Bedford care professionals focused on keeping a man with mental health problems in his own home at a cost to his health and welfare, an investigation has found.

The joint investigation by the Local Government Ombudsman (LGO) and Parliamentary and Health Services Ombudsman into Bedford Borough Council and South Essex Partnership University Trust found that the man suffered from malnutrition and poor dental health because professionals did not properly assess whether he had the capacity to make decisions for
himself.

The man, who is in his late 50s and who has paranoid schizophrenia, had been living independently in a flat and was visited regularly by social workers and health care professionals. His sister and their parents started to raise concerns about his health and well-being in 2008.

Over the next three years, the area’s support team reviewed his situation, but the family still had concerns about the level of care. The authorities assessed the man as having the capacity to make decisions about where he lived and how he spent his money, but no assessment was made about his ability to manage his food, personal care or oral health.

A support package was put together but there was confusion between the council and the trust over the amount of care the man was receiving. The man finally moved into supported accommodation in December 2011 and his general condition has improved.

The joint investigation found that the council and trust failed to provide proper care and support for the man and did not carry out proper capacity assessments. Support workers did not visit regularly enough, did not encourage him to attend to his oral health or adopt a healthy lifestyle. There was also a delay in seeking appropriate supported living accommodation.

Dr Jane Martin, Local Government Ombudsman, said:

“While I have no doubt in this case that the care team was seeking to provide the best support, their presumption that the person affected had the mental capacity to make his own decisions resulted in him being malnourished. This was detrimental to his health and distressing for his family.

“Despite his family repeatedly raising concerns about the man’s welfare, the care team presumed that the man had the capacity, and therefore the right, to make decisions for himself, however unwise they were.

“Appropriate supported accommodation should have been considered much sooner for him.”

Parliamentary and Health Service Ombudsman, Julie Mellor said:

“This vulnerable man was left living in squalor because he did not receive the care he was entitled to.

“His sister repeatedly raised concerns about her brother’s ability to make decisions for himself, especially about his health and money. She resorted to taking food parcels to her brother’s home to ensure he didn’t go hungry.

“Health and social care professionals were so fixated on the man’s wishes to live independently, that they failed to carry out a capacity assessment of his ability to look after himself, which would have revealed that he was unable to cope with everyday tasks like feeding himself and cleaning.

“As a result, he was two and a half stone underweight, his teeth were rotten and his bedclothes hadn’t been washed in months. At one point his family were so concerned for him that they brought him to live with them.’"

The ombudsmen have recommended that the council and trust should develop action plans to address the failings identified and write jointly to the man and his sister to acknowledge the failings and apologise for their impact. The authorities should jointly pay the man £2,000 in recognition of the impact that their failure to assess his capacity properly had on him.

The authorities should also jointly pay the man’s sister £500 for the inconvenience and distress caused by the service failures.

Article date: 12 June 2014