Wigan Metropolitan Borough Council not investigated in relation to hospital discharge chaos

Decision Date:   21 February 2023

What happened

Ms B, a care provider of an unspecified sort, complained to the LGSCO after the Council refused to pay for care she had provided to Mr C. Mr C seems to have been discharged from hospital into Ms B’s care on transfer from another area and then back to her after a period of hospitalisation. 

She said the Council delayed in assessing Mr C’s needs when he was transferred from his previous area and that she had not yet been provided with Mr C’s hospital documents as promised.

Ms B said she was told by the mental health team that Mr C required 1:1 care and support, which she arranged to be in place between 27 June and 10 July 2022

Thereafter the Council told her to stop providing this [although the report does not detail when Ms B was told to stop] which led to Ms B complaining that she had been told Mr C needed the 1:1 support and she wanted to be paid for providing it. 

The LGSCO noted the Council said it was not informed of his transfer until 6 April 2022, although Mr C had lived in the area since 24 February 2022. The Council then contacted Ms B on 3 May 2022, at which point Ms B advised the Council that Mr C required more hours of daily support than he’d received in his previous area [implying that no arrangements had been made by the original authority to ensure continuity of care]. 

As such, on 6 May 2022 the Council conducted a needs assessment and arranged for a moving and handling team to assess him. This assessment determined that on occasion Mr C required a 1:1 carer, however the Council said it did not find that Mr C would need 1:1 care and support upon hospital discharge and found no record from the Home Treatment Team (HTT) to contradict this. Therefore, Mr C was discharged from the hospital on 27 June 2022 and from the HTT on 29 June 2022 as he no longer needed a bed or ongoing support.

The Council also acknowledged Mrs B had contacted a social worker on 27 June 2022 requiring support for Mr C that evening and that it had agreed to pay for the support she agreed to arrange for that same evening, but the Council refused further funding covering the period between 27 June and 10 July 2022.

What was found

The LGSCO’s view was that if Ms B had a contract with the Council or the hospital which agreed to pay for Mr C’s 1:1 care, then it would be reasonable for her to ask a court to consider responsibility for payment under that contract. Also that Mrs B could ask the hospital to provide her with the outstanding documentation and if it refused she was at liberty to ask the Information Commissioner’s Office (ICO) to consider whether she should be provided with it.

The LGSCO also noted that it was unable to establish what Ms B was told about Mr C’s ongoing care needs on discharge from hospital, but that the Council had confirmed it did not agree to fund Mr C’s 1:1 care such that the LGSCO could not say there was enough evidence of fault with the Council’s actions to warrant an investigation.

Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public

Hospital Discharge

This is unfortunately an all too familiar example of the chaos that ensues upon a hospital discharge. This hospital discharge took place in June 2022 and therefore the relevant law relating to hospital discharge is set out in Schedule 3 of the Care Act and the Care and Support (Discharge of Hospital Patients) Regulations 2014. Since this time, Section 91 of the Health and Care Act came into force on 1 July 2022, revoking the procedural requirements in Schedule 3, which required local authorities to carry out long-term health and care needs assessments, in relevant circumstances, before a patient was to be discharged from hospital. For the purposes of this complaint Schedule 3 of the Care Act is still relevant, but Discharge to Assess protocols had already superseded Schedule 3 arrangements – overlaid with Covid funding rules in one iteration or another. 

It is unclear from the reported facts whether the social worker told Ms B at the time, when the out of hours social worker contacted them on 27 June, that they would only provide funding for that evening or whether this was something the Council said later, as it had not been agreed. It may very well be that the hospital discharge notes would have provided some clarity on what support was required which Ms B may then be able to rely on.

What comes across is that no-one seemed to know what instructions had been given. Bizarrely, the needs assessment which was eventually carried out determined that on occasion Mr C required one-to-one care but that he did not need one-to-one care and support upon hospital discharge; the Council’s view was that since they could find no record of the Home Treatment Team contradicting this, that was sufficient. The problem is everyone wants to shift the responsibility onto someone else. What should happen is the planning of discharge should start at the earliest opportunity and it should involve health and social care staff in the hospital and community working together for an intermediate NHS funded package if a bedded setting is needed. This clearly did not happen here.  

Delay in assessment/moving area

The Statutory Guidance sets out the position when a person moves from one local authority area to another. It is not known on what basis Mr C moved from his previous local authority to the second local authority; however the relevant guidance in relation to moving local authorities is set out in Chapter 20 (and Sections 37-38 of the Act) and is based upon the notion of continuity of care. 

The Guidance sets out what is expected from local authorities, when people known to them for care and support functions, want or need to move out of area – including the following:-

  • supporting people to be fully involved in the process;
  • what local authorities should take into account when they plan the move with people;
  • ensuring continuity of the person’s care if the second local authority has not carried out an assessment ahead of the move;
  • documents that the first local authority must provide to the second.

The first and second local authority are meant to work together, much like what is meant to happen upon a hospital discharge, to ensure needs are met and this includes the timely completion of a care assessment.

Additionally, Sections 9 and 10 of the Care Act require a local authority to carry out an assessment for any adult with the appearance of need for care and support.

The circumstances in relation to Mr C’s move are not known. What is clear is that something went wrong, as Mr C had been in the area since February and yet the local authority knew nothing of this. 

Whilst an assessment was carried out, there was a significant delay from when the local authority said it became aware of Mr C being in the area (6 April 2022) until they did one (6 May 2022).  This Guidance says that while there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion proportionate to the needs to be met.

If you want help, please consider seeking advice from CASCAIDr via our referral form on the top bar menu of the site.

The full Local Government Ombudsman report on the actions of Wigan Metropolitan Borough Council Council can be found here: Wigan Metropolitan Borough Council (22 014 593) 

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