Summary: Mr F complained about the way the NHS Trust and the Council dealt with his adult son’s discharge from hospital to a supported housing tenancy. We found fault in the way the Trust acting on behalf of the Council assessed Mr F’s son’s needs and completed the support planning process. This meant Mr F’s son, Mr D, did not have the assessment of his needs properly recorded and reviewed in a person-centred way. The fault caused uncertainty to Mr F and
Mr D’s mother, Mrs F. The Trust and the Council have agreed to our recommendations and will apologise to Mr D and his parents and make payments to acknowledge the injustice caused. They will also remind their officers about the importance of completing assessments and support plans in a person-centred way.

The complaint

1. The complainant, who I shall refer to as Mr F, complains on behalf of his adult son, Mr D. Mr F complains about the way Greater Manchester Mental Health NHS Foundation Trust (the Trust) and Trafford Council (the Council) dealt with his adult son, Mr D, discharge from hospital. Mr F says the Council and the Trust did not work together to complete an assessment which ensured his son was offered a property in the community that met his needs when he was discharged in October 2020. He says, Mr D was not offered a choice of accommodation.
2. Mr F said he and his wife had to fund new furniture for the property when the Council and the Trust should have considered this as part of Mr D’s discharge plan. Mr F also complains his son was not financially assessed before being asked to pay care charges. He says the Council delayed in cancelling the charges and both organisations delayed in responding to his complaint.
3. Mr F says the alleged faults caused his family to experience avoidable distress and worry and had adverse impact on his son’s general wellbeing. To put things right he wants the Council and the Trust to learn lessons and make a payment for the claimed injustice.

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The Ombudsmen’s role and powers

4. The Ombudsmen have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, and Health Service Commissioners Act 1993, section 18ZA)
5. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. The Ombudsmen cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
8. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)
9. The Ombudsmen cannot investigate late complaints unless they decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to the Ombudsmen about something an organisation has done. (Local Government Act 1974, sections 26B and 34D, as amended, and Health Service Commissioners Act 1993, section 9(4).)

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How I considered this complaint

10. I have considered information provided by Mr F and information from the Council and the Trust in response to my enquiries. I have also considered the law and guidance relevant to this complaint.
11. Mr F’s complaint to the Ombudsmen is late but I consider there are good reasons to investigate now because of the way the Trust handled his complaint.
12. All parties had an opportunity to respond to a draft of this decision.

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What I found

Law and relevant guidance

13. Under the Mental Health Act 1983 (MHA), when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. This is sometimes known as ‘being sectioned’. Usually three professionals need to agree that the person needs to be detained in hospital. These are either an Approved Mental Health Professional (AMHP) or the nearest relative, plus a doctor who has been specially approved in Mental Health Act detentions and another doctor. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person and their nearest relative about this. Admission should be in the best interests of the person and they should not be detained if there is a less restrictive alternative.
14. The purpose of detention under section 2 of the Mental Health Act 1983 is for assessment of a patient’s mental health and to provide any treatment they might need. Patients can be detained under section 2 for a maximum of 28 days.
15. The Community Mental Health Team (CMHT) provides mental health care support from professionals in the community. This usually includes social workers, community psychiatric nurses, psychologists and psychiatrists.
16. The Care Programme Approach (CPA) is the process by which mental health services assess a patient’s needs, plan how to meet them and ensure they are met. Under Refocusing the Care Programme Approach (Department of Health, 2008), people under CPA should have a comprehensive assessment of their health and social care needs. They should have a care coordinator; have a care plan to show how their needs will be met and have the care plan reviewed by a multi-disciplinary team (MDT). When a patient is in hospital, their care coordinator is the key person responsible for arranging the care and support they will need on discharge.
17. The MHA 1983 Code of Practice (2015) shows professional how to carry out their responsibilities under the MHA and provide high quality and safe care.
18. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
19. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
20. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
21. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
22. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
23. The Care and Support Statutory Guidance (CSSG) sets out how councils should go about performing their care and support responsibilities to comply with the Care Act 2014.
24. Regulations do not say how long a complaint investigation should take. But they do say an expected timescale must be explained at the start, usually in discussion with the complainant. If the complainant does not want to discuss this, the responsible body must decide the timescales and confirm them to the complainant in writing. The body must keep the complainant informed of progress during the investigation ‘as far as reasonably practicable’. If the responsible body has not provided its response after six months (or after a longer period agreed with the complainant), it must write to the complainant to explain why. (Regs 13 and 14, Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

Background

25. Mr D lived at home with his parents and was visited by a mental health practitioner and the police following concerns about his mental health. Mr D is diagnosed with an obsessive compulsive disorder (OCD – a mental health condition where a person has obsessive thoughts and compulsive behaviour). He was admitted to hospital under the terms of section 2 of the MHA in August 2020. Once the section 2 ended he remained in hospital as an informal patient.
26. The Trust started discussing Mr D’s discharge arrangements in September 2020. He had capacity to make specific decisions. Mr F was Mr D’s Department for Work and Pensions appointee for benefits.
27. The documentary evidence provided by the Trust confirmed Mr D wanted to live in an independent property upon discharge from hospital. Mr D sent an email to the Trust in September to say he did not want to live in an NHS assisted living property. He said he wanted a final say on what happened regarding his discharge.
28. Around this time the care coordinator working with Mr D spoke with a support provider about a potential self-contained supported living property. The care coordinator also spoke to Mr and Mrs F about the potential property. The family expressed concern about whether the Trust had properly considered the risks to Mr D. Mr D did not want to visit the property but agreed that his mother could.
29. Near the end of September Mrs F and other family members met with the care coordinator at the potential property. The notes provided by the Trust summarise that the family took pictures to show to Mr D and they discussed the pros and cons of supported housing with the care coordinator. The officer also told Mrs F to discuss with Mr D and advised he view the property before signing the contract.
30. Mrs F contacted the care coordinator to confirm Mr D was happy to sign the tenancy for the property. Mr D had said he wanted the washing machine in the property to be replaced because of his concerns about how clean it was. The care coordinator told Mrs F the washing machine could not be replaced as confirmed by the supported housing provider. However, although the washing machine could not be replaced the supported housing provider would sanitise it.
31. Mr D also asked for other furniture and flooring to be removed because he wanted new items. Mr and Mrs F said they spent around £5,000 replacing items and flooring.
32. Mr D was discharged from hospital to the supported living tenancy in October 2020. Mr F says his son was not supported to understand the tenancy agreement before he was asked to sign the form. He said none of the organisations involved took the time to explain the community care charges to Mr D or to him as he was acting as Mr D’s appointee.
33. Mr F said the property was also unsuitable for his son because of incidents that had occurred with other tenants who lived in neighbouring self-contained flats in the same building where Mr D’s flat was located.

Mr F’s complaint to the Trust

34. Mr F complained to the Trust around July 2021 about the care and support it provided to his son. He made the complaint on behalf of Mr D. He also complained about the charges the Council had asked Mr D to pay despite never being told about the charges. He said the charges amounted to thousands of pounds and the way this had been dealt with had caused the family alarm and distress.
35. The Trust responded to the complaint in May 2022 and confirmed the CMHT had dealt with Mr D’s discharge from hospital and his move to the supported housing tenancy. It said there was a process in place for the CMHT to review placements and how this affected a person’s finances. The Trust apologised as it appeared Mr D was not told about the charges when residing at the property.
36. The Trust sent Mr F a second response in September. In summary, it said Mr D had received information about accommodation which would have assisted him to find his own accommodation. It said his family had visited the supported housing placement and supported Mr D when he made his decision to move there.
37. The Trust said the property was habitable, but Mr D asked for new furniture items and replacement flooring. This was arranged by his family. It said a financial assessment of the placement was completed with Mr D in October and ‘charges for community care form’ was sent to the Council at the same time.

Findings

The way the Trust and the Council assessed Mr D’s needs as part of his discharge from hospital

38. Mr D was an informal patient in hospital and was not eligible for aftercare as prescribed by section 117 of the Mental Health Act 1983. The Trust said he was subject to the CPA which should have considered his health and social care needs.
39. The Council and the Trust operated an integrated team in line with a Section 75 agreement in place at the time of events complained about. Under this agreement the Council delegated specific social care duties to the Trust. The Trust had delegated responsibility to complete assessments, person-centred support plans and reviews in line with the Council’s Care Act 2014 responsibilities.
40. The Trust provided a copy of a CPA care plan it completed on 2 October 2020. The MHA code of practice says, “the care plan should be prepared in close partnership with the patient from the outset, particularly where it is necessary to manage the process of discharge from hospital and reintegration into the community.”
41. The document provided by the Trust is complete in some areas but is incomplete in other areas. For example, the care plan has a section to record Mr D’s views of the care plan, but this section is blank. The document confirms Mr D was not given a copy of the plan and a check box is ticked to indicate he did not agree to or sign the plan. This is fault.
42. In response to our enquiries, the Trust said there is no evidence to show it completed a Care Act assessment. This is fault. The Trust referred to COVID-19 Hospital Discharge arrangements that was in place at the time being a contributory factor. I have not seen evidence to show the Council and the Trust followed the requirements in place at the time.
43. I cannot say how the Trust and the Council involved Mr D in the assessment process because of the lack of available evidence. The Trust and the Council should have assessed Mr D’s needs in line with the CPA or the Care Act. He and his personal representative(s) should have been involved in the assessment and had a say in any subsequent support plan as set out in the associated Care Act guidance and MHA code of practice. The evidence available suggests the Council and the Trust did not do this. This fault is likely to have meant Mr D did not have his needs properly assessed and recorded in a person-centred way. The fault is also likely to leave Mr and Mrs F with uncertainty about the adequacy of their son’s support arrangements when he was discharged from hospital.
44. Although the evidence available suggests the Council and the Trust failed to involve Mr D in the written assessment of his needs there is evidence to show he was involved in choosing the property he moved to. For example, the care coordinator discussed the property with Mr D and explained supported housing compared to other options such as mainstream housing.
45. Mr D was offered the option to view the property but he declined to view it. This was not because of fault by the Council or the Trust. Mr D made a capacitated decision not to view the property. He was supported by his mother and other family members who did view the property and this is likely to have assisted his decision making.
46. The offer to view the property also likely meant there was an opportunity for Mr D to discuss any concerns he had about his move and the support on offer directly with the supported housing provider. As he did not visit the property he could not do this but this was not because of fault by the Council or the Trust.
47. Mr D raised some concerns in email communication with his care coordinator. The evidence available shows the care coordinator relayed these concerns to the supported housing provider. For example, when Mr D had concerns about the items of furniture which came with the property the care coordinator liaised with the support provider to have these removed and replaced with the ones paid for by Mr and Mrs F. This evidence shows Mr D had the opportunity to be involved in actions relating to his care and support arrangements.
48. Mr D could have chosen not to accept the tenancy for the supported housing placement but he did not. I have not seen evidence to show he was placed under undue pressure to accept the tenancy by the Council or the Trust.

Mr D’s choice of accommodation and suitability of accommodation

49. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.
50. These rules did not apply to Mr D’s housing situation. He was not entitled to aftercare and the Council did not arrange the placement in the same way it does for care homes. Mr D was an informal patient in hospital and could have returned to live with his parents or find other accommodation. The Trust and the Council supported him to find accommodation which was identified to suit his needs and housing situation. Mr D signed for the tenancy for the property and paid the rent although this may have been funded through state benefits.
51. Mr F says Mr D did not have a choice but I have not seen evidence which would allow me to agree with this view. Therefore, I do not find the Trust or the Council at fault regarding this part of the complaint.
52. Mr F complains the property was unsuitable for his son’s needs based on his OCD. Mr F feels he and Mrs F should not have had to fund the replacement furniture but that the Council and the Trust should have considered the costs when support planning. Mr D was not entitled to MHA aftercare and it is unlikely that any assessment or care plan properly completed in line with the MHA code of practice or the Care Act 2014 would have led to the Council or the Trust buying new furniture or white goods for the property based on an eligible need. The decision to buy new items was made between Mr D and his parents. I do not find the Council or the Trust at fault regarding this point.
53. Mr F also referred to another tenant who lived in the same building whom he felt had put Mr D and other tenants at risk. All tenants in the building would most likely have signed a tenancy agreement which would have set out their rights and responsibilities. They all lived in separate self-contained accommodation. Mr F said the supported housing provider should have taken action against the tenant who was causing problems. I have not considered this issue within the summary of complaint or as part of my investigation. It is likely that Mr D would have been able to report his concerns to the supported housing provider as it was his landlord or the landlord’s agent. The Council and the Trust were not responsible for tenancy enforcement. Therefore, I have not considered this point further.
54. Within two weeks of moving to the property the evidence available suggests Mr D expressed his dissatisfaction with the property. The Trust said Mr D told it he did not want support from the supported housing provider or the CMHT. There appears to be a gap in contact between Mr D and the CMHT from November 2020 until February 2021. The CMHT discharged Mr D from its service in
    March 2021.
55. I have not seen evidence to show how the Trust or the Council reviewed the support arrangements in place at the time. This is fault. I cannot say, on balance, what the outcome of any review may have been or whether Mr D was caused an injustice. This is because the evidence available suggests Mr D said he did not want to engage with the CMHT or the supported housing provider.

The way the Council and the Trust dealt with Mr D’s financial assessment

56. Mr F says the Council and the Trust did not make Mr D aware of charges he would need to pay towards the support element of his tenancy before he moved to the property. The evidence available shows this is likely to have been the case.
57. The care coordinator did not complete a form to request a financial assessment until three days before Mr D moved to the property. This is fault as Mr D should have been aware of the charges and able to make an informed choice before he moved to the property.
58. The Council has not said when it acted on the request for a financial assessment from the Trust. It said it sent a financial assessment form to Mr F and that he said he was never told about charging. It said it completed a light touch financial assessment by checking DWP records and inputting Mr D’s income.
59. The CSSG says, where a council proposes to undertake a financial assessment it should, “take steps to assure itself that the person concerned is willing, and will continue to be willing, to pay all charges due. It must also remember that it is responsible for ensuring that people are not charged more than it is reasonable for them to pay. Where a person does not agree to the charges that they have been assessed as being able to afford to pay under this route, a full financial assessment may be needed.” I have not seen evidence to show the Council acted in line with the CSSG and so it is at fault.
60. I have not seen evidence to show either Mr D or Mr F as his appointee agreed to the charges at any point. Mr F said they received letters telling them they owed over £8,000 for support charges. This situation is likely to have caused Mr D and Mr and Mrs F to experience avoidable distress and worry for a period of around eight months. The Council said it received a request from the Trust to waive the charges and agreed to do so in line with Care Act principles. This action by the Council is likely to have alleviated any ongoing distress to Mr D and his parents from the date it agreed to waive the charges.

Complaint handling by the Trust and the Council

61. When Mr F complained to the Trust he referred to issues relating to health and social care responsibilities. In line with the regulations the Trust and the Council should have provided a coordinated response. The Council said it sent information to the Trust so that it could coordinate this into its complaint response. The Trust said it did not receive information from the Council. As a result of this Mr F did not receive a coordinated response to his complaint. As the lead agency handling the complaint the Trust should have ensured Mr F received a coordinated response.
62. Mr F complained to the Trust in July 2021 and the evidence available suggests it did not seek consent from Mr D until about four months later. It provided complaint responses to Mr F in May and September 2022.
63. In response to our enquiries the Trust accepted it delayed responding to Mr F’s complaint outside of agreed timescales. It said this was mainly due to delays in allocating the complaint to a manager for investigation. I have not seen evidence to show the Trust provided Mr F with this explanation or apologised. It is likely
    Mr F was put to avoidable time and trouble in pursuing his complaint. The Trust says it has now improved by ensuring overdue complaints are overseen by senior staff on a weekly basis so that action can be taken as necessary. It is therefore not necessary to make a recommendation for improvement.

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Agreed recommendations

64. Within four weeks of our final decision the Trust and the Council have agreed to take the following action:
• The Trust (and on behalf of the Council) will write to Mr D and apologise for the impact on him caused by the failure to assess and record the assessment of his needs in a person-centred way. The letter will include an apology for the distress caused to Mr D when he was charged for support services he had not been made aware of before his tenancy started.
• The Trust will arrange with the Council to pay Mr D £300 to acknowledge the injustice caused.
• The Trust (and on behalf of the Council) will write to Mr and Mrs F and apologise for the uncertainty they experienced because of the lack of written assessment and support planning in line with the law and good practice when their son was discharged from hospital. The letter will include an apology for the distress and worry they experienced when they believed they would have to pay thousands of pounds for support and the way the Trust handled Mr F’s complaint.
• The Trust should arrange with the Council to pay Mr and Mrs F £300 between them for the impact the faults had on them.
65. Within two months of our final decision the Trust and the Council have agreed to take the following action:
• Remind their officers working as part of the integrated joint working arrangements and who are responsible for assessments under the CPA and Care Act of the importance of completing assessments in a person-centred way. They will also be reminded of the importance of involving the person or their representative at the centre of the assessment as far as possible. This includes sharing copies of assessments and support plans, obtaining signatures and completing reviews.
• Remind their officers working as part of the integrated joint working arrangements of the importance of sharing financial information with those using services so they will be enabled to make an informed choice before a service starts.
66. The organisation should provide us with evidence they have complied with the above actions.

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Final decision

67. I uphold Mr F’s complaint in the areas outlined in the findings section of this decision statement. The Council and the Trust have agreed to our recommendations and this remedies the injustice caused. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman