Lewis Mendelson

4 STOCKPORT __ 2°Ftoor Stopford House

METROPOLITAN BOROUGH COUNCIL Piccadilly

Stockport SK1 3XE
Tel: 07866 999857
| i
Ask for:
Alison Mutch, Senior Coroner
Manchester South Coroners Court
1 Mount Tabor Street
Stockport

SK1 3AG
Wednesday 12" February 2020

Dear Ms Mutch

Re: The Regulation 28 Report submitted to Stockport Metropolitan Borough Council regarding
Lewis Victor Mendelson

This response solely addresses the concerns under paragraph 1, “The MATTER OF CONCERN”.
Stockport Metropolitan Borough Council are unable to comment in respect of paragraph 2 which
refers to the individual's hospital treatment as, in accordance with the Mental Capacity Act 2005, the
decision maker for best interest decisions in relation to medical treatment had been the NHS Trust.
The arrangement of an IMCA and formal best interests meeting had been the responsibility of the
Trust as this had concerned medical decisions. In this instance the NHS Trust would have been
under a duty to consult with Stockport Council as stated in the Mental Capacity Act “...anyone
engaged in caring for the person or interested in his welfare...”. Ultimately, if the matter had gone
to the Court of Protection, the NHS Trust would have been the applicant. The same issue applies in
relation to paragraph 3 as this would have been the decision of the NHS Trust, or alternatively the
General Practitioner, to place the individual onto the pathway for End of Life Care.

Response to “The MATTER OF CONCERN”, Paragraph 1

Stockport Council acknowledges that there has been a historic issue with regards to the timely
undertaking of annual reviews in the Learning Disabilities Service. This is not an issue unique to
Stockport Council alone as indeed many other local authorities are also challenged in this area, due
to the present resources, service pressures and competing priorities.

However, at present Stockport Council is in the process of addressing these matters. A business
case has been presented and agreed, in order to fund and create a dedicated review team
comprising initially of six social workers plus a team manager - including an option to increase staff
numbers as required - with a view to addressing the entire backlog of reviews throughout the
financial year 2020/21. Furthermore, additional work will be undertaken with the intention of
evaluating Stockport Council's staffing resource and implementing a sustainable model for managing
reviews from April 2021 onwards. For individuals who are supported by Stockport Council within
community settings and who may be deprived of their liberty, there will be an expectation that, on
review, the allocated social worker will triage the case in accordance with the national Association of
Directors of Adult Social Services (ADASS) guidance.

| trust that the above information provides you with the reassurance that Stockport Council are
addressing the areas of concern that you have raised in relation to paragraph 1 of the Regulation 28
Report. However, if you do require further details, please do not hesitate to contact me.

Yours Sincerely,

ik

Director of Adult Social Care,

On behalf of Stockport Metropolitan Borough Council

Your Ref: 13020/CH 
Our Ref: PFD-1198676 

Ms Alison Mutch OBE 
HM Senior Coroner, Manchester South 
HM Coroner's Court 
1 Mount Tabor Street 
Stockport SK1 3AG 

Dear Ms Mutch

From Helen Whately MP 
Minister of State for Care 

39 Victoria Street 
London 
SW1H 0EU 

020 7210 4850 

28th April 2020 

Thank you for your letter of 17 December 2019 to Matt Hancock about the death of Lewis 
Mendelson.  I am replying as Minister with portfolio responsibility for learning disabilities 
and I am grateful for the additional time in which to do so.  

Firstly, I would like to say how saddened I was to read of the circumstances of Mr 
Mendelson’s death.  It is important that we take the learning from Mr Mendelson’s death to 
ensure that people with learning disabilities receive the highest quality care that meets 
their needs.  

I am deeply concerned to read in your report that Mr Mendelson was not assigned a social 
worker and an annual review of his care was not conducted by the Stockport Metropolitan 
Borough Council.  This is the second Prevention of Future Deaths report received by the 
Department where Manchester South coroners have raised concerns that annual care 
reviews have not been conducted by Stockport Council as required by law.  This is clearly 
unacceptable and I expect Stockport Council to look into this matter thoroughly.   

The Social Care Act 20141 is clear that local authorities should carry out regular reviews of 
care plans.  The guidance states that:  

“without a system of regular reviews, plans could become quickly out of date 
meaning that people are not obtaining the care and support required to meet their 
needs. Plans may also identify outcomes that the person wants to achieve which 
are progressive or time limited, so a periodic review is vital to ensure that the plan 
remains relevant to their goals and aspirations.” 2 

Local authorities should establish systems that allow the proportionate monitoring of both 
care and support plans to ensure that needs continue to be met.   

1 http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted 

2 https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-
guidance#Chapter13 

 There are several different routes to reviewing care and support plans.  These include: 

•  A planned review, the date for which is agreed with the individual during care and 

support, or support planning, or through general monitoring; 

•  An unplanned review, that results from a change in needs or circumstance that the 

local authority becomes aware of, e.g. a fall or hospital admission; and, 

•  A requested review, where the person with the care and support, or support plan, or 
their carer, family member, advocate or other interested party makes a request that 
a review is conducted.  This may also be the result of a change in needs or 
circumstances. 

It is the expectation that local authorities should conduct a review of the plan at least once 
every 12 months, although a light touch review should be considered six to eight weeks 
after agreement and sign-off of the plan and personal budget, to ensure that the 
arrangements are accurate and there are no initial issues to be aware of.  This light-touch 
review should also be considered after revision of an existing plan to ensure that the new 
plan is working as intended. 

Councils are accountable to their local populations and that includes accountability for 
meeting their statutory duties under the Care Act 2014.  

If an individual is unhappy with the care arranged by a local authority, they can make a 
complaint using the local authority complaints process.  If they remain dissatisfied, they 
can seek assistance from the Local Government and Social Care Ombudsman. 

In relation to Deprivation of Liberty Safeguard (DoLS), we recognise that the current DoLS 
system is bureaucratic and inefficient and that it fails to provide vital safeguards to people 
who lack capacity to consent to their care and treatment arrangements.   

As a short-term solution, the managing local authority can use an urgent authorisation 
while also making a request for a standard authorisation.  Looking forward, the Mental 
Capacity (Amendment) Act (2019)3 introduced Liberty Protection Safeguards (LPS), that 
are planned to replace DoLS in October 2020.  LPS will provide protections for individuals 
in a more streamlined and focused way.  Each application will take the responsible body 
less time to process and more people will be provided with safeguards than under DoLS. 

We are aware that social worker support is not always as available as it should be for 
people across our health and care system, leading to health inequalities and poor 
outcomes for people.  Social workers have a professional duty and an accountability not 
just to tackle these health inequalities but to lead solutions and protect people’s rights.  
That is why the Chief Social Worker for Adults in the Department of Health and Social 
Care is leading work in Government, with our systems partners, the wider public and 
crucially, experts by experience, to develop social work and social care practice in this 
critical area. 

3 http://www.legislation.gov.uk/ukpga/2019/18/enacted 

 
 
  
  
 
 
 
 
 
 
 
 
                                                           
 
 To support local authorities, we are providing councils with access to an additional 
£1.5billion for adults and children’s social care next year.  This includes an additional 
£1billion of grant funding for adults and children’s social care, and a proposed 2 per cent 
precept4 that will enable councils to access a further £500million for adult social care.  This 
£1.5billion is on top of maintaining the £2.5billion of existing social care grants and will 
support local authorities to meet rising demand and continue to stabilise the social care 
system.   

For Stockport, this means that the Council is set to receive an additional £4.8million from 
the new Social Care Grant and the Council could raise up to £3.6million of additional 
funding specifically for adult social care in 2020/21 following the introduction of the 
precept5.  In addition, Stockport Council will receive £11.6million of funding through the 
maintenance of the existing Adult Social Care grants in 2020/21.  Future funding for social 
care will be set out at the next spending review.  

I share your concern that no best interests’ meetings were held to consider Mr 
Mendelson’s care in hospital.  While a formal best interests meeting is not a duty, under 
section 4 of the Mental Capacity Act (2005)6 (MCA) the decision maker must take into 
account, if it is practicable and appropriate to consult them, the views of anyone named by 
the person as someone to be consulted, anyone engaged in caring for the person or 
interested in their welfare, any person with lasting power of attorney or a deputy appointed 
by a court.   

The person at the centre of the authorisation should also be consulted and the Code of 
Practice recommends that all possible and appropriate means of communication should be 
tried.  A best interests meeting may be required if there is a dispute or a decision is 
required concerning a long-term move or serious medical treatment. Section 4 (9) of the 
MCA confirms that if someone makes a decision which they reasonably believe is in the 
best interests of the person who lacks capacity they will have complied with the best 
interests’ principle set out in the Act.  

In relation to an Independent Mental Capacity Advocate (IMCA) for Mr Mendelson, under 
the MCA an IMCA must be instructed and consulted for people lacking capacity to consent 
to their care and treatment when an NHS organisation is proposing to provide serious 
medical treatment.  The MCA Code of Practice7 provides guidance on when an IMCA 
should be instructed.  I am advised that it is currently under review by the Ministry of 
Justice and consultation is planned.  The revised Code will improve protections for the 
person at the centre of the authorisation and ensure that their wishes and feelings are 
considered.  

Turning to the wider aspects of your report, you may wish to note that in 2015, the 
Government established the Learning Disabilities Mortality Review (LeDeR) Programme.  

4 https://www.gov.uk/government/speeches/provisional-local-government-finance-settlement-2020-to-2021-statement 

5 This projection includes a small proportion of base tax rate growth. 

6 http://www.legislation.gov.uk/ukpga/2005/9/section/4 

7 https://www.gov.uk/government/publications/mental-capacity-act-code-of-practice 

 
 
 
 
 
  
 
                                                           
 
 
 
 
 The Programme systematically reviews the deaths of all people with a learning disability, 
aged four years and above, that are notified to it. The Programme enables a detailed 
picture to be built of key improvements that are needed both locally and at a national level, 
to reduce the inequality in life expectancy between people with a learning disability, and 
those without.   

I am advised by NHS England and NHS Improvement that Mr Mendelson’s death is 
currently being reviewed under the LeDeR process and I expect the local NHS to reflect on 
the findings of the review and take necessary action to address any failings in the care 
provided locally for people with a learning disability.  

One of the commonly reported learning points in local LeDeR reviews is the need for 
learning disability awareness training for staff in health and social care settings.   

On 5 November 2019, we published our response to the consultation on mandatory 
learning disability and autism training for health and care staff8.  We are now working with 
Health Education England and Skills for Care to develop and test, during 2020/2021, a 
standardised training package, backed by £1.4million investment.  Work is already 
underway to develop the training and testing will take place in a variety of health and social 
care settings to help shape how it will be rolled out and delivered in future.  Our plans to 
introduce mandatory training will go a long way to ensuring more people receive the safe, 
compassionate and informed care they have a right to expect. 

Finally, I have asked officials to bring your report to the attention of the National Director 
for Learning Disabilities, Ray James, who is leading work nationally to improve services for 
people with learning disabilities and/or autism.   

I hope this response is helpful.  Thank you for bringing these concerns to my attention.  

HELEN WHATELY 

8 https://www.gov.uk/government/consultations/learning-disability-and-autism-training-for-health-and-care-staff