A council and health team, who were “co-located” in the same offices, failed to talk to each other about a woman’s mental health care, a watchdog found.
Milton Keynes Council and the Central and North West London NHS Foundation Trust (CNWL) have accepted the Local Government and Social Care Ombudsman’s conclusions about omissions in the care of a woman they are calling Miss A.
“We wish to formally apologise to Miss A and her family,” said the council and CNWL in a joint statement. “We have worked closely to improve our information sharing and how we work together.
“We have also revised our processes and policy for aftercare and our joint discharge planning.”
The Ombudsman found that “MIss A” did not receive rehabilitation that would have been beneficial in maintaining her mental health and “preventing further hospital admission.”
The Ombudsman, in its decision, said the lack of aftercare is likely to have impacted on Miss A’s wellbeing.
A “missed opportunity” to provide treatment, rehabilitation and social support was also a “missed opportunity to minimise the risk of the suicide attempts and damage to property,” the Ombudsman said.
“Although the council says it was not aware of Miss A, its teams are co-located with the trust’s,” said the Ombudsman.
Miss A had been detained after a suicide attempt in October 2014.
She was assessed for community rehabilitation in late 2016, but there wasn’t a bed for her and she went to live with her parents to wait for one.
Even though the Ombudsman found that there was no guarantee that her care would have been successful, it had not been planned. Miss A and her family lost trust in professionals, the report says.
In a short space of time from December 2016 to September 2017, she had undergone several assessments and been told of referrals to various teams.
The Ombudsman said: “Had the organisations assessed her properly… this would have alleviated the need for several assessments and her needs would have been considered holistically.”
She took an overdose in February 2017, returned to her parental home and decided she did not want to move to rehabilitation.
The council said it had not been invited to any hospital discharge meetings and had no referral requesting an adult social assessment until April 2017.
Miss A accepted the assessment but later declined it, and in July 2017 she moved into a supported living placement run by a private company, paid for by her parents. A refund has been agreed.
One month later there was an incident when Miss A became aggressive and damaged cars in the street.
The council and the trust then agreed to take over joint funding of 14 hours a week whilst a further assessment took place. Then another assessment cut it to three hours a week.
The council, CNWL, and the clinical commissioning group, have also agreed to pay Miss A £1,500 and her mother, Mrs B, £1,000 each in recognition of the impact of the and length of time Miss A had a lack of support.
