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I Just Want to go Home
Staff working in health and social care need to be aware of the Mental Capacity Act and the Deprivation of Liberty Safeguards, and an Ombudsman’s report a couple of weeks ago highlights this. This is the distressing case of Mr RK, a retired miner from near Sheffield. He was a 77 year old man in poor physical health who could not walk, and who had developed Alzheimer’s disease. The GP practice looking after him found his house in “a terrible state” and were so concerned about his health that they arranged for him to be admitted into a nursing home bed in early 2009, and then in March he was moved to a hospital bed after he developed breathing difficulties. He then asked to go home, and assessments were undertaken to see if that was possible, but the practice staff thought home conditions were so bad that he should go to a nearby care home . His brother asked for him to be discharged home, but never got his wish and RK died in a nursing home in December 2009.
Agencies working together
The case was complicated by the number of agencies involved, including his GP practice and the Social Services department, coupled with the fact he lived in the Sheffield Council area, but his GP practice was in Derbyshire. After his death an advocate made a complaint which was investigated jointly by the Health Service Ombudsman and the Local Government Ombudsman. Their report was critical of the role of the various agencies and awarded compensation to his brother.
Lessons to be learned
The Ombudsman concluded that the agencies had failed to take account of the law. However, the report did say that the agencies were all acting with the best of intentions. GP practice staff thought the man’s home was not suitable for the care of someone with multiple health problems, and understandably the professionals thought he would get better care in a home or hospital. You can read the full report on the Local Government Ombudsman’s website (www.lgo.org.uk) but I have picked out a couple of key issues from the report that show where the agencies failed to apply the principles and practice of the Mental Capacity Act 2005.
- If someone has capacity to make choices about where they want to live this cannot be ignored. In the case of RK, though the agencies talked about getting his capacity assessed, the Ombudsman found there was never a formal assessment undertaken.
- If someone is at risk of their liberty being deprived, then authorisation of this may need to be applied for. One of the key questions in deciding this, is the person’s family are asking for the person to be returned home? Whoever undertook this assessment whilst RK was in a care home said they weren’t, when clearly his brother did want him home.
One of the factors highlighted in the report was that at the time of Mr RK’s care, the Mental Capacity Act and the Deprivation of Liberty Safeguards had not been operating for very long and ‘awareness was low’. Now we’re in 2014, we can’t say that anymore.
As I write this blog, the House of Lords Committee reviewing the operation of the Mental Capacity Act has published their report which concludes that the Deprivation of Liberty Safeguards aren’t working properly. What happened to Mr RK just reinforces that.
David Beckingham – QCS Expert Mental Health " href="http://www.ukqcs.co.uk/cqc/mental-health/" target="_new" data-tooltip="According to statistics produced by the Mental Health Foundation, 1 in 4 people will suffer from a mental health issue at some point in their life. For care providers, this means being aware that mental health issues require specialist skills in handling and that they can come on at any point in life. Depression in particular must be looked out for by care professionals, as it affects 1 in 5 older people.<br /><br />Mental health problems range from mixed anxiety and depression to bipolar disorder and feelings of suicide. Mental health isn’t just about dealing with service users who have specific problems, but ensuring that all service users remain mentally healthy. Good care will look towards enabling service users to make the most of their life and their potential, to remain active and stimulated and to play a full role in their community, in their family and in their treatment.<br /><br />There are now specialist care homes and domiciliary care agencies which specialise in the care of people with mental health problems, doing their best to eliminate the stigma and to offer those in its care respect and dignity at all times.">Mental Health Contributor