HPP/HI – Week 8

• Some developments/discussions:
• Grenfell Inquiry – End of Phase 2
• https://www.grenfelltowerinquiry.org.uk/
• https://www.youtube.com/watch?v=dHxp8
eTfP1g

• Awaab Ishak death

• F & V Case study
This Week - Housing
• Grenfell & Awaab Ishak both Social
Housing Regulation Issues
• Are there policy gaps?
• Nearly Legal Blog -
https://nearlylegal.co.uk/2022/11/an-avoid
able-death/

• https://www.amazon.co.uk/Show-Me-Bo
dies-Grenfell-Happen/dp/0861546156
Coroners Reports
• Coroners’ courts
• Coroners investigate certain deaths which are
deemed to be unnatural, violent, or where the
cause is unknown.
• Useful resource:
• https://www.judiciary.uk/courts-and-tribunal
s/coroners-courts/
A Case Study - Joint work around
self-neglect and hoarding.
Acknowledgements
• Special thanks to Toby Deans & London
Borough of Camden.
• Produced by Toby Deans (E.H.O.) and
Martin Hampton (Social Worker). LB
Camden
• Photographs by Mike Warren (E.H.O.)
 Brief case history
• Mr A is an 87 year old single man who
occupies a small single bedroom studio
flat in a converted house; there was self-
neglect of himself and the property. The
door to Mr A's flat had been broken down
by the police on two occasions as the
odour from his flat and his poor health
have led people to believe that he may
have died in the flat.
Case History (Cont.)
• Mr A owns the lease of his neglected flat in a house
shared by four other flats, the tenants of which own
the freehold. When I first visited Mr A he opened
the door and I observed papers and newspapers
strewn on the floor reached to knee/waist height.
The whole house smelt of rotting meat, vegetables
and urine and faeces. There were traces of vermin
(rats). The toilet was full of fruit and unusable.
Timber blocked the entrance. Mr A also kept road
kill (squirrels and pigeons) along with off cuts of fish
and meat all over the bedsit (below).
 Case History (Cont.)
• Camden Social Services were first approached
from a neighbour to advise of concerns of self-
neglect. On several occasions Mr A flooded the
ground floor flat below him. As stated, Mr A
collects fruit and vegetables from the street
which he stores in carrier bags in the flat.
These have rotted and caused flies and odour
throughout He also leaves packets of meat and
fish which he proceeds to forget about. He has
left buckets of faeces and urine in his doorway.
 Case History (Cont.)
• Recently, and most worryingly, Mr A had a
small fire in his living room which caused
considerable alarm with his neighbours.
His room is full of papers and discarded
food wrappers and the kitchenette area is
filthy as is his bedding. As far as we were
concerned this was the prime risk – we
were concerned for the safety of Mr A and
the other tenants.
Single room studio flat
Cooking area
Kitchen area
W.C.
Bath
Papers
Kitchen
Kitchen
Standing on newspapers
Fly dirt on windows
Windows
Chamber pot (improvised)
Close up kitchen area
Rat droppings
Rat-chewed fabric flex to electric fire.
Chewed fabric flex
Electric fire – note newspaper stuck
to front
Spider egg nests
Cobweb matting
Depth of clutter
 Legislation - Public Health Act 1936
Section 83 Cleansing of filthy or verminous premises. E+W
• (1)Where a local authority, upon consideration of a report from any
of their officers, or other information in their possession, are
satisfied that any premises—
• (a)are in such a filthy or unwholesome condition as to be prejudicial
to health, or
• (b)are verminous,
• the local authority shall give notice to the owner or occupier of the
premises requiring him to take such steps as may be specified in
the notice to remedy the condition of the premises by cleansing and
disinfecting them, and the notice may require among other things
the removal of wallpaper or other covering of the walls, or, in the
case of verminous premises, the taking of such steps as may be
necessary for destroying or removing vermin.
 Legislation (continued)
• S84) Where it appears to a local authority upon a certificate of
the proper officer of the authority] that any article in any
premises—
• (a)is in so filthy a condition as to render its cleansing, purification
or destruction necessary in order to prevent injury, or danger of
injury, to the health of any person in the premises; or
• (b)is verminous, or by reason of its having been used by, or
having been in contact with, any verminous person is likely to be
verminous,
• the local authority shall cause that article to be cleansed,
purified, disinfected or destroyed, as the case may require, at
their expense and, if necessary for that purpose, to be removed
from the premises.
Enforcement
• On expiry of notice, apply for warrant to
enter at Magistrates’ Court.
• Carry out work in default of the notice.
• Seek tenders for cleaning contractors/pest
treatments.
• Police invited to attend on day
 Discussion Cue
• Under S83 Public Health Act 1936. None
compliance of the notice can lead to a fine
(Scale 1).
• Please discuss whether this course of
action is appropriate.
• How would you determine whether to
prosecute or not?
• What should you take into account?
Support
• Mr Toby Deans provided an excellent case
note summarising the case and at all
stages emphasised joint work needed.
• Police attended throughout the day and
provided friendly but firm response.
• An outreach worker attended to all details
regarding new goods and was present
throughout.
 Planning involved for the day of warrant being
issued
• The first thing we did was try to establish a
relationship with Mr A. We took a photograph that
he wanted copied and had it reduced to pocket
size. This proved to be a useful tool to engage Mr A
in a lengthy discussion;
• We told Mr A politely but firmly that in the very near
future we would be visiting with Mr Toby Deans
EHO to help Mr A get rid of the filthy items that had
accumulated in his flat, and take an inventory with
regards to what Mr A needed in terms of bed,
settee and white goods.
 Planning (cont.)
• We later introduced an Outreach Officer, who
would be available to help with funding for the
white goods/furniture and support on the day.
• We delivered a microwave as an advanced
indication of our intentions (sourced through
RFH)
• We informed Mr A that there was a date fixed
for the Execution of the Warrant for 22nd
October 2012 at 09:00 hrs for the removal of
filthy and verminous articles
 Medical Assessments
• We sought the opinions of Mr A's GP and Nurse
Practitioner.
• We visited Mr A with the Consultant Old Age Psychiatrist to
look at Mr A's mental health and to see if we could offer him
any such services. The consultant stated that 'overall from
my brief time with him there was nothing to suggest an
obvious psychiatric illness. He did not appear to have a
major mood disorder or to be floridly psychotic or
significantly cognitive impaired. He clearly has problems
with self neglect and is living in squalor and it would seem
that this is the situation for some time', This may relate to
some underlying personality issues'. This was an important
opinion and would have direct import on my response.
Diagnosis
• Diogenes syndrome, also known as
senile squalor syndrome, is a disorder
characterized by extreme self-neglect,
domestic squalor, social withdrawal,
apathy, compulsive hoarding of garbage,
and lack of shame.
Details are important
• What could go wrong with entering a
persons premises and clearing out their
possessions?
• Recent anecdote
• What smaller points may need to be
addressed?
On the day
• Social worker to shadow client and ask her and
him firmly but politely to sit down in a comfortable
position/chair by front door - so they client can
see what is going on. Constantly reassure client.
Avoid arrest of client if possible - it is tempting to
arrest for assault if client stamps on foot and
holds on to goods. However firm blocking and
distracting by Police/SW worked wonders.
• Work with the Police - give them as much
information as possible.
 Distraction
• Note how Police cheerfully engaged with client (Police
were excellent on day)
• Make sure that EHO uses photography to document
goods (this was done particularly well by Mike Warren)
• Make sure client is not dehydrated and continually offer
water, tea or coffee.
• Offer to take client for a meal or coffee.
• Invariably lost articles are found in the clear out -
emphasise to client the advantages of a 'spring clean'.
• If clear out takes two days - on first day make sure that a
new bed is made up with clean sheets and that client has
food for night.
 Advice
• An offer for alternative accommodation might be given but
in this case - client wanted to stay at home
• Do not get involved in pointless interactions i.e. 'What did
you do with my Christmas cards?'
• Have S/W supervisor/Police involved and informed at
planning stage to oversee and point out any oversights.
On day itself it was a great support that Police/ Supervisor
continually communicated with Support Worker and SW to
check on progress, make suggestions and offer support.
• Collaborative work in this case with DS Jenny Black, Toby
Deans, EHO, Mike Warren EHO, Mary Cullinan, Martin
Hampton.
Post Cleansing
Bath
Wash Basin
Kitchen Sink
Kitchen worktop & baiting
 What went well with the case
• Social Worker and Support worker established a
relationship with client
• Police support was unobtrusive, friendly and clear
• Introduced Support worker
• Have an MDT meeting before clear out - write down all
preparatory work undertaken - for example: Offer client
something
• Present clear removal of filthy and verminous goods as an
opportunity and stress that new things (white goods, beds
will be offered).
• Seek the guidance of GP and Nurse - not just on capacity
but on risk of potential adverse shock reaction/stroke.
 What didn't go so well/ what we
can learn from this
• The offer of alternative accommodation
should be kept on back burner - unless
absolutely necessary
• Do not let client back into property until
end of day one or two! Stress that this is
for their health and safety (he/she doesn't
want to be bumped into by busy workers).
Future Support/ Care Package
• Use client's interest (in this case rat
catching) to assess home environment
(later visit with rat catcher).
• Maximisation of benefits
• GP visit
• Full assessment - introducing a small
personal and domestic care component
and building on it.
Appendix
• Diogenes syndrome is a behavioural disorder of the
elderly.
The cardinal features of this condition include
extreme self-neglect, domestic squalor, and tendency
to hoard excessively (syllogomania). This is associated
with self-imposed isolation, refusal of help, and
marked indifference or lack of awareness.1 Diogenes
syndrome has been referred to as senile breakdown,
social breakdown, senile squalor syndrome, and messy
house syndrome.