Report slams council and NHS trust after man left to live in "unacceptable" conditions

An NHS trust and a local authority have been sharply criticised following a joint investigation by the Health Service Ombudsman and the Local Government Ombudsman into how a vulnerable man with schizophrenia was left to live in “unacceptable” conditions.

The joint Community Mental Health Team run by St Helens Metropolitan Borough Council and the 5 Boroughs Partnership NHS Trust was responsible for the care of Mr B, who had a long history of involvement with mental health services.

He lived independently in his own home for more than ten years with a support package, which included regular visits from a support worker and a community psychiatric nurse from the CMHT along with practical help from cleaners employed by St Helens.

But Mr B’s health and living conditions deteriorated and he was unable to care for himself. He also developed a serious physical illness.

His cousin, Ms A, contacted 5 Boroughs and the council after becoming concerned about his personal health and hygiene and the condition of his flat. Dissatisfied with their responses, she complained to the Ombudsmen.

According to the cousin’s account, Mr B had come to their aunt’s home in a dirty and unkempt state. He had lost a lot of weight and was feeling unwell.

She visited his flat and found cockroaches and flies as well as food that was more than a year out of date. There was uneaten takeaway food, stains on every surface, and faeces and urine stains on the carpets and furniture. The cousin said it took her several days to clean the flat.

When Mr B returned home, his physical health deteriorated and he was admitted to hospital in an emergency. He was found to be suffering from malnutrition, dehydration and a number of other symptoms.

Mr B was subsequently diagnosed with a type of bone cancer and died later in a nursing home.

The Ombudsmen’s report did not uphold two of Ms A’s complaints, namely that: Mr B’s consultant psychiatrist had failed to respond to his poor physical state and had instead prescribed inappropriate drugs for depression; and that no one had supported Mr B to claim the welfare benefits to which he was entitled.

However, the report concluded that the CMHT had failed Mr B. It said that his care plan was not properly implemented, there had been insufficient contact over a period, there had been poor communication, and there were gaps in records.

The report also said there had been a failure to review Mr B’s care, to assess in depth his mental state, capacity or risk. The council’s cleaners had raised concerns but little action followed, it added.

The Ombudsmen said they could not definitely conclude that there would have been a different outcome for Mr B, in terms of the diagnosis and treatment of his myeloma. But they did find that the failure to implement his care plans and to manage risk appropriately played some part in his rapid deterioration.

The Health Service Ombudsman, Ann Abraham, said: “This is an extremely sad case about a vulnerable person who was not supported in the way he should have been. The Trust and the Council failed to deliver the standard of care Mr B was entitled to and he was left to live in unacceptable conditions.”

Anne Seex, the LGO, said the investigation had resulted in assurances from 5 Boroughs and St Helens that lessons had been learnt and others were now less likely to suffer as Mr B did.

“A key lesson is the importance of observations from workers like cleaners who had the most regular contact with Mr B,” she added.

Seex added that the Ombudsmen’s power to investigate complaints jointly was particularly important when health and local government join together to provide a combined ‘seamless’ service. “Joint services mean joint accountability if things go wrong,” she said.

In recognition of the distress and emotional upset Mr B’s family experienced, the Ombudsmen recommended that the Trust and the Council apologise to Ms A and pay her £2,000 compensation. They called on the public bodies to pay a further £1,500 to cover her legal costs.

The Ombudsmen also asked 5 Boroughs and St Helens to produce an action plan within three months of the final report, setting out what they would do to prevent other vulnerable people being let down in the same way in the future. The Trust and the Council have agreed to all of the Ombudsmen’s recommendations.