A vulnerable man was without bathing facilities for six months because care providers failed to monitor him, say two ombudsmen.
The 31-year-old from Plymouth, who suffers from schizophrenia and Asperger’s syndrome, was also wrongly charged more than £8,000 for accommodation and put at risk of financial exploitation.
Parliamentary and Health Service Ombudsman Julie Mellor, who conducted the investigation with the Local Government Ombudsman, said what had happened to the man was truly shocking.
“This vulnerable man was left suffering and was out of pocket by thousands of pounds because no one took responsibility for co-ordinating his care properly.
“The NHS has a duty to care for people with a mental health problem which doesn’t stop when that person leaves a psychiatric unit or when a service is outsourced.
“This case demonstrates the shocking consequences when that duty of care is ignored.
“Opportunities to put things right were repeatedly denied because he had woefully insufficient aftercare plan reviews.
“He only had three in five years, when the Mental Health Act Code of Practice states that he should have had ten.”
Local Government Ombudsman Dr Jane Martin said the complainant offered those responsible for his care, Plymouth City Council and the now abolished Plymouth Primary Care Trust, the chance to review and remedy matters, but they had not done so.
The man, who has not been named, was discharged from a psychiatric unit under the Mental Health Act in 2004 and the investigation found that the monitoring of the man’s care after he was released was so far below what it should have been that it amounted to service failure.
It found carers expected him to manage his household money by using two tins, into which money was paid into or taken out and the information recorded in ledgers. But the investigation found that some of that data from the ledgers was missing, meaning the system was open to abuse.
It also found that at a flat where he lived for more than two years there were no bathing facilities for six months. There were also tensions between him and the landlord who was also his carer, which as the care company commissioned to look after him later acknowledged, was unacceptable.
Plymouth Council and NEW Devon Clinical Commission Group, which took over from the primary care trust, have been ordered to pay the man £6,000 each, as well as write a letter acknowledging their failure.
In a joint statement they said lessons had been learned.
“We acknowledge the findings from the ombudsman and sincerely apologise for the distress caused to the patient and his family by the failings of care.
“We want to learn from this complaint and are developing an action plan to identify how we could prevent a similar event from happening again to others.
“We have also resolved any outstanding expenditure to the patient and his family.
“Patients’ care and safety remains at the heart of everything that we do and we want to reassure people that it continues to be the case.”