Social workers missed opportunities to assess a vulnerable man’s mental capacity and safety before he died in a house fire, a coroner found.
Malcolm Campbell, 76, passed away at South Tyneside District General Hospital on 15 January 2023 after inhaling smoke from a fire in his bungalow the day before.
An inquest heard Mr Campbell, who had dementia and significant mobility problems, had been identified as being at high risk of fire due to repeatedly smoking in bed.
Assistant Coroner James Thompson concluded there had been missed opportunities to assess Mr Campbell’s capacity and consider whether he should continue living alone. He found those failings were ‘possibly causative’ of his death.
The inquest heard Mr Campbell was diagnosed with dementia in May 2022 and became increasingly frail in the months before he died.
In July 2022, an occupational therapist raised concerns about his ability to understand the risks of smoking and respond to a fire.
By November, Tyne and Wear Fire and Rescue Service assessed him as being unable to escape his home within five minutes in an emergency.
In the month before his death, Mr Campbell was admitted to hospital twice. Doctors found he lacked capacity to make decisions about his care and treatment on both occasions.
The corner said social workers failed to carry out a capacity assessment during their involvement with Mr Campbell between November 2022 and his death. ‘There was an assumption of capacity throughout this period,’ he said.
Against this backdrop, during the inquest – which was held on 16 June – Thompson said he would issue a Prevention of Future Deaths report to the Secretary of State for Health and Social Care.
He said concerns would include the need for continuity in social work support and the risks of sending vulnerable people home under a ‘home first’ approach.
Following the hearing, Mr Campbell’s granddaughter Marie Campbell and daughter Sarah Desborough said: ‘We welcome the coroner’s conclusion and are grateful for the care and thoroughness with which he has investigated the circumstances surrounding his death.’
Since Mr Campbell’s death, the NHS trust and South Tyneside Council have worked together to improve hospital discharge arrangements, the inquest heard.
Leanne Devine, a human rights partner at Leigh Day, said: ‘Malcolm Campbell died after South Tyneside social services lost sight of the need to be fully aware of his capacity to live alone in his bungalow.
‘It is now on record that the state failed in its operational duty under Article 2 of the Human Rights Act to take reasonable steps to protect Malcolm’s life.’
Image: Jay Heike/UnSplash
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