Decision Date: 25 February 2025
Summary
Mr X complained for his late father Mr Y against Birmingham City Council and the Care Provider for various services failures after the father’s hospital discharge. Mr X said the failings caused the death of his father and caused him to lose trust in the Council. He wanted the Council to improve service in relation to its IT systems, communication and consistency of workers.
What happened
The complaint included the fact that Mr Y was discharged without a care plan in place, and with no care provided until two days later. Additionally, the council did not provide introduction on an assessment visit and then wrongly recorded Mr Y’s niece as his next of kin.
Mr X’s issues with carers from the Care Provider company included that the visiting carers failed to sign in/out, wear identification and complete handovers, gave Mr Y medication meant for his wife and left bags of soiled pads in Mr Y’s bedroom.
Furthermore, they spoke to each other in a different language whilst on visits and did not talk to Mr Y.
What was found
The matter was not further investigated, after initial enquiries, so no finding of fault (or lack thereof) was found. The LGSCO did not believe the investigation would achieve a meaningful outcome.
The report says that this was the conclusion arrived at, because the council in its own investigations had struggled to come to a robust conclusion in several areas; the LGSCO could not envisage being able to do any better.
The problem seems to have been that there was a lack of corroboration of the evidence about the complaints – for instance, that the carers had chatted in their own language, which would obviously have been disrespectful.
In areas where the council did accept fault, it had acted to address the fault. It had undertaken proper safeguarding inquiries [what it did about its own actions in relation to the discharge is not covered by the report.]
The council made appropriate referrals to the Care Quality Commission [presumably about respect etc.]
Furthermore, there was a lack of evidence to suggest that these faults caused significant injustice.
The LGSCO said it would have been impossible to arrive at conclusions regarding the complaints and any link with Mr Y’s death and it could not conclude that Mr Y suffered a significant injustice because of any of the complaints submitted by Mr Y.
Finally, the LGSCO was unable to make recommendations to remedy the injustice to Mr Y, because he had since passed away.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
We’ve highlighted, below, the areas of discretion that the LGSCO’s own founding legislative framework permits the organisation regarding its investigations work. It has discretion to decline to investigate or to discontinue an investigation if its staff conclude that
- there is not enough evidence of fault to justify investigating, or
- any fault has not caused injustice to the person who complained, or
- any injustice is not significant enough to justify our involvement, or
- we could not add to any previous investigation by the organisation, or
- further investigation would not lead to a different outcome, or
- there is no worthwhile outcome achievable by our investigation.
On discharge from hospital, reablement support services are normally available if the person being discharged is regarded as able to benefit from them. These are time-limited with the aim to reinstate or preserve independence for the individual. They are to be provided without charge for up to six weeks for all adults under Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014.
The report does not say whether Mr Y qualified for reablement support or was being sent home terminally ill: there is simply insufficient information to know whether what should have happened, was even appreciated.
Discharging Mr Y from hospital without any care in place (assuming from the arrival of care very soon afterwards, that he in fact needed it and would have been eligible) raised concerns, for which it is noted that the Council took appropriate safeguarding enquiries, including referrals to the CQC.
The Care Provider and their care workers were regulated by the CQC. It issues standards for Care Providers to abide by, including treating individuals with dignity and respect. The treatment of Mr Y here – if it had been upheld as having happened, would have demonstrated a failing against this standard. On the facts, the Care Provider took action to address the matters with the carers involved.
Although the LGSCO did not find systemic issues that would warrant service improvement recommendations or further involvement, we think that this incident evidences the need for a better internal complaints system.
Individuals must be able to highlight wrongdoings and hold both Councils and Care Providers to account. They must be able to enforce their rights and highlight misgivings that could infringe upon these.
In this situation, Mr Y may not have been assisted to complain at the time, so all the evidence would have been ‘hearsay’ – he might have told his relatives what had happened and he’d been made to feel like, but he was not there any longer to tell the ombudsman.
The report doesn’t say when he died, in relation to the beginning of the care period, or whether he’d spoken to anyone other than his family about what he thought of the care. The report doesn’t say whether any other relatives or visitors had themselves witnessed poor behaviour. That would have been direct evidence, so one can only assume that there was none.
We at CASCAIDr are equally concerned as to how the man was discharged from hospital without care in place. We have seen many other reports in which that would have led to a joint investigations team for health and social care maladministration going into the hospital discharge process in Birmingham. Assessments for a care plan should be carried out over a suitable and reasonable timescale, considering the urgency of needs. Additionally, assessments must be carried out for any adult with an appearance of need for care and support (or for support, for a carer) (Care Act 2014, s9, s10).
Discharging someone without care is not inappropriate if they don’t need it, of course, but since most patients on their day of hospital discharge can feasibly assert an appearance of need for care and support, the Care Act assessment duty is triggered.
The provision of reablement doesn’t mean that the Care Act assessment hasn’t been started or that the Council isn’t responsible for what then happens, and ensuring that it’s there when one gets home is clearly of central importance.
It may be that this man was not someone who was thought to NEED an assessment or care and when he got home that was quickly appreciated to be a misjudgement, which was put right – but one simply cannot tell.
Most significantly, the Care Act process culminates – for someone who is found eligible – in the production of a care plan, and the care plan underpins the commissioning function, which itself involves selecting a competent care company.
So this report comes over as inadvertently conveying that Birmingham was operating in a parallel universe to the real world in which legal rights exist under the Care Act – and without commenting on it, if in fact that was a fair description of its involvement in the local hospital discharge process.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Birmingham City Council (24 015 748) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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