Services for vulnerable adults (eg with learning difficulties. or with mental health issues) : Wrexham County Borough Council

Mrs X complained that the Council failed to provide appropriate and adequate support to her sister, Ms Y, in the months leading to her death, including whether information was shared appropriately between the Council and a third-party organisation providing services on behalf of the Council (“the Provider”), and whether the Council took appropriate action in relation to any information shared.
Ms Y, an adult with learning disabilities, had lived with and been cared for, by members of her family all her life. Mrs X approached Social Services with a view that Ms Y should lead a more independent life and a series of assessments took place to determine appropriate living accommodation for Ms Y. Ms Y’s alcohol consumption was a long-standing problem which Mrs X relayed to the Council as one of her main concerns. Ms Y moved into supported living accommodation in April 2019. The Council entered into a contract (“the Contract”) with the Provider to provide on-site daily care/support to the residents in the supported living accommodation, which included Ms Y.

The Ombudsman found that despite mounting concerns about Ms Y in terms of her regular refusal of support, about the state of her flat, and around her drinking, the Provider did not escalate these concerns to the Council until March 2020. The Contract clearly set out the circumstances in which matters should have been escalated to the Council, and the threshold for raising concerns had been met several weeks before March 2020. When the Provider did contact the Council in March and April 2020, they were unable to access help/advice. Whilst this was at the period marking the beginning of the COVID-19 lockdown, the Provider should have been able to access help/advice. Ms Y sadly died in April 2020.

Whilst the Provider was under contract to provide services on behalf of the Council, the Council remained responsible for the delivery of services to Ms Y. The Council should have ensured it monitored the delivery of this service to make sure it met Ms Y’s needs as outlined in her care package, and if not, it could have arranged a service review.

The Ombudsman was satisfied there were several failings in Ms Y’s case, namely the Council’s management of its approach to Ms Y’s drinking problem, the failure by the Provider to escalate matters to the Council in accordance with the terms of the Contract, and when concerns arose about Ms Y, the Council’s failure to respond to contact from the Provider when matters were eventually escalated. The Ombudsman was also concerned that information was not shared with Mrs X about Ms Y’s condition or, at the very least, that Ms Y’s consent was not sought to discuss concerns with Mrs X; she may have refused consent but attempts to seek it should have been made. These deficiencies in care amounted to a service failure. This was an injustice to Ms Y as she was denied earlier involvement by the Council to assess her support requirements and an injustice to Mrs X as Ms Y was not given the opportunity to consider whether she wanted to consent to Mrs X being consulted about her situation. The Ombudsman could not say that earlier interventions would have altered the sad outcome. Ms Y, an adult with capacity, may have continued to decline support/drink in excess even if these actions had been more robustly pursued. However, the Ombudsman was clear that several opportunities to intervene were lost.

The Ombudsman was also concerned about the way Mrs X’s complaint was handled. Mrs X’s complaint to the Council was investigated under the social services complaints procedure and an independent investigator (“the II”) was appointed to investigate her complaint at stage 2 of this process. The II did not uphold Mrs X’s complaint but shared a Management Note (“the Note”) with the Council relating to issues about the Provider’s handling of the situation which did not form part of the Stage 2 investigation conclusions; the Note was not shared with Mrs X.

The Note suggested that the II thought the Provider should have escalated the matter. The Ombudsman found that the Note findings ought to have been openly included and transparently analysed in the Stage 2 report and she was concerned that the Council did not share with Mrs X matters that were relevant and potentially critical of the Council’s actions (taken on its behalf by the Provider) in an open manner. The Ombudsman found that, had the findings of the Note been included in the II’s report, then the outcome of the II’s investigation should have been different. This was maladministration resulting in a serious injustice to Mrs X, as she was unaware of the Note findings. This also departed from the Ombudsman’s guidance on the principles of openness and accountability which public bodies should adhere to.

The Ombudsman upheld Mrs X’s complaint and made several recommendations to the Council; the Council agreed to implement these which were:
a) To provide a meaningful, written apology to Mrs X for the shortcomings identified in the Ombudsman’s report.
b) To implement all the actions contained in the Note if it had not already done so.
c) To remind those it contracts to undertake independent investigations on its behalf to ensure that any findings/critique of the service provided to a client should be reflected in their report and findings and not shared separately with the authority.
d) To remind relevant staff of the importance of regular contract monitoring in relation to the delivery of social care services by third party providers to ensure appropriate intervention if there are concerns about the provision of service/a change in a client’s needs.