A London council which took too long to assess a vulnerable woman’s needs has been asked by the Local Government and Social Care Ombudsman to pay nearly £20,000 in care home fees.

The Ombudsman investigated the complaint about the London Borough of Hackney, finding it took too long to carry out a care assessment, under-funded many months’ worth of fees, and wasted time disputing responsibility with another council.

Michael King, Local Government and Social Care Ombudsman, said:

“Hackney’s delay in assessing this woman’s needs left a family with the uncertainty of not knowing whether the council would foot the bill for her care. It should not have taken both a solicitor’s letter and my investigation for the council to recognise its duties towards her.

“It is imperative that people in need are assessed in a timely fashion. And if there are any doubts about that person’s residency, it should be referred to the Secretary of State to decide.

“Hackney council has agreed to my recommendations and I hope other councils will learn from this complaint and ensure staff are aware of their proper duties when assessing care needs.”

The elderly woman, who had dementia, was told she could not return home after a stay in hospital in early 2014. Instead, her daughter said she could live in Hackney with her with the help of daily visits from carers.

Some months later, struggling with her caring commitments and her own ill health, the daughter placed her mother in a care home in a different borough, for what she believed was a period of respite.

When she asked London Borough of Hackney to reassess her mother’s care needs, she was told to speak to the borough in which her mother was now living. This second borough told the family the woman was still resident in Hackney. Some 10 months after the request was first made, Hackney carried out an assessment and found  the mother needed significant help with aspects of her life including food and nutrition, toileting, dressing and staying safe.

Hackney council agreed to fund the mother’s placement from October 2015, but this still left a significant sum of unpaid care home fees.  The family complained to the council via a solicitor. When they were not happy with the council’s response, they complained to the Ombudsman.

The Ombudsman’s investigation found the council took too long to assess the mother’s care needs, and should have paid the care home fees from November 2014, not October 2015. This was the point at which the council should have assessed the mother’s care needs.

The Local Government and Social Care Ombudsman’s role is to remedy injustice and share learning from investigations to improve local public, and adult social care, services.

In this case, the council agreed to settle the care home fees for the period between November 2014 and October 2015 – this amounts to £19,898 - and pay the family’s solicitor fees

The Local Government and Social Care Ombudsman has published details of the complaints it has received about all local councils in England in 2016-17.

The Ombudsman investigates complaints about all local authorities and social care providers in England. Every year it publishes the information it sends to councils to help with transparency and improve local services for residents. This annual summary is the number of complaints and enquiries it has received about the council, and the decisions made about those complaints.

Local Government and Social Care Ombudsman, Michael King, said: 

“Our annual data release is a great opportunity for the public, councillors and council officers to gauge how their local authority responds to, and learns from, the complaints we receive about them. 

“The best councils use our data to scrutinise the services they provide. I urge all councils to do that to make their services better in future. 

“I want to encourage an open and mature attitude to complaints - one where they are valued within organisations as ‘free feedback’ and learning opportunities. Indeed, how an organisation deals with complaints says a lot about its culture.

“The data we have issued, and wealth of information we publish on our website, are a valuable source of information about complaints handling and council performance. I would urge people to take a look to see how they can use it to improve or scrutinise their authority’s performance."

While issuing the figures this week, the Ombudsman is keen to point out that a high number of complaints does not necessarily mean a council is performing poorly. It may indicate an authority that welcomes and encourages feedback, through a transparent system which signposts people appropriately when its own processes have been exhausted.

This year (2016-17) the Ombudsman received over 16,500 complaints and enquiries about councils. The greatest proportion were about Education and Children’s Services, followed by Adult Social Care, and Planning.

It’s not just about numbers though. What matters is the outcome of the complaints investigated in detail and over the year, across England, the Ombudsman upheld 54%. This is up from 51% in 2015-6, and 46% the previous year. The region with the highest proportion of complaints upheld was London (60%), and the lowest was the East Midlands (44%).

Overall, the Ombudsman was most likely to find fault in Adult Social Care cases (64% upheld), and least likely to find fault in complaints about Planning and Development (35% upheld).

Other statistics from across the country include:

• 26% of all complaints received over the past year are about London councils (4,230)
• the highest uphold rate for Children’s and Education Services complaints was in the north east, with 67% upheld, this compares with an uphold rate of 63% nationally
• Yorkshire had the lowest percentage of Children’s Services complaints upheld, at 58%
• the West Midlands area had the highest uphold rate for Adult Care Services at 73%, higher than the average of 64%
• the southern region saw the lowest proportion of complaints about Adult Care services upheld, at 52%
• the London area saw a higher proportion of complaints about housing than any other area in the country - they made up 23% of the area’s total complaint numbers, compared with a national average of 12%
• the Ombudsman upheld 61% of those housing complaints in the London area compared with a national average of 54%

One of the Ombudsman’s main roles is to remedy injustice, and try to put people back in the position they would have been in, had the fault not occurred. This year, the Ombudsman made 3,562 recommendations to put things right. This included apologies, financial remedies (for example paying for care which should have been provided) and procedural changes to help improve services for others.

The Deputy Ombudsman and Head of the National Preventive Mechanism (NPM) Ivan Šelih and Adviser to the Ombudsman Jure Markič, MSc, attended the meeting of the Network of National Preventive Mechanisms (NPM) for SV Europe, held from 5 – 6 July 2017 in Podgorica, the capital of Montenegro, where they addressed the issue of providing medical care in prisons and psychiatric institutions.

In his opening address, Deputy Ombudsman Šelih as the chairperson of the Network's legal group stressed that the assessment of the state of medical care should be based on the general principle that prisoners are entitled to the same level of health care as everyone else. This is a fundamental and inalienable right of every imprisoned person. Only adequate health care can ensure a high quality of life in a closed institution. Inadequate medical care my lead to inhuman and degrading treatment. It also should not be ignored that the healthcare service makes an important contribution to preventing poor treatment by carefully monitoring prisoners’ health status, providing appropriate medical care, alerting (responding) to possible health concerns and by preventive activities.

In the continuation of the meeting the participants exchanged their views regarding the accessibility of physicians, equal provision of medical care, consent to medical treatment and confidentiality, preventive healthcare measures, assistance to persons with special needs, professional independence, and competence. All these are the aspects that are monitored by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) on its visits to the healthcare services in prisons.

One of the conclusions of the meeting was that the healthcare service in prisons should be part of the public healthcare network (it is organised this way in our country), with an emphasis on special and additional tasks and position of healthcare service in providing medical care to imprisoned persons.

Health care is undoubtedly also very important for patients who are detained in psychiatric hospitals. Furthermore a Slovenian representative pointed out the need of distinguishing between detention in a ward under special supervision and the medical treatment itself. The lively discussion on this important issue was also continued on the second day of the meeting. Although initially it appeared that the view of the participants were different, after the discussion it turned out that in principle they agreed, which made it possible – on the basis of the opinions expressed – to draw a suitable conclusion that would undoubtedly represent a guideline not only for all NPMs in this area but also more broadly. In accordance with CPT standards, the basic principle governing this area should be the patients' right to give their free and informed consent to treatment. The admission of a person to a psychiatric establishment on an involuntary basis should not be construed as authorising treatment without their consent. It follows that every competent patient, whether voluntary or involuntary, should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon the law and only relate to clearly and strictly defined exceptional circumstances.

NPM members: Deputy Ombudsman Ivan Šelih, Adviser to the Ombudsman Robert Gačnik, and a representative of the selected NGO PIC Boris Nusdorfer made a regular monitoring visit to the detention premises of the Piran Police Station on Tuesday, 20 June 2017. On Wednesday, 21 June 2017, they also visited the Koper Prison.

A report will be drafted on the findings of both visits, along with recommendations for improving the situations and recommendations on short-term and long-term measures for mitigating the consequences of high summer temperatures in Koper Prison.

Both visits were attended by two observers – members of the Antigona organisation from Rome, its President Patrizio Gonella, and National Coordinator Susanna Marietti. As this organisation regularly visits prisons in the neighbouring country of Italy, this event was an opportunity for a mutual exchange of experience in conducting preventive visits to the closed institutions.

The two foreign observers also noted good relations in Koper Prison, which contribute to a pleasant atmosphere, which is important for the security conditions and order in the institution.

The Deputy Ombudsman and Head of the National Preventive Mechanism (NPM) Ivan Šelih, and the Ombudsman's Advisers Jure Markič and Robert Gačnik, attended the meeting of the Network of National Preventive Mechanisms (NPM) for SE Europe, held from 25 – 26 May 2017 in Belgrade, the capital of Serbia, where they addressed the issue of persons with mental disorders in detention. This is one of the particularly vulnerable population groups that can be detained in various closed institutions, such as police stations, prisons, social welfare institutions, psychiatric hospitals and others.

The meeting was attended by all members of the Network and some other representative of NPM or human rights protection institutions, and of international organisations.

In his opening address, Deputy Ombudsman Šelih as the chairperson of the Network's legal group stressed that persons with mental disorders are socially marginalised and as such are particularly vulnerable and helpless. Because of the difficulties they face, they can hardly manage to protect their own interests, write an application or appeal, etc. As such they are particularly prone to several risks and discrimination, as well as to possible abuse during detention. All NPM are accordingly bound to ensure that these persons receive appropriate and dignified treatment.

The main objective of the Network is to establish intensive mutual cooperation and exchange of experience, create synergies among the network members, provide mutual assistance, and create conditions for the efficient implementation of the NPM mandate. Therefore, this meeting was an excellent opportunity to exchange experience in our daily practice of dealing with persons with mental disorders in detention.

The treatment of persons with mental health problems is nevertheless determined by several standards, including the Convention on the Rights of Persons with Disabilities. The core message of all standards is to provide those with disabilities equal, adequate and decent treatment, adequate and decent accommodation, and access to medical and other assistance. To comply with the international standards in this field, all persons with severe mental disorders should be placed in appropriate institutions and facilities. They should be provided special activities and training. In order to be provided suitable treatment, they must be recognised as such. It is important to subject them to a thorough examination so as to prevent their possible further victimisation and abuse during detention. In this regard we should not ignore the need to educate the staff of those institutions concerned so as to enable them to identify these persons, acknowledge their needs, provide them additional care, and also learn de-escalation techniques, etc.

The introductory part of the meeting was followed by workshops with a lively exchange of views and practices. Thus, the participants came to the conclusion that additional training in working with such persons should be organised for police officers, which should aim at specialisation, certification and evaluation of the training programmes. The participants unanimously agreed that in the event that an individual person is found to show signs of a mental disease or disorder, the police should immediately inform the competent medical personnel thereof, and the police may only provide assistance to such personnel in the event of the mentally disturbed person's dangerous behaviour.

As regards mentally disturbed persons in prisons, the participants agreed that such persons do not belong in ordinary prisons but should be provided additional care in so-called prison hospitals or other healthcare facilities. It was also found that the treatment of so-called forensic patients in individual states is not uniformly regulated; in some it is within a prison hospital and elsewhere within a special department of a general hospital (as is the case in Slovenia). Dealing with this group also requires additional training in working with such persons to be organised for prison personnel, which should aim at specialisation, certification and evaluation of the training programmes.

An interesting exchange of opinions concerned the admission of persons with mental disorders to psychiatric hospitals or social care institutions, and there was a presentation on arrangement procedures of admission to closed wards of psychiatric hospitals in individual countries. There were thus a few interesting questions opened regarding consent to placement and the possible consent of (the person's) legal representative. Regarding this issue, the relevant regulation in Slovenia was presented in detail, especially in connection with the Constitutional Court's decision to partially repeal the Mental Health Act in this part. However, the participants were unanimously of the opinion that placing a person who does not give consent to detention in a closed unit (according to the law in Slovenia this applies to a ward under special supervision) of a psychiatric hospital or a social welfare institution should be decided upon by the competent court in the shortest possible time. The participants further discussed issues relating to the difference between consent for detention and consent for medical intervention, as well as to the use of special safeguarding measures.