a practical decision to facilitate the wishes of S and her daughter, rather than a clinical decision.

The Ombudsman found that S should have received a further s117 assessment of needs after it was decided that she could not return home, for a reconsideration of the care options available to her.  York should have made time for a further assessment prior to S’s discharge.  This would have properly explored all options available and allowed S and her family to make an informed decision.  Failure to carry out the assessment was maladministration.

Also, since York had agreed that residential care was necessary, it had a duty to arrange this within a reasonable time taking into account relevant factors.  It was unlawful for a council to delay care provision in pursuance of a statutory duty on the basis of a lack of financial resources.  In this case York inappropriately linked the provision of care to the availability of financial resources.  This was maladministration.  It also gave S and her family the incorrect impression that in order to move to S’s chose placement, she had to be discharged from s.117.  This was contrary to the legal advice provided, which advised that S could have her placement partly funded by the council under s.117 with a contribution from S or her family.  Failure to properly consider this legal advice was maladministration.  There should not have been a 12 month wait for funding had an appropriate placement been identified.  Such a wait was unreasonable.

The council was recommended to reimburse S for her financial loss plus interest, amounting to approximately £37,000.  It should agree to fund S under s.117 if appropriate under a new assessment and pay S’s son £250 for his time and trouble in making the complaint.  Finally it should review its relevant policies and procedures so that similar mistakes were not made again in the future.

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