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

Professionals ‘so fixated’ on man’s wishes to live independently they failed to carry out proper capacity assessments, says watchdog

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.

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

  1. Dan June 16, 2014 at 6:04 am #

    To implement the Mental Capacity Act fully, a sharp increase in social workers is needed. Most councils near to where I work completely underestimated the impact on worker time of the practical application of the MCA.

    No amount of training will be enough, withought adequate staffing levels to do the job properly.

  2. Pamela June 17, 2014 at 6:46 am #

    I agree with Dan, but I also think that training is an issue. Currently qualified Social Workers have been depleted in Social Care Teams, replaced by unqualified staff. Senior Managers expect unqualified staff to complete capacity assessments, and in some cases expect Social Workers to sign them off. The sheer demand on Social Work staff now puts them in an incredibly difficult position because they have to juggle between managing their case load, covering duty rota’s (and other rotas’ such as Appropriate Adult, DoLS, AMHP etc) taking safeguarding cases and undertaking capacity assessments often for people that they do not know well. The pressure put on them to complete work quickly to meet with departmental targets, processes and time-scales often means that they are made to choose between being targeted as poor performers or providing quality assessments and intervention. Training is often adhoc and provided in a lot of areas, as in-house and not from professional training companies who understand the needs of social workers. Most of all the Government are failing Social Workers and vulnerable people by the constant slashing of social care budgets putting so much pressure on Local Authorities to cut corners. Capacity Assessments are not a simple tick box exercise, and it is not just Social Workers who undertake them or contribute to them, but unfortunately it appears it is the Social Workers who yet again have to fall on their sword for the failings of an MDT, expectations of Local Authorities and the Impact of Austerity Measures by Government,