Decision Date: 30th July 2024
Summary
Mrs B complained that her son’s care provider did not provide sufficient care for her son prior to his admission to hospital and that communication from the care provider was poor. Mrs B also complained that the Council did not investigate her complaints properly and that their communication with the family was poor, which added to her distress.
What happenedMr C is an adult man with a mild learning disability and an asthma diagnosis. He lives in a flat in supported housing accommodation with his care funded by the Council.
In late January 2023, Mr C was reported to be coughing and feeling unwell. Following a few days of coughing, and concerns from his employer, his health deteriorated, and his care providers organised a visit to the GP.
Mr C’s blood oxygen level was low, and the GP tried but failed to improve it to a safe level and called an ambulance to take him to hospital.
The care provider also ensured that his hospital passport, providing nursing and ward staff with background information about his needs, was with him when he left the surgery.
A support worker was supporting another resident of the care provider at the same hospital. The provider’s manager decided Mr C would travel alone in the ambulance as this support worker was already at the hospital and was asked to stay and wait for Mr C.
The provider’s own internal policy stated with regard to hospital visits that ‘The responsible line manager ensures that arrangements are made for relatives or friends of the casualty to be advised fully of the situation.’
Mrs B contacted the care provider, and the manager informed her that a member of staff accompanied Mr C to the GP and that another support worker would meet him at the hospital. Mrs B continued to contact the facility throughout the evening for updates. She contacted the care provider the following morning who said it would call with an update but did not.
Mr and Mrs B visited Mr C at 9:00 am that next morning and perceived Mr C to be in an extremely anxious state. Mrs B said the consultant told them they considered moving Mr C to the intensive care unit and putting him on a ventilator but would see first how Mr C was responding to the treatment he was receiving. The manager stated that staff contacted the hospital at 11:30 but did not state at which time they had started attempting such contact. The doctor said he needed Mr C’s consent to share information, however, to a staff member at 12.30pm. Mr B deterred a staff member from the placement from visiting, which was offered, Mr C because of family members’ plans to be visiting, themselves.
Mrs B contacted the Council, stating that Mr C had been admitted to hospital and diagnosed with severe asthma and pneumonia. She outlined concerns with the care provider and stated a safeguarding meeting was needed.
In early February 2023, Mrs B sent an email to the Council formally outlining her complaints and safeguarding referral. Amongst her complaints, she noted that she was not aware that Mr C was on his way to the GP until she called him, nor was she informed of the ambulance being called until she rang Mr C and the GP nurse informed her. She was also not notified of Mr C riding unaccompanied in the ambulance and that he had been left alone in the hospital after 10pm. The care provider also had no information on Mr C the following morning and did not attempt to get updates on him until lunchtime. There was also a lack of communication from the provider in the following days, as far as Mrs B was concerned
Later in February, Mr C was released from hospital. The Council implemented an interim support plan to support Mr C in his recovery, which included increased monitoring of Mr C during the day and a decrease in his regular activities.
The Council carried out a safeguarding enquiry which concluded that if the care stated by the care provider had actually been provided, then Mr C had been adequately cared for. Although it was noted that the family did not believe that the care provider’s account was accurate, the Council believed it was not possible to reach an accurate conclusion as there were no other persons who could verify either claim, and therefore the Council decided that no further action would be taken.
In March 2023, the Council held a meeting with Mr C’s parents to discuss their complaints and safeguarding referrals. The Council analysed their concerns, citing budgetary constraints as the reason why Mr C travelled alone in the ambulance and limiting their criticisms to only the lack of communication from the care provider. Following a consideration of the safeguarding concerns and complaints, the Council agreed to carry out a new care plan with the care provider, with changes outlined relating to Mr C’s health. These changes included:
- Staff to carry out mental capacity and best interest assessments when Mr C was unwell as Mr C did not always fully understand his own health care needs.
- The Care Provider to establish a procedure for Mr C to have non-prescribed medication and record any non-prescribed medication in the care plan (Staff were not allowed to buy this).
- The Care plan should set out how Mr C should be supported when he is unwell.
- The Care Provider should put in place guidelines on communication with family and clarify what support was available to those in hospital.
- All health information should be up to date.
What was found
The LGO upheld Mrs B’s complaint, finding fault which had caused an injustice.
The LGO found that the care provider was not at fault for any delay in seeking medical help for Mr C prior to his admission to hospital. They contacted the appropriate medical staff and acted on their advice, which was to monitor Mr C throughout the day.
They had waited an appropriate amount of time to arrange a GP visit and when they arrived at the appointment, the GP tried to improve Mr C’s levels themselves before calling an ambulance, which implied that Mr C did not visibly need hospitalisation on arrival at the surgery.
The LGSCO also found no fault with Mr C travelling in the ambulance unaccompanied, although it was outlined in the care provider’s policy that a staff member should accompany a client to the hospital, if appropriate and if possible.
The LGSCO acknowledged the need for a care provider to make a professional judgement in the situation that had arisen and that a support worker was at the hospital and able to meet Mr C as soon as he arrived. The support worker’s going home at 10pm and leaving Mr C unattended was not an indication of fault as he had been admitted to a safe environment.
Fault WAS found with the care provider’s limited communication with the family, as their policy outlined that the manager should ensure that the family is fully informed in matters such as this. Mrs B had had to contact the care provider consistently following Mr C’s admission to hospital, and otherwise she would not have received information. The nub of the matter was that neither the support worker, who was with Mr C in the hospital for the entire evening, nor the Care Provider’s manager rang Mr and Mrs B even once on the first evening of hospitalisation to give them an update.
The LGSCO did also find faultwith the safeguarding enquiry led by the Council, which addressed the concerns of Mr C’s parents, in terms of its communication.
Following Mrs B’s email in February, the Council held a safeguarding enquiry that only acknowledged her first concern, which was the care provided that led to the hospital admission. Although these concerns were discussed during the meeting in March, they were not included in the report. The LGO inferred that the other concerns were not eligible for the enquiry but states that their eligibility should have been made clearer in the report. As these concerns were addressed in the meeting, the LGO notes that the initial injustice caused by poor communication was limited.
The LGSCO found that Mr C had not suffered any significant injustice from the faults found, but Mr and Mrs B had suffered unnecessary distress from the poor communication. An apology from the council was sufficient to remedy the injustice if the provider confirmed making the March 2023 changes that had been agreed.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public
Whilst the Care Act requires councils to provide or arrange services to meet needs, and the standard to which that must be done, imposed by public law, is adequately and appropriately, there is no obligation that is thereby passed on to a contracted provider to ensure that people never get ill. All that they can be required to do is behave appropriately in the light of apparent illness and support the person to access the services that anyone else is entitled to – here, primary care and the ambulance service and then NHS services from an acute hospital.
In our experience, most supported living providers leaving staff on site in a supported living house are doing so because they are contracted to deliver and paid for wrap-around care. That is, access to scrutiny and supervision, even if the individual is not ‘minded’ or provided with assistance on a one to one basis all the time.
This reflects normal life, after all; but the backstop nature of the scrutiny and supervision through staff who are well trained to know how to react to unexpected developments is infinitely variable.
In our experience, the extent of the backstop service will not be stated in the care plan, other than in a contingency section, sometimes; it may be stated in the provider’s mission statement or marketing materials, or in the specification within a framework agreement, but only at a very general level such as ‘support to access emergency services’ as an aspect of daily living. Specialist providers may be expected (in return for the higher fee that their service might well command) to attend hospital and stay there with people who would find it distressing, or even attend a police station if a client is asked to attend or arrested. It all depends.
Here, the fault lay in the provider’s thoughts for the parents. The man, however, had only mild learning disabilities and one wonders what his own feelings were about keeping his parents in the picture – the report mentions that he would spend a lot of time on his phone but did not always have full insight into his own health needs. On the other hand, he was employed 4 days a week as a cook, as it happens. The report also makes it clear that he was able to (or at least able to be helped to) text.
We are not surprised that an apology was all that was felt appropriate to remedy the injustice, and we think it significant that the report states that Mr C’s hospital passport had not stated anything in terms of a need regarding transport by ambulance or overnight stays in hospital. No additional requirements were added when the passport was updated in July 2023, after this period of hospitalisation, either.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Royal Borough of Windsor and Maidenhead Council (23 014 909) report. If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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