The joint investigation by the Parliamentary and Health Service Ombudsman and the Local Government Ombudsman found the woman was left without the right care package for more than a year, because of a dispute between Sheffield City Council and Sheffield Health and Social Care NHS Foundation Trust, a mental health trust.
Before her legs were amputated the woman received an annual personal budget of approximately £7,000, to help her with her mental health problem of moderate to severe depression, which was funded by the NHS.
When she had both her legs amputated, following a blood disorder and problems with her vascular system, her personal budget had to be re-assessed.
But the council and the mental health trust couldn’t decide how much support she should receive. This left her without sufficient funds for more than 14 months. (Her personal budget ran out and she was left without an appropriate budget for more than 14 months). During this period her clinical psychologist, her physiotherapist and prosthetist wrote a joint letter to the council saying that the delay was having a 'significant adverse impact' on the patient’s 'physical and psychological wellbeing'.
The letter stated that her mental health history was well-known to the council and that her health was at significant risk of deteriorating further if there was no agreement on her support package within a reasonable timeframe. Her GP and her clinical psychologist sent further letters raising concerns about the delay.
Parliamentary and Health Service Ombudsman Julie Mellor said:
Our role is to investigate complaints that have not been resolved by the local organisation. Even though this complaint was upheld by the trust and council, they failed to put things right, which meant that a vulnerable woman was left without the right care package for more than a year.
'Both the council and the trust should have acted sooner to prevent the unnecessary distress experienced by this woman.
'When complaints haven’t been resolved by public services, knowing where to turn to, can often be complex and confusing. That’s why we are calling for a single public ombudsman service covering all public services for England - including health and social care - to make it easier for people to get justice when things go wrong.'
During the 14 months without an appropriate care package, she only received a basic package of care which consisted of two visits a day by agency workers. They helped her with basic care such as housework, emptying bins, putting laundry in the washing machine and doing one hour’s shopping a week. They were unable to take her out of the house.
This meant that she was mainly house-bound, becoming more isolated and depressed. She found it difficult using public transport and had to spend her money getting taxis to go to medical appointments, as well as to go swimming, do voluntary work and take part in social activities.
Local Government Ombudsman Dr Jane Martin said:
This is an example of two organisations, with an important role in supporting vulnerable people, being unable to communicate properly and take a co-ordinated approach to provide suitable assistance for this woman.
'I am pleased that the council and the trust have agreed to our recommendations and will now produce an action plan to ensure better working relationships and a more joined up strategy for dealing with cases such as this. I hope this will ensure that similar situations will not recur.'
The woman complained to the NHS trust and the council about them taking so long to decide how much support she should get. But even though the NHS upheld her complaint, she was forced to complain to the ombudsmen as four months after the complaint was upheld by the trust, her new budget had still not been decided.
The ombudsmen recommended the council and the trust:
- Write to the complainant to apologise for the faults identified in their investigation and for the distress caused.
- Reimburse her £14,000 for the costs she incurred in buying support that should properly have come from her Self Directed Support (SDS) budget, covering the period January 2014 to February 2015 inclusive. The £14,000 figure was what the ombudsmen services estimated she would have received over this period, if her budget was decided in time.
- Agree her monthly SDS budget as a matter of urgency and ensure that payments are made within three months at the latest and backdated appropriately.
- Pay her £12,000 to acknowledge the impact on her of not having an adequate SDS budget in place. This figure was arrived at after considering her vulnerability, the impact on her daily life, and the length of time she has been affected.
- Pay her a further £1,000 to acknowledge the avoidable stress and frustration from having to continue to pursue her complaint.
- Produce an action plan within three months addressing the faults identified by the ombudsmen’s’ investigation, and setting out what action has and will be taken to address them.
The trust and council have accepted the ombudsmen’s recommendations in full.
The woman complained to the Local Government Ombudsman in July 2014. The Local Government Ombudsman then contacted the Parliamentary and Health Service Ombudsman so that they could carry out a joint investigation, as this was a complaint which spanned both the NHS and council-funded social care.
The Parliamentary and Health Service Ombudsman makes final decisions on complaints that have not been resolved locally by the NHS in England. The Local Government Ombudsman looks at complaints about councils and other bodies acting on their behalves such as care homes and school appeals panels.
Notes to editors
- The mental health trust, which investigated her complaint about it and the council taking too long to decide how much support she should get, upheld the complaint in March 2014.
- The dispute between the council and the trust was about whether - following the amputation in February 2013 - her needs were mostly related to her physical disability (which would mean they would be covered by the council) or whether they mostly related to her mental health needs (which would mean they would be funded by the mental health trust).
- In August 2013 the trust and the council agreed 50-50 funding split for a new SDS budget. After that, a new joint assessment took place in October 2013. Again, this recommended joint funding by the council and the mental health trust.
- But when further meetings took place between the trust and the council, it was decided that her needs were defined largely by her physical disability.
- Her budget from the mental health services ran out on 31 December 2013. She was then left with just the basic care package of two agency visits a day, paid for by the council, which was meant to be an interim measure.
- She complained to the trust and council on 17 January 2014. On 24 January 2014 the complainant was told that her budget should be 100% funded by the council. If it was solely funded by the council, her overall support package was likely to be less. She made a further complaint to the trust about this decision as she believed her package should be jointly funded by both the council and the trust.
- The trust investigated and upheld the complaint about the failure to agree and provide her with a continuing SDS budget, on 12 March 2014. The trust also accepted that the complainant had social care needs directly related to her mental health condition and said that this should be ‘immediately’ reconsidered and the amount of her new budget should be determined.
- It still wasn’t resolved by July 2014 and the complainant was still only receiving the basic care package. She complained to the Local Government Ombudsman in July 2014.
- The Parliamentary and Health Service Ombudsman makes final decisions on complaints that have not been resolved locally by the NHS in England. The Local Government Ombudsman looks at complaints about councils and other bodies acting on their behalves such as care homes and school appeals panels.
- For more information please contact senior press officer at the Parliamentary and Health Service Ombudsman Marina Soteriou on 0300 061 4996 or email marina.soteriou@ombudsman.org.uk