Man ‘left in squalor’ after errors assessing his mental capacity, ombudsman finds

A man with a diagnosis of paranoid schizophrenia was left ‘in squalor’ after his care team failed to adequately assess his mental capacity to look after himself at home, an ombudsman investigation has found.

Health and care professionals from South Essex Partnership University NHS Foundation Trust (SEPT) and Bedford Borough Council were so focused on supporting the man, who is in his late 50s, to live independently that they failed to properly assess his capacity, the joint investigation by the health service and local government ombudsmen found. As a result he suffered malnutrition.

The ombudsmen found that two capacity assessments of the man were inadequate as neither properly considered his capacity to feed himself or care for himself.

“We consider that the failure of the trust to carry out a capacity assessment about [the man’s] ability to make decisions about managing his food and his self-care needs amounts to service failure,” the ombudsman report said.

A principle of the Mental Capacity Act 2005 states that a person should be presumed to have capacity unless it is established that they lack capacity. However, the ombudsman found that there was “sufficient information” for professionals to challenge the presumption that the man had capacity to make certain decisions, including occupational therapy reports that noted he was underweight and there was no food in his flat.

The ombudsman also found that there was confusion between the council and the trust over the amount of care the man was receiving. After years of inadequate care, the man finally moved into supported accommodation in 2011 and his general condition has “improved”.

Julie Mellor, the parliamentary and health service ombudsman, said the man “was left living in squalor” because he did not receive care he was entitled to.

“Health and social care professionals were so fixated on the man’s wishes to live independently, that they failed to carry out a capacity assessment of his ability to look after himself, which would have revealed that he was unable to cope with everyday tasks like feeding himself and cleaning,” she said.

“As a result, he was two and a half stone underweight, his teeth were rotten and his bedclothes hadn’t been washed in months. At one point his family were so concerned for him that they brought him to live with them.”

Dr Jane Martin, the local government ombudsman, said: “While I have no doubt in this case that the care team was seeking to provide the best support, their presumption that the person affected had the mental capacity to make his own decisions resulted in him being malnourished. This was detrimental to his health and distressing for his family.”

In a statement, Bedford Borough Council and SEPT, said: “We acknowledge the decision of the ombudsman and will make a joint payment of £2,000 to the person affected, and a further joint payment of £500 to a family member of the person affected, in recognition of the distress and inconvenience caused.”

A House of Lords committee report published earlier this year raised concerns over professionals’ implementation of the Mental Capacity Act principles. While risk-averse practitioners assumed a lack of capacity on the part of people because of their impairments, the committee also found that social care staff misused presumption of capacity to avoid capacity assessments or providing vulnerable adults with support.

It heard of cases where adults had been left at risk of harm, in some cases leading to death, because people had withdrawn from services, and their decision to disengage had not been sufficiently examined by social workers on the basis of the presumption of capacity.