Lack of home care for woman on discharge split couple for 10 months

Ombudsman urges councils changing commissioning of care to consider findings on capacity problems with Lincolnshire’s new provider model

A council has been criticised for leaving a man separated from his wife for 10 months because there was no home care support available in their area.

Lincolnshire council placed the woman in a dementia unit 15 miles away from home following a hip operation, because none of its contracted providers had the capacity to care for her.

The Local Government and Social Care Ombudsman’s investigation found the council at fault for placing the woman in a dementia unit, even though she did not have the condition, and for not revising her care and support plan when her circumstances changed.

The investigation also found other families may have been similarly affected by the council’s contracting arrangements, which had been put in place to try and stabilise the local market.

The council has agreed to review other families’ cases and to pay the couple £1,750 in recognition of the distress caused to them. It will also refund the man’s travel expenses.

The ombudsman said the investigation also provided “important learning points” for other councils changing how they commission care and urged them to consider its findings.

‘Prime providers’

The woman received a home care package of four calls a day from an agency arranged and funded by Lincolnshire council. This was suspended when she went into hospital for the hip operation. She was ready for discharge on 9 June 2015.

A few months earlier, the council had started to change its home care contracting arrangements. It used to have more than 75 arrangements with providers, but this led to several providers working in small areas, work was not guaranteed and there was not enough capacity to meet demand.

Between March and July 2015, the council selected new home care providers, which resulted in contracts with 12 ‘prime’ providers across the county. By September 2015, 3,500 people had been moved over to these services.

‘No available home care’

However, despite these changes and repeated enquiries with a number of providers, the council could not find one to take on the woman’s care package when she left hospital.

One of the providers was Bloomsbury Homecare, which had the contract to provide home care in the area where the couple lived. The agency could not take on her package as it had no capacity for calls by two carers, which was required to support the woman.

The investigation found that the woman remained in hospital and on 29 June she was placed on Bloomsbury’s waiting list. The council then began looking into care home vacancies.

The woman was offered a bed in a care home out of county, which her husband had been involved in selecting. With no home care available, she was moved into a room on the care home’s dementia unit on 7 July 2015, even though she does not have dementia.

‘Not commercially viable’

A social worker who later visited her noted that she was locking herself in her room because other residents, who did have dementia, were wandering in and out. Her husband was also making a 30-mile round trip every day to visit her.

In March 2016, the husband gave the social worker details of an out of county agency that had carers available in his area. The ombudsman’s investigation found that the council had offered the man a direct payment to use this agency, but he did not want this.

The council also refused to enter into a spot contract with the agency – where a service is purchased by an authority on behalf of an individual – because it was not commercially viable.

The purpose of the new ‘prime provider’ model was to stabilise the market and increase capacity for all users, the council said, and a spot contract arrangement would only be considered if a person had “exceptional specialist needs”.

The woman eventually returned home in May 2016, when Bloomsbury Homecare started providing her care.

Care Act obligations

The ombudsman accepted the council’s argument that, under section 5 of the Care Act 2014, it is not obliged to ensure the care market in Lincolnshire provides for every individual’s specific needs or that they receive a specific form of care and support.

It also said it considered that the council “is entitled to have a panel of agencies to carry out its duty to meet eligible needs under Sections 8 and 18 of the Care Act 2014”.

The report added: “We also note that Mr and Mrs A could have engaged an agency of their choice using a direct payment, although we also appreciate managing a direct payment involves a degree of responsibility which not everyone is willing to accept.

“On balance, we are satisfied there was no fault in the council’s decision not to spot contract because of the danger of threatening prime providers’ status.”

However, the investigation concluded that while the council did not have an “absolute duty” to arrange home care for the woman, it should not have placed her in a dementia unit.

‘Unsuitable environment’

Michael King, the local government and social care ombudsman, said: “This woman was placed for too long in an unsuitable care environment.

“She wanted to return home to be with her husband, but instead had no choice but to live with people whose care needs were very different to her own, causing her significant distress.

“Lincolnshire council should have reviewed her care and support plan once her circumstances had changed and moved her to a more suitable room sooner.”

A spokesperson for Lincolnshire Council said it had “sincerely apologised to the individuals mentioned in the report”.

“The Ombudsman acknowledged the council complied with our duty to provide a service that was safe and met identified needs,” the spokesperson said.

“In the period July 2015 to April 2016 we successfully transferred over 3,500 people, of which there were 14 married people placed in care homes.

“There are currently no individuals waiting longer than they should be for home care in a short stay residential bed. Since July 2015 we have seen a significant reduction in people waiting for support at home, and waiting lists for home care services are at the lowest they have ever been. There are now regular updates and an escalation process in place to prevent these situations arising in the future.”

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