Roche Healthcare Limited (19 018 115)

Category : Adult care services > Residential care

Decision : Not upheld

Decision date : 09 Nov 2020

The Ombudsman's final decision:

Summary: The care provider took appropriate action to supply medication to Mrs X when she was near the end of her life. There is no evidence Mrs X suffered an injustice as a result of the actions of the care provider.

The complaint

  1. Mr A (as I shall call the complainant) complains about the care and treatment of his late mother Mrs X. In particular he complains about a delay in administering morphine, that she was unnecessarily admitted to hospital, and that the care provider would not allow him access to her records.

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The Ombudsman’s role and powers

  1. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
  2. We may decide not to start or continue with an investigation if we believe there is another body better placed to consider this complaint (Local Government Act 1974, section 24A(6), as amended). The Office of the Information Commissioner considers complaints about withholding of data.

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How I considered this complaint

  1. I considered all the information provided by the care provider and Mr A. We spoke to Mr A. Both the care provider and Mr A had the opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

  1. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
  2. Regulation 12 says care and treatment must be provided in a safe way for service users. That includes ensuring sufficient quantities of medication to meet the service user’s needs.
  3. NICE produces guidance on care of dying adults in the last days of life. The guidance includes recommendations on anticipatory prescribing and the administration of anticipatory medicines.

What happened

  1. Mrs X had been resident at the home since 2017. She was assessed as needing nursing care. She had dementia.

Admissions to hospital

  1. The care provider says Mrs X was taken to hospital in May 2019 and twice during June. The care home records for 20 June note: “Dr advised to call ambulance and bring to a/e hospital for more treatment.”
  2. The care home manager says “Any admissions to hospital due to (Mrs X’s) condition would have been made with other health care professionals involved. ….(Mrs X) would not have been taken to hospital without a medical assessment. Staff can call an ambulance but decision to admit is not taken by home staff alone.”

Availability of anticipatory medicines

  1. In November 2019 Mrs X contracted a chest infection. The care provider says when she did not improve, the home’s GP spoke to Mr A about the likelihood that Mrs X was nearing the end of her life. Mr A was asked his preference for Mrs X to be transferred to hospital or cared for in the home. The care provider says Mr A agreed Mrs X should only be transferred to hospital if her condition worsened.
  2. The care provider asked the GP to review Mrs X on 16 December. The GP did not prescribe anticipatory medication. Mrs X was already taking painkillers and drugs to reduce anxiety. The GP did not consider Mrs X needed additional pain relief.
  3. The care provider says the GP visited again on 18 December following concerns expressed by Mrs X’s family that she was in pain. On 20 December he left a prescription for anticipatory medicines.
  4. The care home manager says staff could not find a local chemist who could supply all the prescribed drugs. On 21 December Mrs X’s family asked for the GP to visit again as they were concerned Mrs X was in pain. Care home staff were able to obtain the prescribed drugs including morphine which were administered on 21 December.
  5. Mrs X died on 23 December.

The complaint

  1. In January 2020 Mr A wrote to the care provider to complain particularly about the last three weeks of his mother’s life. He said her death had not been painless and it had taken a manager from another home to obtain the drugs for her at the end of her life. He complained about her admission to hospital in the early hours of the morning when she was discharged straight back to the care home. He asked for copies of her medical records.
  2. The care home manager responded on 23 January. She said there were no changes in Mrs X’s behaviour which would signify she was in more pain. She said anticipatory drugs were prescribed after the GP’s visit prompted by family concerns, but none of the qualified staff on duty considered Mrs X was in need of the drugs. The night nurse who contacted 111 to obtain the drugs recorded “in his clinical judgement” the drugs were not needed at that time, but he did not want to cause further distress to the family. She said she did not have authority to release the medical records which were the property of the care provider.
  3. Mr A complained to the Ombudsman.
  4. The care provider says the concern about failure to provide morphine soon enough was reported to the local council safeguarding team and the CQC. The care home manager carried out a Root Cause Analysis of the concerns raised. She concluded it could not be determined Mrs X had been affected by the lack of administration of morphine: she had not shown signs of distress, and the decision to obtain medication urgently had been at the behest of her family and not in response to additional clinical signs.
  5. However, she also concluded that in future a list should be maintained of chemists who stocked anticipatory medications; the GP should be informed if they were not able to be obtained, and there should be a clear audit trail for staff to follow.
  6. The safeguarding process was concluded without action against the care provider.

Analysis

  1. It must have been distressing for Mr A and other family members to perceive Mrs X was in pain. Staff said however that there was no change in her behaviours which would lead them to conclude she needed additional pain relief. The GP had not considered she needed more pain relief.
  2. It was unfortunate that staff were unable to obtain all the medication included on the prescription at one chemist. As a result of the complaint, the care provider instituted a different procedure to ensure staff knew which local chemists would supply anticipatory medicines. However, there is no evidence the failure to obtain the anticipatory medications caused Mrs X additional distress. The GP’s actions and the clinical nursing staff records indicate otherwise.
  3. The care home manager said she received advice not to release medical records except to specific people (and she explained to Mr A she would do so on the grant of probate). In any event, Mr A can raise that issue with the Information Commissioner if he remains concerned.

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Final decision

  1. The actions of the care provider did not cause injustice to Mrs X.

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Investigator's decision on behalf of the Ombudsman

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