Health service ombudsman criticises NHS trust over hospital detention

An NHS trust was wrong to detain a man with
severe learning difficulties for four months, according to a report
by the health service ombudsman.

The man, L – who cannot be named for legal
reasons – was detained in hospital in July 1997 by staff at the
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 behaviour
problem, and so decided to admit him for observation.

He did not leave care for another four months,
during which time his case was the subject of high-profile
litigation over 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.
However, 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 1983 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.

However, 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
Court of Appeal’s findings rather than the House of Lords. It
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 necessary 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, 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 in future
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.