Council at fault in consideration of best interests of elderly woman, Ombudsman finds
The Local Government and Social Care Ombudsman has found fault in the way that Stockton-on-Tees Borough Council considered an elderly woman’s best interests before placing her in a nursing home.
The woman behind the complaint, Ms Y, complained that professionals failed to understand her mother’s personality and wrongly determined she lacked capacity.
She said this led to a decision to transfer her mother to a nursing home which caused her distress. In addition, she said it led to the hospital and the nursing home placing “unnecessary restrictions” on her mother.
Outlining the background to the investigation, the Ombudsman said Mrs X went into North Tees Hospital in April 2023.
Ms Y told the Ombudsman that the North Tees and Hartlepool NHS Foundation Trust (NTH Trust) “inappropriately and unnecessarily” implemented urgent Deprivation of Liberty Safeguards (DoLS) for Mrs X for four days.
After she left hospital, Mrs X moved into a care home, Allison House, and stayed there for two days.
On her first evening there, Mrs X asked staff for her inhalers. Staff gave her two inhalers. Mrs X asked for them all.
While a member of staff was away, Mrs X moved to another area and called an ambulance. Paramedics arrived and did not have any concerns about Mrs X’s health and supported her to return to bed.
Mrs X also called the police and said Allison House was depriving her of her nebuliser.
The care home contacted Mrs X’s social worker to note it was struggling to manage Mrs X’s needs and that she wanted to return home.
The Ombudsman said: “A social worker called Ms Y and encouraged her to wait for a review for a planned discharge. They told Ms Y there was nothing to prevent her from taking Mrs X home. Ms Y said she would collect Mrs X and take her home that day, and would provide support to her there.”
Mrs X returned to North Tees Hospital in May 2023. On 9 June she had a seizure on the ward and died later that day.
Ms Y complained to the Ombudsman that the Trust and the council inappropriately and unnecessarily implemented DoLS (the Deprivation of Liberty Safeguards) during this admission.
Considering the complaint that staff failed to consider all relevant factors to properly understand the nature of Mrs X’s presentation and wrongly determined that Mrs X lacked the capacity to make decisions about her care and accommodation, the Ombudsman did not find fault.
The Ombudsman said: “The evidence from the two Trusts’ records and the Council’s records shows that staff did not rush to conclusions about Mrs X. There is evidence to show that staff sought advice and second opinions from colleagues. There is also evidence to show that various professionals had appropriately detailed discussions directly with Mrs X before reaching conclusions about likely diagnoses, and about Mrs X’s capacity.
“Overall, there is evidence to show that professionals considered a proportionate and adequate amount of information before making decisions about Mrs X’s presentation and capacity.”
The investigation also found no fault with the decision by the NTH Trust and the council to implement DoLS during Mrs X’s hospital admission in May 2023.
The Ombudsman said: “As with the earlier decision, in April, there is evidence to show that professionals acted in line with the Mental Capacity Act. They thought about the necessary factors when considering whether Mrs X had the capacity to decide whether to stay in hospital and whether to agree to investigations and treatment.
“There is also evidence that NTH Trust completed appropriate paperwork in order to implement urgent DoLS and to request standard authorisation. As such, I have not found fault here.”
However, the Ombudsman did find fault in the way the council considered Mrs X’s best interests before placing her in a nursing home.
The report noted: “Mrs X was an inpatient of an NTH Trust hospital, and staff from Tees, Esk and wear Valleys NHS Foundation Trust also took part in discussions. However, the evidence suggests it was the Council which made the final decision about Mrs X’s discharge plans.
“The impact was that there was a missed opportunity to have a full and proper discussion about Mrs X’s wishes and the options available to her.”
The Ombudsman added: “Given the outcome of the discharge discussions in May, and what we know about Mrs X’s wishes when she was deemed to have capacity, it is more likely than not that a properly completed best interests process would have resulted in different decision.”
It noted that the evidence available demonstrates that Mrs X found her time in Allison House to be “stressful and upsetting”.
To remedy the injustice caused, the Ombudsman recommended the council to write to Ms Y to acknowledge the impact that its failings in the best interests process had on her, and to pay her £250 to acknowledge the “avoidable distress” she experienced.
A spokesperson for Stockton-on-Tees Borough Council said: “We recognise the findings of the Ombudsman and have offered our apologies for the distress Ms Y has experienced. A payment of £250 has also been made to Ms Y.
“Steps have now been taken to ensure this does not happen again, including employing a dedicated officer based in the University Hospital of North Tees, who supports the discharge of residents with a complex need. Further training on the Mental Capacity Act has also been provided for officers.”
Lottie Winson
