London Borough of Croydon and NHS Trust at fault for delaying assessments and referrals, and allocating unsuitable accommodation

Decision Date: 2nd January 2020

What Happened

Ms G lived at home with her daughter (Miss H) and family.

In March 2018 she was admitted to hospital where a respiratory clinician said Ms G would require long term oxygen therapy for a minimum of 16 hours per day. This was as a result of scarring of her lungs from previous cancer treatment.

In addition, clinicians determined Ms G experienced disordered sleep breathing that was contributing to her general breathlessness.

Due to Ms G’s increased health needs, the clinical team established she would not be able to return home with her daughter, and referred her to the Council for a housing assessment.

A social worker initially visited Ms G on 12th April 2018 to assess her social care needs. She found Ms G had no eligible care and support needs.

However, in what may have been a joint housing and social services assessment, for reasons unexplained in the LGO report, she found Ms G was at risk of homelessness and referred her to the Council’s housing team. Ms G was placed on the waiting list for sheltered accommodation.

Miss H was unhappy with this assessment so the Council reallocated Ms G’s case to another social worker.

They completed an assessment in May 2018, which found that a package of daily reablement care visits could support Ms G to regain her independence.

On 23 May 2018, Ms G accepted the Council’s offer of temporary accommodation on a first floor property with a lift. An Occupational Therapist (OT) assessed the property and found it would be suitable for Ms G with some additional equipment.

The Hospital Trust discharged Ms G to her temporary accommodation on 30 May 2018. She received three daily reablement care visits and additional support from a charity.

Ms G was under the care of the Living Independently For Everyone (LIFE) team – a multidisciplinary team comprised of health and social care professionals.

On 26 June 2018, an OT from the LIFE team reviewed Ms G. Ms G and Miss H felt the property was not suitable for her; Ms G could not have a pendant alarm. The alarm required a landline to be fitted and the property would not allow this.

The OT established the reablement service and charity support was due to end. She recommended a social worker visit Ms G to discuss rehousing options.

A social worker referred Ms G for EHC accommodation on 24 July 2018.

Ms G was admitted to hospital on 8 August 2018 as her cancer had returned. She died on 13 August 2018.

Miss H complained about the care and treatment provided to her late mother:

  • The Council and Trust did not properly assess Ms G before discharging her from hospital which meant the Council discharged Ms G to unsuitable accommodation that did not meet her needs;
  • The Council delayed unreasonably in arranging an assessment for Ms G by a community social worker, following her discharge from hospital; and
  • The Trust delayed in referring Ms G for assessment by a specialist sleep disorders clinic at another Trust.

What was found

Assessment on discharge

The LGO was satisfied that the Council’s decision took account of Ms G’s needs and was made in accordance with the Care Act and therefore found no fault by the Council for this assessment.

The LGO stated that the social worker’s assessment of May 2018 represented athorough consideration of Ms G’s needs. It identified that Ms G could complete most activities of daily living (such as washing and dressing) but that she would need some support due to the fatigue caused by her breathing difficulties. The social worker arranged a package of reablement care and additional support from a charity. It was appropriate for the social worker to focus on supporting Ms G to regain her independence in the community with a short-term package of care in the first instance.

The multi-disciplinary team agreed that Ms G did not require Extra Care Housing type accommodation at that time and that, if properly supported, her needs could be met in sheltered accommodation.

Suitability of accommodation

When the Council first identified possible temporary accommodation for Ms G, a housing officer felt it would be unsuitable because the suggested flat was on the first floor and it was felt Ms G would struggle to walk down the stairs in the event of an emergency due to her breathing difficulties. The housing officer felt a ground floor property would be more suitable.

However, the Council went ahead and offered Ms G the first floor flat on the grounds that there was a lift to allow her easy access in and out of the property. The LGO found no evidence to suggest the OT gave any consideration to how Ms G would leave the building in the event of an emergency, when the lift would not have been operational. This would have required Ms G to walk down the stairs.

Furthermore, the assessment in May found Ms G to be at risk of falls as a result of her increased fatigue and the need to carry oxygen with her. The social worker identified that Ms G would require a pendant alarm “to guard against the risk of falls”. Despite this, the Council failed to identify before Ms G’s discharge that it was not possible to install a pendant alarm in the proposed property.

Section 17.5 of the Code says local authorities “will need to consider carefully the suitability of accommodation for applicants whose household has particular medical and/or physical health needs.” The LGO found the Council at fault, as it failed to carry out a robust assessment of suitability.

Delay in assessment

Ms G’s reablement care package was due to end on 11 July 2018. An OT from the LIFE team reviewed Ms G (on 29 June 2018) before the package ended and said Ms G would continue to need care visits, as well as input from a social worker to discuss housing options.

The Council should have arranged for a social worker to carry out a reassessment of Ms G’s needs at this stage. This is because the evidence strongly suggested her progress in the community had been limited and that she needed care on an ongoing basis. Reablement cannot simply end without a decision as to what, if anything, is needed next.

Despite this, the Council did not allocate the case to a social worker until 31 July 2018, over a month after the LIFE OT review had identified the need for social worker involvement. This in turn delayed the Extra Care Housing referral. The case records indicated the Council only made the referral on 24 July 2018 as a result of Miss H’s persistence.

All in all the LGO found that the Council delayed unreasonably in arranging a reassessment of Ms G’s needs in the community. It also delayed in referring her for ECH. This was fault.

Referral to specialist sleep disorder clinic

The respiratory consultant who was responsible for Ms G’s care in hospital determined that she should be referred to the sleep disorders clinic for assessment. During a discharge planning meeting on 10th May, the respiratory team said Ms G would benefit from a BiPAP machine to help her breathing at night.

The LGO found no evidence in the records to suggest the Trust ever made the referral for the machine. Again, it was only when Miss H chased the matter with the Trust in late June and early July 2018 that the Trust made the referral. This was fault by the Trust.

The LGO recommended the Council pay Ms G £200 and apologise for its delays. It also recommended the Trust pay her £100 and apologise for its referral favour.

Points for the public and service users

The report is a combined report into the approach taken to suitability, which can be done through the court, and the approach taken to care and support after reablement. The law is that if the person has a housing need, that is not to be assumed to be part of the social care package, and should be regarded as the Housing Authority’s responsibility.

Reablement is free for up to 6 weeks, but that does not mean that it can just end without further professional thinking about the person’s needs. That is because it’s often provided BEFORE an assessment, and in that context, it defers the Care Act consideration of need. If it is done as part and parcel of assessment and service provision, it cannot just be ended if it has not worked, because its absence would mean that the person needed to be reviewed, regarding the feasibility of the care plan meeting the needs in the longer term.

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The full Local Government Ombudsman report of London Borough of Croydon’s actions can be found here

https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/18-005-311

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