Summary: We found fault by NRS Healthcare as it failed to deliver the equipment Ms D required in a timely manner. This caused Ms D and her husband, Mr D, significant frustration and distress. NRS Healthcare will apologise and pay a financial remedy in recognition of this. We are satisfied the provider, along with London Borough of Bromley and NHS South East London Integrated Care Board, have now taken appropriate action to improve the service.

The complaint

1. The complainant, Mr D, is complaining about the support provided to his wife, Ms D, by NRS Healthcare, London Borough of Bromley (the Council) and South East London Integrated Care Board (the ICB).
2. Mr D complains that NRS Healthcare failed to provide important equipment, or delayed in doing so, when Ms D was at end of life. Further, he says the Council and ICB failed to maintain proper oversight of NRS Healthcare to ensure it provided its contracted services to an appropriate standard.
3. Mr D says NRS Healthcare’s poor performance caused him additional stress and worry during a very difficult period and put him to unnecessary time and trouble.

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The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
5. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. If we are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

8. In making my final decision, I considered information provided by Mr D and discussed the complaint with him. I also considered relevant documentation from the Council, ICB and NRS Healthcare. I invited comments from all parties on this draft decision statement and considered the responses I received.

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What I found

Relevant guidance

Continuing Healthcare (CHC) funding

9. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’.
10. The Department of Health and Social Care’s National Framework for NHS Continuing Healthcare and NHS funded Nursing Care (July 2022 (Revised)) (the National Framework) is the key guidance about Continuing Healthcare. It states that where an individual is eligible for Continuing Healthcare funding, the ICB is responsible for care planning, commissioning services and case management.
11. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist, potentially followed by a full multidisciplinary assessment.
12. However, the National Framework allows for an alternative process to be used for a person who has a rapidly deteriorating condition and is considered to be near the end of their life. This is known as the Fast Track Pathway Tool.
13. The Fast Track Pathway replaces the need for a Checklist and full assessment. This is intended to ensure the person receives the care and equipment they need without delay. The National Framework says ICBs should take urgent action to agree and commission a care package and that this should usually be done within 48 Hours of the Fast Track Pathway Tool being completed.

Local responsibilities

14. NRS Healthcare provides community equipment on behalf of a number of health and social care organisations across the UK. The service offered by NRS Healthcare includes installation, delivery, maintenance, collection and recycling of equipment.
15. Professionals requesting equipment access NRS Healthcare’s service via an online portal known as ‘IRIS’. These professionals would typically be physiotherapists or Occupational Therapists (OTs).
16. In the Bromley area, the Council and ICB jointly commission NRS Healthcare to provide equipment services on their behalf.

Background

17. Ms D was receiving treatment in hospital for cancer. In November 2023, the clinical team concluded Ms D was approaching the end of life. She was discharged home with support from Mr D and the palliative care team from a local hospice.
18. On 15 January, Ms D became eligible for Fast Track CHC funding. Ms D’s Fast Track Care Plan noted she would require a hospital bed, pressure-relieving mattress, commode, sheets and a stand aid (a piece of equipment to support a person to move from a sitting to standing position).
19. On the same date, the hospice placed an order for equipment for Ms D. The order included an adjustable bed, pressure relieving mattress, bed rails and bed bumpers. In addition, the hospice ordered a base sheet, drawsheet, overbed table and a commode.
20. The IRIS system showed that the mattress selected by the hospice was a special “reissue” item only. This meant it was not held in stock and could only be provided if one was returned from the community. The hospice received a notification from NRS Healthcare that the item was out of stock.
21. NRS Healthcare delivered the adjustable bed with the bed rails on 17 January. However, the remaining items were out of stock.
22. On 18 January, the hospice ordered an alternative mattress. This was delivered on the same day.
23. On 22 January, NRS Healthcare delivered the bed bumpers and drawsheet. This left the base sheet, overbed table and commode outstanding. Mr D wrote to the hospice that day to express his concerns, copying in his MP.
24. An OT ordered a riser recliner chair and a stand aid on 25 January.
25. Mr D emailed his MP directly on 26 January with his concerns about the delays.
26. On 29 January, NRS Healthcare delivered the riser recliner chair and stand aid.
27. On 5 February, an OT assessed Ms D. The OT found Ms D could no longer safely use the stand aid or maintain an upright sitting position. The OT concluded that Ms D could no longer be safely transferred and would need to be nursed in bed with bed-based exercises. The OT requested collection of the riser recliner chair and stand aid as Ms D no longer needed these items.
28. A manager from the OT service contacted the Council and hospice on 7 February regarding the outstanding equipment and the need to provide this urgently. The OT service also escalated the matter to NRS Healthcare.
29. On 8 February, an order was placed for two slide sheets for Ms D. These were delivered on the same day. The ordering officer also cancelled the commode order.
30. The following day, NRS Healthcare collected the stand aid and a piece of equipment provided by a previous supplier. However, Mr D declined collection of the riser recliner chair at that stage.
31. On 12 February, the hospice again requested collection of the riser recliner chair. NRS Healthcare attempted to make the collection on 14 February but was unable to access the property. However, the driver left the base sheet outside the property.
32. On 16 February, an order was placed for bed sheets, a commode and an overbed table. The NRS Healthcare records do not note who placed this order.
33. NRS Healthcare attempted to collect the riser recliner chair again on 17 February. However, Mr D declined the collection as he said this would require two people and only one technician had attended. NRS Healthcare was able to collect the chair on 23 February.
34. On 19 April, the hospice notified NRS Healthcare that Ms D had died and requested collection of all remaining equipment. NRS collected all items on 26 April.

My analysis and findings

Delays in equipment provision

35. Mr D complained that NRS Healthcare failed to provide Ms D with the equipment she required when she was nearing the end of her life. He said NRS Healthcare delivered some items of equipment late or failed to deliver them at all. Mr D said this meant Mrs D had to be nursed in bed rather than being able to move around. Mr D said NRS Healthcare’s failings caused him additional frustration and stress at what was already a very difficult time.
36. The case records show NRS Healthcare first received an equipment order for Ms D on 15 January 2024. This included several standard items of community equipment, including an adjustable bed, pressure-relieving mattress and commode.
37. NRS Healthcare delivered the bed and alternative mattress within the target five-day timescale. However, there were delays of several days, or even weeks, before other items were provided.
38. For example, the overbed table and commode formed part of the order of 15 January. By 8 February, over three weeks later, these items remained outstanding. Similarly, the base sheet for the bed was part of the same original order. This was not delivered until 14 February, one month after the order was placed.
39. The care records show that, by January 2024, clinicians considered Ms D to be near the end of her life. This meant she required the equipment set out in her Fast Track Care Plan as a matter of urgency. I have seen no evidence to adequately explain the significant delays on the part of NRS Healthcare, particularly given these were standard items of equipment. The failure to provide this equipment in a timely manner represents fault by NRS Healthcare.
40. This caused Ms D and Mr D significant frustration and distress. It also put Mr D to unnecessary time and trouble as he was required to repeatedly pursue the outstanding items.

Subsequent action by the Council, ICB and NRS Healthcare

41. Mr D complained that the Council and ICB, as commissioners, failed to maintain proper oversight of NRS Healthcare. He said NRS Healthcare was clearly failing to provide its contracted service and that the Council’s solution of regular meetings with the company was inadequate.
42. In the NRS Healthcare complaint response, it acknowledged “areas which contributed to the failure in service delivery” in Ms D’s case. In my enquiries, I asked NRS Healthcare to identify these areas. It identified three specific factors:

• The person placing the order was unaware the OLA 7 mattress was no longer a standard stock item. Once this error was identified, a replacement mattress was delivered on the same day.
• The levels of stock held and how these were communicated to prescribers before orders.
• The need for additional training to ensure customer service staff understood when an activity requires two people (such as the collection of the chair).

43. I also asked NRS Healthcare what changes it made to its services because of Mr D’s complaint.
44. NRS Healthcare explained that it took over the contract to supply 21 London boroughs with equipment in April 2023. It acknowledged initial difficulties during the handover period from the previous supplier. NRS Healthcare categorised these problems into two main areas.
45. The first related to stock levels. NRS Healthcare explained it had been working with commissioners to agree Close Technical Equivalents (CTEs) for most products. This is an arrangement whereby, if a specific item is unavailable, a similar alternative item can be supplied. NRS Healthcare said it had also agreed with commissioners’ minimum and maximum stock levels, as well as a buffer stock to manage demand surges or supply disruption. Finally, NRS Healthcare said the OLA 7 mattress has now been marked clearly in the catalogue as a reissue item, making clear it would not be appropriate for urgent delivery.
46. The other area NRS Healthcare focused on was customer service. It said it has provided additional training to its Community Support Technicians. This is to ensure they confirm with the person placing the order whether all equipment is available prior to delivery. NRS Healthcare says all Community Support Technicians now have access to a reference document that makes clear how many officers it needs to allocate to each order. As an example, NRS Healthcare referred to the riser recliner chair, which requires two people to deliver or collect.
47. Further, NRS Healthcare says it now allocates driver teams and their managers to specific London boroughs. It says this allows teams to work in smaller areas and allows for greater knowledge of orders in each borough. In addition, NRS Healthcare says this allows more detailed daily debriefs with drivers to understand any unsuccessful activity and provide feedback to the customer service teams. Finally, NRS Healthcare said drivers are now required to confirm with a line manager prior to leaving a location where they have been unable to carry out a successful delivery.
48. Given Mr D’s concerns about the quality of the oversight of NRS Healthcare, I put similar questions to the Council and ICB. Both organisations have responsibilities as commissioners for managing the NRS Healthcare contract.
49. The Council was not involved in organising Ms D’s equipment as she became eligible for fast track CHC funding on 15 January 2024. However, the Council does have oversight responsibilities as one of the joint commissioners (along with the ICB).
50. The Council said it meets with NRS Healthcare every six weeks to discuss performance and stock management. In addition, a commissioning consortium of London local authorities meets every two weeks to review NRS Healthcare’s performance. Finally, the Council says its OT lead maintains a list of complaints and meets regularly with NRS Healthcare to review these.
51. The ICB explained that the NRS Healthcare contract is mainly overseen and managed by the Council (as above). As a result, it has little involvement from an oversight perspective. However, it was actively involved in attempting to expedite Ms D’s orders. This is reflected in the available records.
52. Taken as a whole, I am satisfied the above actions will minimise the chance of similar problems occurring for other service users in future.

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Agreed actions

53. Within one month of my final decision statement, NRS Healthcare will:

• write to Mr D to apologise for the distress and frustration caused to him by its failure to deliver the equipment Ms D required promptly and with regard to the urgency of her situation; and
• pay Mr D £500 in recognition if the impact of this fault on him.

54. NRS Healthcare will provide us with evidence it has complied with the above actions.

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Final decision

55. I found fault by NRS Healthcare in relation to its failure to provide the equipment Ms D required in a timely manner. In my view, the actions NRS Healthcare have agreed to undertake represent a proportionate remedy for the injustice caused to Mr D by this fault.
56. I am satisfied NRS Healthcare, the Council and the ICB have now taken appropriate action to address concerns about the service.
57. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman