Section 1: Introduction
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This is the report of our joint investigation into Ms A’s complaint made on behalf of her cousin Mr B, about the 5 Boroughs Partnership NHS Foundation Trust and St Helens Metropolitan Borough Council. Mr B, who has since died, gave permission for Ms A to complain on his behalf. This report contains our findings, conclusions and recommendations with regard to Ms A’s areas of concern.
The Complaint
Mr B had had a diagnosis of schizophrenia for some time. In 2007 he had been living in the community, supported via a care plan managed and implemented jointly by the Trust and the Council, through a community mental health team (CMHT), for more than ten years. It appears that these arrangements worked satisfactorily until approximately 2006. In 2007 his cousin, Ms A, moved back to his area. Mr B visited her and his aunt in February 2008 saying that he was unwell. Ms A went to his home to collect clothes for him and found it in a filthy and unsanitary state.
Ms A made attempts to alert the Trust and the Council to Mr B’s unacceptable living conditions and to his deteriorating mental and physical health but was not satisfied with their responses. On 4 April 2008 Mr B was admitted to Whiston Hospital, suffering from severe malnutrition, dehydration, a severe fungal infection of his toenails, anaemia and impaired kidney function. Malignancy was suspected and he was later diagnosed with myeloma, a form of cancer of the bone marrow. Mr B died in June 2010.
Matters investigated
The matters investigated by the Ombudsmen were:
- Complaint about the Trust:
- in March 2008 a psychiatrist failed to respond appropriately to Mr B’s poor physical state; instead he prescribed inappropriate drugs for depression.
- Complaint about the Council:
- no one supported Mr B to claim the benefits to which he was entitled.
- Complaints about both bodies who, through the CMHT, had joint responsibility for managing Mr B’s care plans:
- care plans were not implemented, and no one responded appropriately to the developing signs of risk to Mr B’s physical and mental health.
Ms A said that as a consequence of these failures, Mr B had lived in squalor and pain. She says that on his first admission to hospital, he had been so ill that it had not been certain whether he would survive. He had been too weak to receive the normal treatment for myeloma, and so his life expectancy had been considerably reduced.
Summary of our decision
We have considered all the available evidence related to Ms A’s complaint about the Trust and the Council, including her recollections and views. We have taken account of the clinical advice we have received and reached a decision.
We have not found that the Trust’s psychiatrist failed to provide appropriate care to Mr B or that the Council failed to support Mr B in claiming benefits. However, we have found that the Trust and the Council failed in their joint responsibility to manage and implement care plans for Mr B and to take adequate account of the developing signs of risk. This was service failure which contributed to the injustice of unnecessary pain and neglect experienced by Mr B. We uphold the complaint made about both the Trust and the Council.
The Health Service Ombudsman’s remit
The By virtue of the Health Service Commissioners Act 1993, the Health Service Ombudsman is empowered to investigate complaints about the NHS in England. In the exercise of her wide discretion she may investigate complaints about NHS bodies such as trusts, family health service providers such as GPs, and independent persons (individuals or bodies) providing a service on behalf of the NHS.
In doing so, she considers whether a complainant has suffered injustice or hardship in consequence of a failure in a service provided by the body, a failure by the body to provide a service it was empowered to provide, or maladministration in respect of any other action by or on behalf of the body. If she finds that service failure or maladministration has resulted in an injustice, she will uphold the complaint. If the resulting injustice is unremedied, in line with her Principles for Remedy, she may recommend redress to remedy any injustice she has found.
The Local Government Ombudsman’s remit
Under the Local Government Act 1974 Part III, the Local Government Ombudsman has wide discretion to investigate complaints of injustice arising from maladministration by local authorities (councils) and certain other public bodies. She may investigate complaints about most council matters, including social services and the provision of social care.
If the Local Government Ombudsman finds that maladministration has resulted in an unremedied injustice, she may recommend redress to remedy any injustice she has found.
Powers to investigate and report jointly
The Regulatory Reform (Collaboration etc. between Ombudsmen) Order 2007 clarified the powers of the Health Service Ombudsman and the Local Government Ombudsman, with the consent of the complainant, to share information, carry out joint investigations and produce joint reports in respect of complaints which fall within the remit of both Ombudsmen.
In this case, we agreed to work together because the health and social care issues were so closely linked. A co-ordinated response consisting of a joint investigation leading to the production of a joint conclusion and proposed remedy in one report seemed the most appropriate way forward.
