Failure to raise safeguarding alert prevented couple from receiving support to stay together

A social worker and health professionals’ failure to raise a safeguarding alert regarding an alleged assault by a carer on her husband meant adequate support was not provided to help the couple stay together at home.

Instead the couple, Mr and Mrs X, who both had dementia, suffered a “needless loss of dignity” as their needs increased without adequate support to meet them, and Mr X was deprived of his liberty and then admitted permanently to residential care.

That was the conclusion of a report published last week by the local government and the health service ombudsmen, which heavily criticised Kirklees Council and South West Yorkshire Partnership NHS Foundation Trust’s care of the couple and the agencies’ dealings with their son.

The case dates back to 2009 when Mr X, who was 80 at the time and already had advanced Alzheimer’s disease at the time of the events, was being cared for at home by his wife, Mrs X. However, by then she had started suffering from memory problems and delusional episodes, so in March of that year their son, Dr X, asked Kirklees Council to arrange a care package for his father.

Later that month, Mr X was admitted to a hospital run by the trust with acute glaucoma. Dr X wrote to the social worker who had assessed his father for community care, saying he believed this had been caused by Mrs X striking Mr X in the face.

Mrs X denied this when asked by the social worker but also was unable to retain information from discussions on previous days about her husband’s care needs, suggesting impaired capacity on her part.

No safeguarding alert

Despite this, no safeguarding alert was raised by the social worker, nor hospital ward staff, with whom she discussed the allegation. In their investigations the ombudsmen found that this was the first safeguarding situation that the social worker had confronted and, at that time, little training on safeguarding had been delivered to trust staff.

The social worker intended to put in an enhanced care package for Mr X’s return. However, this happened more quickly than anticipated, due to family concerns about his care on the wards, and he returned without the enhanced package in place.

In evidence to the ombudsman, the social work’s manager and the trust’s safeguarding lead agreed that an alert should have been raised, and if this had happened a more robust care package would have been put in place for the couple.

Though the social worker arranged more care for Mr X in the evenings, Mrs X’s memory grew worse and professionals grew increasingly concerned about her ability to look after Mr X. In September, Mrs X went into hospital with an acute confused state, caused by a urinary tract infection, and an emergency respite care home placement had to be found for Mr X.

There followed a breakdown in communication between professionals and the couple’s son, Dr X. Dr X took his mother out of hospital to his house against the advice of Dr Z, her psychiatrist from the trust. He then recruited a carer to look after his father and support his mother, from 9am to 2pm each day, supplementing evening care from the council-arranged domiciliary agency, so both could return home. However, all the professionals concerned – Dr Z, the social worker and the trust community mental health team working with the couple – saw this package as inadequate, with no support to deal with Mr X’s night-time wandering.

However, in a meeting with Dr X in November, shortly before he was due to take his father out of the care home neither the social worker nor Mrs X’s community psychiatric nurse offered any opinion on the adequacy of the care package.

Deprivation of liberty

Professionals then held a strategy meeting – to which Dr X was not invited – and agreed that a return home for Mr X was inappropriate. The care home then applied for him to be deprived of his liberty in the home and this was authorised by Kirklees council, much to the anger of Dr X.

While a 24-hour care package at home was then agreed to enable Mr X to return home in January 2010, this broke down within three days after Mrs X attacked one of the carers, and Mr X then returned to the care home. In March, the social worker and her manager sent a letter to Dr X recommending that the couple be placed in separate care homes, as Mrs X resented anyone else looking after her husband. However, this letter was also sent to Mrs X, making her extremely upset.

The ombudsmen concluded that had a safeguarding process been implemented in April 2009, “it is likely that the crisis would have been averted” through a comprehensive care package that would have given the couple the best chance of living at home together for as long as possible. They also found that professionals failed to properly to consult Dr X or consider his views and strongly criticised the decision to send Mrs X the letter about her future care arrangements in March 2010.

“As a result of actions by both the council and the trust, the couple were denied the chance of living at home together in a settled lifestyle for longer than they did,” said Local Government Ombudsman Jane Martin. “The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care.”

Council and trust agree compensation 

The council and trust have accepted the ombudsmen’s proposed remedies, which were to:

• Make a payment of £1,000 to Mr and Mrs X in acknowledgement of distress caused;
• Make a further payment of £250 to Mrs X in recognition of distress caused by her receiving a letter about her future care;
• Make a payment of £500 to Dr X for the distress and frustration caused him by a failure to consult with him properly;
• Consider a further payment to Dr X for any financial loss he can evidence was caused by the failure to consult with him properly about arrangements for his father’s care.

A council spokesperson said: “Both organisations acknowledge the findings and recommendations in the report. Whilst the report does highlight areas for improvement, it is important to stress that a plan has been agreed by both organisations and action has already been taken to address issues.”