Date of decision: 22/07/2019
Ms G had been known to Mental Health services since 2007. She had a diagnosis of personality disorder and persecutory anxiety. She lived in a property owned by a Housing Trust for 10 years. During that period, she reported many issues with her heating and electrical supplies, and problems with her neighbours which had resulted in police involvement.
In November 2015 Ms G was detained under s.2 Mental Health Act 1983. She was reported to be paranoid towards her neighbours.
Whilst in hospital the landlord Housing Trust obtained an interim injunction that prevented Ms G from returning to the property, presumably on the grounds of the long-standing neighbour dispute related issues.
Hertfordshire County Council (the Council) had a partnership agreement with Hertfordshire Partnership Foundation Trust (the Trust) which acted as the formal delegate of some of the council’s responsibilities under the Care Act 2014.
Ms G’s complaint centred around her homelessness application and the length of time she was housed in unsuitable accommodation. Watford Borough Council (the Borough Council) were also subject to Ms G’s complaint as the responsible housing authority. It also appertained to a lack of care and support provided by the Council and the Trust since her discharge from hospital on 29th March 2016.
Following Ms G’s detention in November 2015, Trust records showed that regular reviews took place.
In January 2016 the landlord Housing Trust agreed to consider whether one of its supported living schemes would be suitable for Ms G. A discharge planning meeting at the end of January 2016 asserted that Ms G could ‘go back home until she is rehoused’. Ms G and her solicitor were present and stated that she could not return because of the issue with her neighbour and the interim injunction which prevented her from doing so. The care co-ordinator then referred Ms G to a different supported housing provider.
Ms G’s landlord informed the care co-ordinator that Ms G had rent arrears as her rent had not been paid whilst she had been in hospital for four months.
From February 2016, Ms G became a ‘delayed transfer of care’ as she no longer required an acute hospital bed. These are counted for NHS management purposes although there is no fines regime for those who are sectioned patients in psychiatric hospitals.
Trust records showed that clinicians had continued to discuss the option of her returning home. Ms G indicated that she could not do so because of the problems with her neighbours and utilities. There were no supported housing vacancies with the Housing Trust or other providers and the care co-ordinator had also contacted the Continuing Care and Placement Service which was also unable to point to any accommodation. It gave advice and suggested options to consider based on knowledge of Ms G’s rent arrears.
In March 2016, the care co-ordinator contacted the Housing Trust which said it could not offer Ms G alternative accommodation and stated that it did not have any landlord-based duty to re-house her. The care co-ordinator recorded the need to contact another housing provider. The social worker also explored the option of a step-down bed, which was deemed unsuitable, and then contacted a housing association that had no supported housing vacancies.
The care co-ordinator then met with the Trust’s Housing and Accommodation Adviser. This was four months after Ms G had been admitted to hospital. The care co-ordinator then contacted the Borough Council with housing responsibilities for homeless people, which requested a full medical and risk assessment prior to placing Ms G in temporary accommodation.
From a ward round in March 2016, a doctor recorded ‘to contact social re accommodation. Discharge on 29th March’. This was a confirmed date for Ms G to leave the hospital but with no plan for where she would go and how she might be supported.
Ms G was discharged from hospital on 29th March 2016 and met her care co-ordinator at the housing office. The Borough Council refused to accept her homeless application on the basis that:
- she was discharged from hospital without any paperwork;
- the Housing Trust had confirmed there was an interim injunction in place and not a full injunction (so Ms G could return to the property) but the Housing Trust would apply for a full injunction if she did return; (so she was clearly threatened with homelessness in legal terms) and
- the Borough Council had not received a risk assessment from the Trust to inform the homelessness application process.
That evening the Trust’s housing advisor informed the Borough Council that Ms G was homeless due to miscommunication on the part of the care co-ordinator and that she was vulnerable. The Borough Council provided temporary accommodation that night.
Ms G contacted the care co-ordinator to inform that this accommodation was unsuitable as it housed mainly single males and that she could not access the shower due to her physical difficulties. Ms G did not have any of her belongings from the hospital and asked for them to be collected.
The Borough Council
The Borough Council ultimately accepted that it had an interim duty to Ms G upon hospital discharge. It provided temporary accommodation and claimed that the Trust had not followed the discharge protocol / policy which required 5 days’ notice to find suitable accommodation.
Initially Ms G was placed in a hotel that was not in her preferred area. The Borough Council then offered her accommodation in a shared house with couples and singles. Ms G stated that she needed self-contained accommodation because of her mental health difficulties. The Borough Council had limited options available, and approached her previous landlord who would not accept Ms G. It accommodated her in a hotel and in September 2016 accepted her application as eligible, unintentionally homeless and in priority need. The Borough Council then moved Ms G to temporary accommodation.
On leaving hospital the rent arrears had begun to accrue as Ms G could not claim housing benefit for two properties. Ms G had an ongoing rent liability towards both properties, which led to arrears in the region of £4000. The Borough Council did not recognise this problem yet relied on their nominations policy citing ‘former tenant arrears’ as a reason not to progress Ms G’s application for housing. The Borough Council had suspended her Part VI housing register application on the basis that she had accrued rent arrears and had not paid towards the debt or set up a repayment plan.
Ms G informed the care co-ordinator that she did not like having to pay rent towards two properties. The Housing Trust officer informed Ms G that if she gave up her tenancy, she would be deemed intentionally homeless. It is unclear why the housing trust did not simply regard her as surrendering her tenancy by dint of having moved out, or terminate it for non-payment of rent and commence possession proceedings on that ground.
In May 2017, the Borough Council offered Ms G temporary accommodation which it deemed suitable. Ms G disagreed. She did not challenge this decision but did request a review of the decision to suspend her housing application a few months earlier.
In July 2017 Ms G was offered a privately rented one bedroomed flat. The Borough Council deemed this suitable on the basis that it met her size, location, welfare and affordability requirements. Whilst Ms G did not request a formal review of this decision, she made several complaints about the safety of the property, in particular the gas boiler.
The County Council
In June 2016, Ms G’s probation officer contacted the Council whilst she was living in temporary accommodation. The probation officer was concerned that she was vulnerable and that her presentation was deteriorating. The Council’s formal arrangements with the Trust required the Trust to carry out Care Act needs assessments on behalf of the Council. The Council referred Ms G to the Trust for assessment on the basis that this concern pertained mainly to her mental health issues. It did not determine that its safeguarding procedures ought to be applied at this time.
The Hertfordshire Partnership Foundation Trust
The Trust received the referral, but its records do not indicate what action was taken despite several care plans being on trust records. This is characterised as a decision not to assess, but may have just been an omission due to incompetence.
In September 2016, the care co-ordinator withdrew from supporting Ms G and she continued to see a clinical psychologist.
In January 2017, a probation officer expressed further concern to Ms G’s consultant psychiatrist about her deteriorating presentation following discharge earlier in March 2016. The probation officer requested information as to Ms G’s care plan.
During a medication review with a consultant psychiatrist Ms G expressed anger and frustration at what she perceived to be a lack of support from the agencies involved within this complaint.
In July 2017, she had been offered another property and was due to move the next day. She requested assistance from the Foundation Trust to move her belongings. It explored charitable options but informed her it was unable to assist.
At the end of July 2017, records held by the Trust referred to a plan for Ms G to be referred to an occupational therapist, a medication review, floating support and a psychological assessment. Ms G stated that she did not know the outcome of those assessments and had not received floating support.
What was found
The Council and Trust’s discharge planning
The LGSCO found the Partnership Trust’s discharge planning to be poor. It had regular meetings with the Housing Trust, but the housing duty to Ms G was owed by the Borough Council. It was aware that Ms G could not return to her property but failed to include the relevant bodies in the planning process.
The Trust failed to provide the risk information as requested by the Borough Council, under a protocol that it must have itself agree. The Trust also failed to act in accordance with NICE Guidance N27 which requires a discharge summary to be made available to both the person and their GP within 24 hours. This led to the initial refusal of the homelessness application.
The lack of formal discharge plan meant that Ms G was more likely to suffer distress and frustration at a time when she was vulnerable.
The LGSCO found that the Borough Council was not (ultimately) at fault for the way it responded to Ms G’s housing application. It acted in line with housing legislation by placing her in accommodation despite the limited information provided by the Trust.
The Borough Council provided sufficient reasons to explain why the accommodation was suitable for Ms G. Once the Borough Council had accepted that it had a duty to house Ms G it offered her accommodation in line with legislation.
The Borough Council’s letter to Ms G did not consider that she could not reliably return to her property and the impact that paying for the accommodation with housing benefit would have on rent arrears with the first property.
The Borough Council investigated regular concerns raised by Ms G about the property she moved into. She had identified problems with heating electric and was concerned that the property was unsafe. The concerns were acted upon by the Borough Council’s Housing and Environmental Health services who were unable to substantiate the issues reported by Ms G.
An occupational therapist assessed the property allocated by the Borough Council as ‘suitable’ to meet her housing needs in March 2019. This led the Borough Council to accept that the property was unsuitable to meet Ms G’s needs. She is on a waiting list for an alternative home, which the LGSCO recommended is kept under review.
The County Council and Trust’s consideration of Ms G’s needs
The partnership arrangements between the Trust and the Council are considered jointly by the LGSCO as although responsibilities were delegated, the Council remained responsible for its functions and was therefore also at fault.
On receiving the referral from the probation officer, Ms G’s needs under the Care Act 2014 should have been assessed. The Trust held delegated responsibility to do so but had not properly assessed her let alone care planned for her. The LGSCO found poor practice on the part of the Trust as it failed to include her in care planning meetings and to assess her health and social care needs. The failure to assess Ms G’s needs was likely to have caused her distress and frustration and had an adverse impact on her wellbeing (as well as being unlawful).
The Trust eventually assessed Ms G under the Care Act 2014 in July 2017. The LGSCO found the Trust to be at fault for not sharing the subsequent record of assessment with her. It’s the law under s9 that this is done.
The LGSCO made several recommendations to be acted upon within four weeks of the decision:
- the County Council apologises in writing to Ms G for the avoidable distress and frustration she experienced when it and the Trust decided not to formally assess whether she had needs eligible for social care and support.
- It should also pay her £250 to acknowledge the adverse impact on her wellbeing;
- the Trust apologises in writing to Ms G for the avoidable distress and frustration she experienced because of its poor hospital discharge planning. The Trust should also apologise for the distress Ms G experienced when it delayed assessing her needs and failed to share the outcome of assessments with her. It should also pay Ms G £500 to acknowledge the adverse impact on her wellbeing;
- the Trust and the County Council provide Ms G with copies of assessments completed since her discharge from hospital which relate to her needs and eligibility for formal care and support;
- if necessary, the County Council and the Trust complete an updated co-ordinated assessment of Ms G’s health and social care needs and ensure she is promptly provided with formal support if the assessment determines eligible needs.
- the Council and the Trust review any existing joint working arrangements and ensure staff are reminded to complete formal assessments when presented with someone who has an appearance of need; and
- the Trust remind its staff in hospital settings of the importance of notifying partner agencies of someone’s discharge when it is known a patient has a need for housing.
- The Trust should also ensure that its staff complete formal discharge plans and ensure patients are discharged with all the documents they need to facilitate a good discharge and inform partner agencies.
Points for the public, service users, hospital leavers, family and peer supporters, advocates, and councils etc
This complaint is an example of the ways in which partnership working often fails people who are vulnerable, if there is insufficient attention paid to the nature and scope of the duties being delegated.
Firstly, there is an obligation to effect SAFE discharge, which involves ascertaining what a person is going to be discharged TO, and whether that situation triggers other agencies’ functions or even their duties. This discharge planning process failed to involve the responsible authority despite Ms G having a clearly obvious housing need. The NICE Guidance N27 states:
“From admission, or earlier if possible, the hospital‑ and community‑based multidisciplinary teams should work together to identify and address factors that could prevent a safe, timely transfer of care from hospital. For example:
- safeguarding issues
- lack of a suitable placement in a care home
- the need for assessments for eligibility for health and social care funding.”
Records were even made that demonstrated how clinicians were considering the option for her to return home despite this being prevented by the interim injunction. Had the relevant housing body, rather than her current landlord been involved, the information that needed to inform the Borough Council’s decision-making could have been available much sooner and led to a better plan to re-house Ms G somewhere suitable. That lack of networking indicates a serious lack of competence or awareness on the part of the acute hospital’s discharge planning staff.
Instead, this vulnerable lady left hospital without a discharge plan and arrived at the housing office where her application was unable to be considered due to a lack of information. The local protocol had been disregarded by the Trust despite the blatant significance of a lack of housing for the obligation to achieve safe discharge.
Being discharged without paperwork could not ever be an excuse for a Housing Authority to refuse an application under Part VII of the Housing Act. A risk assessment is not allowed to be a pre-condition to accepting an application!
We are surprised that the housing authority did not come in for more incidental criticism bearing in mind that that was the wholly inauspicious start, with the local protocol appearing to determine the fate of the woman, rather than the law!
The Borough Council was found to have done what it could to assist at the time – a bit later on, however. Ms G was unhappy with its offer, and eventually her complaint that successive settings were unsuitable (in the legal sense of the word) was taken seriously following an occupational therapy assessment.
Ms G’s probation officer reported concerns about the impact that living in a hotel had had on her wellbeing following discharge from hospital.
The Council is entitled to delegate its functions under the Partnership Regulations under the Health Act and under s. 79 Care Act 2014; however s.79(6) states:
‘Anything done or omitted to be done by or in relation to a person authorised under this section in, or in connection with, the exercise or purported exercise of the function to which the authorisation relates is to be treated for all purposes as done or omitted to be done by or in relation to the local authority.’
The Council remained responsible for the Trust’s failings to assess Ms G’s needs. The concerns raised by the probation officer were such as to alert any reasonably competent assessment service to an appearance of need that required an assessment of her care and support needs (as would the facts known at the point of hospital discharge circumstances, because SOME people’s needs for accommodation CAN BE social services’ need.).
The Council had referred for that specific purpose, relying on the arrangements between the two bodies. The probation officer expressed concern about her wellbeing in June 2016, yet it took until July 2017 for the Trust to assess Ms G’s needs – and even then it failed to provide her with a copy of the assessment. Ms G was also unaware of the outcome of subsequent occupational therapy and psychological assessments.
The learning here is that if agencies are going to work in partnership as they should then they must put in place proper and effective training arrangements that include the legal framework. This means Trusts and Councils knowing their responsibilities under the relevant legislation, and establishing mechanisms that ensure responsible bodies review what is actually happening where responsibilities are delegated.
Ms G’s complaint highlights the impact that a lack of information-sharing and joint planning can have, particularly where someone is discharged from hospital with nowhere to go. Ms G was in hospital longer than needed; the agencies she relied on failed her and this unfortunately had an impact on her wellbeing at a time when these agencies should have recognised her vulnerability.
The fact that an updated assessment was flagged up as being a possible outcome after a proper set of remedies was organised – one which appeared to need to include her desire to move to more suitable housing, in the view of the LGO investigator, raises the prospect that the LGO was hinting that housing should be regarded as a possibly essential aspect of her care and support needs, unusually for housing, but consistently with developments in the law relating to s117 and specialist supported living.
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The full Local Government Ombudsman report into the actions of Hertfordshire County Council can be accessed here: