Summary
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The Health Service Ombudsman and the Local Government Ombudsman carried out a joint investigation into serious complaints about the support provided to a vulnerable person, living independently in the community, by 5 Boroughs Partnership NHS Trust (the Trust) and St Helen’s Metropolitan Borough Council (the Council).
Mr B had had a long history of involvement with mental health services, which had included compulsory detention in hospital and a suicide attempt. By 2006, at the time of the events which we have investigated, he had been living independently in his own home for more than ten years, receiving support from Trust and Council staff. He received regular visits from cleaners and from a support worker who helped with his shopping and budgeting and household chores.
He had a care co-ordinator: a community psychiatric nurse, who usually visited him fortnightly to administer medication and to monitor his mental health.
Ms A, his cousin, complained to us that, after she had moved back to the area and had begun to visit Mr B again, she found him to be very unwell and living in a filthy and unsanitary state. She had made efforts to alert the Trust and the Council to her concerns but had not been satisfied with their responses. Finally, when Mr B was admitted to hospital suffering from malnutrition and dehydration and a number of other symptoms, he was investigated for cancer, and was later diagnosed with myeloma – a form of bone marrow cancer – which was to lead to his death in June 2010.
The complaints we investigated were: that in March 2008 Mr B’s consultant psychiatrist had failed to respond appropriately to his poor physical state and had instead prescribed inappropriate drugs for depression; that no one had supported Mr B to claim the welfare benefits to which he was entitled; and, that care plans were not implemented and that no one had responded appropriately to developing signs of risk to Mr B’s physical and mental health. Ms A complained especially that, as a consequence of these failures, Mr B had lived in squalor and pain; and, that by the time it was recognised that he needed to be admitted to hospital he was so ill and weak that he could not receive the usual treatment for myeloma and so his life expectancy had been considerably reduced. Having taken clinical advice, we did not uphold the first two of Ms A’s complaints: about the psychiatrist or the support provided to claim benefits. However, we found that the Trust and the Council had failed in their joint responsibility to manage and implement Mr B’s care plans and to take adequate account of developing signs that he was at risk. We considered that there had been insufficient contact with Mr B over a period – his living conditions deteriorated and his personal health was neglected so that, when he began to experience critical ill health in February 2008, staff were not in a position to recognise the urgency of his situation. Thus, Mr B’s physical condition deteriorated quickly to an unacceptable state. Although we could not conclude definitely that a different outcome would have resulted for Mr B, in terms of the diagnosis and treatment of his myeloma, we did find that the failure to implement his care plans and to manage risk appropriately played some part in his rapid deterioration.
Mr B died whilst our investigation was in progress, so we were unable to make any recommendations for remedy which would have been of direct benefit to him personally. However, we recognised the significant distress and emotional upset which the Trust’s and the Council’s service failures had caused to Mr B’s family, especially Ms A, and our recommendations therefore include not only an apology to her from both bodies, but also the Mr B died whilst our investigation was in progress, so we were unable to make any recommendations for remedy which would have been of direct benefit to him personally. However, we recognised the significant distress and emotional upset which the Trust’s and the Council’s service failures had caused to Mr B’s family, especially Ms A, and our recommendations therefore include not only an apology to her from both bodies, but also the payment of £2,000 financial redress to her, and a further £1,500 in respect of the firm of solicitors which had assisted her in making her complaint. The Trust and Council have accepted our recommendations.
