A local authority failed to consider the human rights of an older couple and put them at undue risk of harm by separating them after almost 60 years together, the Local Government and Social Care Ombudsman has found.
The watchdog heavily criticised Windsor and Maidenhead council in relation to its treatment of the couple, Mr and Mrs Y, who were separated when she was discharged to a care home in March 2018 following a hospital admission. Mr Y, who had also been in hospital, was discharged home with a care package but quickly deteriorated and died in May 2018.
The ombudsman found the separation caused Mr Y significant and undue distress and contributed to his worsening condition, as he became very low and did not eat or drink properly. The watchdog also said Mrs Y was caused undue risk of harm by the decision. She has also since died.
While key actions in the case were taken by Optalis, which provides adults’ services functions including assessment, support planning, occupational therapy and safeguarding on behalf of the council, the ombudsman said responsibility rested with the council.
No evidence rights were considered
He said the separation constituted a limitation on the couple’s right to private and family life under Article 8 of the European Convention on Human Rights, but found no evidence that the council had considered whether this was appropriate, or to consider Mr and Mrs Y’s rights at all.
The watchdog found that the council had not properly considered a live-in care arrangement or placing Mr Y with Mrs Y, despite saying it would.
The watchdog also found the authority had previously left Mr Y at an increased and avoidable risk of harm by not assessing his needs from January to August 2017, and then failed to properly assess his needs under the Care Act after his admission to hospital in 2018.
Other council failings included not evidencing its decision to make Mrs Y’s care home placement permanent, not arranging support for Mr Y to visit his wife until one week before he died, and arranging poor-quality care for Mr Y after his return home from hospital.
Ombudsman Michael King said: “This case is a prime example of the council losing sight of the real people behind its busy caseload. It appears there was little regard paid to the couple’s dignity or basic human rights, with terrible consequences for the family.”
Seven-month wait for assessment
Mr and Mrs Y were married for 59 years and lived together at home, with Mr Y caring for Mrs Y. Mrs Y had various difficulties with hearing, mobility and understanding while Mr Y had difficulties with pain, mobility and frailty. Optalis assessed Mrs Y in January 2017 and she received a care package from Bespoke, a care provider. At the time, Optalis decided that Mr Y needed to have an assessment.
After another assessment of Mrs Y in March 2017, Optalis found Mr Y could no longer feed or dress her, and Mrs Y began attending a day group for social stimulation and to give Mr Y a break from his caring role. It was only in August 2017 that it finally assessed Mr Y in his own right. The assessment identified a need for social interaction and he began attending a social club regularly. His case was then closed.
Both Mr and Mrs Y were admitted to hospital in January 2018, within three days of each other, suffering from dehydration and, in Mrs Y’s case, diarrhea. Both were subsequently discharged home with a care package but then readmitted to hospital.
In March 2018, with Mr Y having been discharged a second time, Optalis assessed Mrs Y in hospital, and found she now needed two people to support with personal care in the mornings. The same assessment noted Mr and Mrs Y had been married for many years and it was important to them both to remain together. It said Mr Y had declined since Mrs Y had not been at home.
On 12 March 2018, the social worker emailed the operations manager and said “.. the importance of remaining together appears important to both [Mr and Mrs Y]. [Mrs Y] will noticeably react to her husband’s visits to her in hospital placing his face in both her hands. [Mr Y] has also noticeably declined since [Mrs Y] has not been at home, becoming withdrawn and less able to manage his personal care and nutritional needs”.
The social worker said she had completed a care needs assessment, mental capacity assessment, and a best interests decision but said “these have not been recorded yet”. The ombudsman’s investigation found no evidence of these. The social worker asked the manager to agree to a nursing home placement for Mrs Y until a direct payment for live-in care could be arranged, and the manager agreed, so Mrs Y was discharged to a care home.
Care home move made permanent
Eight days later, the social worker phoned the couple’s daughter, Ms Z, and told her Mrs Y had settled in well. They discussed a possible return home but decided to wait until the family had discussed it so they could make a best interests decision about her long-term care. That day, however, the council recorded Mrs Y’s care as permanent.
Later that month, Mr Y was readmitted to hospital again with sepsis and acute kidney infection. While he was discharged again three weeks later, with four personal care calls a day, he was readmitted the following day, with the ambulance service raising a safeguarding alert for neglect. This was because a care worker had visited and not been able to mobilise him as he as too weak and there were no mobility aids. The council said it had no record of communicating the concern to the couple’s family, something for which it has apologised.
A support plan for Mr Y said that he was not eating and drinking properly and struggling with personal hygiene. He was discharged again on 10 May, but Mr X emailed the social worker the next day to say he had found his father in urine-soaked clothes and a pad from that morning, and helped him to bed. A care worker had visited 40 minutes earlier than scheduled and left after 10 minutes, rather than the scheduled 30, without toileting him, after Mr Y had said it was too early to go to bed.
Towards the end of May, after a risk assessment had been completed for Mr Y to visit his wife in the care home twice a week, Mr Y collapsed and died at home.
‘We failed on this occasion’
Hilary Hall, director of adult services at Windsor and Maidenhead council, said: “I offer my sincere apologies to the family of Mr and Mrs Y for the distress caused by the failures outlined in the report.
“With Optalis, we work hard to promote the safety and wellbeing of everyone that we work with. I know that we failed on this occasion and whilst we have revised our practices and processes, I regret it will not change what happened, which was unacceptable.
“The revisions to our processes and procedures are designed to ensure this does not happen again, with a particular emphasis on ensuring that families and couples can remain together as far as possible, which is very important.
“We have improved the way in which we respond to complaints as well as the way in which work with our partner organisations to ensure that they are delivering the quality of care and support to our residents that we expect.
“My thoughts are with the family of Mr and Mrs Y and I am grateful for their tenacity in bring these issues to everyone’s attention. Whilst this didn’t help Mr and Mrs Y it will help couples in the future.”
On the ombudsman’s recommendation, the council has agreed to:
- Apologise to Mr X and Ms Z, setting out the faults identified in the report and the action the council will take, or has taken, to put this right.
- Pay Mr X and Ms Z £750 each to recognise the distress it caused in failing to properly consider the risks of separating Mr and Mrs Y.
- Pay Mr X a further £500 for the time and trouble and distress he was caused in bringing his complaint.
- Review any cases where couples are separated by their care needs, to ensure the risks and human rights were fully considered for both parties, and that adequate contact is included on the care and support plans.
- Review assessment practice across the council to ensure it is consistent and Care Act compliant.
- Ensure it has an effective mechanism for following up where complaints about poor practice have been received and to check that improvements are made and sustained.
- Put in measures to ensure complaints about several agencies receive a co-ordinated response and review its commissioning practice when services are rated “requires improvement” to ensure it considers any increased risk to people.