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An NHS trust should not have detained a man with a severe learning difficulty for four months, according to a report by the health service ombudsman, writes Jonathan Pearce.

The man 'L' – who cannot be named for legal reasons – was detained in hospital in July 1997 by staff at Bournewood Community and Mental Health NHS Trust following an incident at a day centre where he was receiving care.

The day centre staff were unable to contact L’s carers – Mr and Mrs E – and were unable to contain the situation, leading to a general practitioner unsuccessfully trying to calm L down with medication before referring him to the local hospital where he was seen by a psychiatrist.

The psychiatrist could not tell whether L had a psychiatric condition or a behavioural problem, and so decided to admit him for a period of observation. He did not leave care for another four months, during which time his case was the subject of high profile litigation over the legality of his detention.

While in Bournewood’s care, the court of appeal ruled that L’s informal admission to hospital was unlawful, even though he was incapable of agreeing to or refusing treatment. But in 1998 the House of Lords overturned the decision, thus ending the situation where people with conditions such as Alzheimer’s disease, dementia or learning difficulties would have to be sectioned under the Mental Health Act before being admitted to care for short periods of treatment.

The trust sectioned L after the court of appeal ruling, before releasing him in December 1997 with a care plan and monitoring arrangements.

But the ombudsman’s report – which was only concerned with whether the trust acted reasonably in connection with the clinical aspects of L’s case – supports the findings of the court of appeal rather than the House of Lords.

The ombudsman agreed with Mr and Mrs E’s complaint of inadequate clinical management, but disagreed that L’s initial admission had been unreasonable.

"Even if it was felt to keep him overnight, it is difficult to see why he was not discharged the next day. Any further assessment could have been conducted in the community," says the report.

"I find it unsatisfactory, especially given the background and nature of the incident in question, that L was not discharged back into Mr and Mrs E’s care for another four months," it continues.

The ombudsman has recommended that Bournewood implement independent assessors’ recommendations that admissions to the intensive behavioural unit should be strictly time-limited, and that adequate resources should be available for multi-disciplinary assessments to be carried out in people’s homes.