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Medvivo Group Ltd (19 019 952b)

Category : Health > Community hospital services

Decision : Not upheld

Decision date : 01 Feb 2021

The Ombudsman's final decision:

Summary: Mrs D complains about a lack of urgent interim care for her mother by a Council, Medvivo, and a GP Surgery. We found fault with the Council which caused distress to Mrs D and her family. The Council has agreed to compensate Mrs D for this.

The complaint

  1. Mrs D complains about a lack of urgent interim care at home for her late mother, Mrs E, in December 2019, while her father (her mother’s main carer) was hospitalised with a broken arm.
  2. Mrs D complains that a home health care service, Medvivo, commissioned by Wiltshire Clinical Commissioning Group (the CCG) and Wiltshire Council (the Council) were unable to provide interim care. Mrs D also complains Medvivo wrongly directed her to Adult Social Care at the Council for help. The Council then provided incorrect advice, directing Mrs D to contact private care homes rather than her GP, the Lansdowne Surgery (the Surgery) or health professionals. Mrs D also complains the Surgery did not properly coordinate and put in place care for her mother at this time. As a result, her father had to discharge himself early from hospital as there was no care and support in place for her mother.
  3. This situation also caused stress for Mrs D who had to travel to her parents’ home and provide care for her mother. This left Mrs D not knowing what she could do in future if the situation arose again. Mrs E sadly passed away in July 2020.
  4. Mrs D would like an apology, service improvements and compensation for the stress caused by the fault on the part of Medvivo, the Surgery and the Council.

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The Ombudsmen’s role and powers

  1. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
  2. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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).
  3. 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.
  4. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their 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

  1. During the course of my investigation, I have considered evidence from the Surgery, Council, Medvivo and Mrs D. I asked Mrs D, the Surgery, Council and Medvivo for comments on my first and second drafts decision before making this final decision.

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What I found

Background

  1. The Care Act gives local authorities a duty to carry out a needs assessment in order to determine whether an adult has needs for care and support. The assessment:
    • must be provided to all people who appear to need care and support, regardless of their finances or whether the local authority thinks their needs will be eligible
    • must be of the adult’s needs and how they impact on their wellbeing, and the outcomes they want to achieve
  2. Jointly commissioned by the Council and the CCG, Medvivo runs the Urgent Care at Home service. This is supposed to provide an integrated, rapid health and social care response for people experiencing a crisis in their own home.
  1. Clinicians coordinate the service and will set up urgent care packages tailored to individual needs. This can be for an initial period of 72 hours depending on available capacity. Referrals are only accepted from health care professionals, in this case, Mrs E’s GP.
  2. The service is designed to bridge the care gap in crisis for 72 hours whilst keeping the patient safe within their own home. Medvivo also said the capacity is dependent on how quickly mainstream services are able to take over care, which is also impacted by capacity within the system as a whole.
  3. Medvivo has explained it uses clinical reasoning to try to ensure patients’ needs are met safely where capacity allows, and signposting to try to access mainstream services if necessary. In this case mainstream services would be social care or NHS resources such as a GP or community nursing.
  4. If Medvivo is unable to meet the needs of the client, it said it suggests alternative signposting and reviews if the patient is safe to remain at home.
  5. On the morning of 6 December Mrs D contacted the Surgery as she was supporting her mother at home. On 4 December her father had been admitted to hospital with a broken arm and could not provide care. Mrs D had travelled from her home over 100 miles away to support her mother. Both Mr and Mrs E were in their 90s but before this period managed with minimal support.
  6. Mrs D said she told the GP her mother needed prompting with medication and she was on oxygen. She said the GP told her not to worry and Medvivo could provide 72 hour interim care so they would organise this.
  7. The GP then contacted Medvivo. The recording of the conversation provided by Medvivo showed that the GP told them that Mrs E was normally cared for by her husband but he had a broken arm and she needed care in the interim. The GP said this would need to be two to three visits a day as Mrs E had poor vision, was on mobile oxygen, needed help with medication prompting, toileting and mobilising.
  8. Medvivo rang Mrs D the same morning. The recording of the call shows Medvivo told Mrs D the Surgery should have made a referral to the Council for social care. This had not happened so Medvivo made the referral to the Council for an urgent care assessment.
  9. Mrs D told Medvivo she needed to return home to look after her son and there were no other family members who could help look after Mrs E. She told Medvivo that she also could not leave her mother as her oxygen levels went up and down, such as when she walked around. As her mother could not see properly, she could not adjust her oxygen to support herself when her levels fluctuated.
  10. Mrs D asked if someone could come to support her mother. Medvivo said it would be difficult to provide care. But it could offer a lunchtime slot for the next day. It also said the Council may be able to offer more support.
  11. Mrs D was worried her mother would not survive due to her needs. Medvivo raised the issue of a respite placement to provide the care Mrs E needed in a nursing home. It said it could not provide 24 hour care and at that time only had capacity to offer the one visit the next day.
  12. Following this call, Medvivo rang the Surgery and explained it had spoken to Mrs D and her mother’s needs appeared to be for 24 hour care. Medvivo explained she may need respite and it could only offer one visit. Medvivo also told the Surgery that Mrs E needed more care than the GP originally thought. It confirmed that it had made the referral to the Council for an urgent assessment.
  13. The Council had taken Medvivo’s referral and rang Mrs D. The Council says Mrs D confirmed her primary concern was that her mother needed support with medication prompting and oxygen levels without which she was concerned she would not last the night. The Council considered, when Mrs D contacted it, that the needs Mrs D set out were primarily health. The Council felt concerns with mealtimes were secondary and could be met by Medvivo providing a lunch visit and her mother could have bananas and biscuits as snacks.
  14. The Council told Mrs D to contact private care homes when she told them she did not think her mother could be left alone.
  15. The Council has told the Ombudsmen it recognises it failed to provide support with liaison back to the Surgery. It also identified a learning need in the team to support people to access services rather than just to signpost. The Council has offered £100 for the distress caused by the feeling that Mrs D was being passed between agencies on the day.
  16. Following Mrs D’s call to the Council, Mr E discharged himself from hospital, late in the evening of 6 December whilst on antibiotics and with his arm in a sling.
  17. The Surgery subsequently rang the Older Persons Team on 10 December. This team visited and told the Surgery Mr and Mrs E were managing well.
  18. In response to the complaint, Medvivo said although it considers the action it took was appropriate, the clinician on the call could have explained the service more thoroughly to Mrs D and that it only had finite resources. It could have explained that oxygen management was not a service it provided. Medvivo also explained that when it does not have capacity to meet a patient’s needs it will refer to the Council for social needs or to Wiltshire Health and Care for new health needs. Medvivo has told the Ombudsman following our first draft decision that in this case, as it related to a ‘carer breakdown’ and Mrs E had not developed new acute health needs, its process would be to refer to social care rather than to Wiltshire Health and Care. Wiltshire Health and Care have confirmed this is the case.
  19. As part of the information Medvivo gave the Ombudsmen, it identified there could be more education for GPs as they frequently ask for the Urgent Care at Home Service before they have made referrals to social care or NHS community teams.
  20. The Surgery has told the Ombudsmen that on the morning of 6 December the Surgery received an urgent referral from its Neighbourhood Team requesting input following Mr E’s broken arm. The Surgery made a referral to the Community Nursing Team who said it was unable to accept the referral but suggested contacting the Council’s Adult Social Care or the Older Persons Team. The Surgery rang Medvivo and passed on the details. The Surgery said it has a protocol which involved primarily contacting Medvivo as a point of access for urgent care and support. The Surgery said Medvivo is the quickest way to seek assessments for urgent care input. The Surgery did not provide a copy of this protocol or guidance.

Analysis

  1. Looking first at the GP’s actions, they made the referral to Medvivo. However, after Medvivo informed the Surgery that Mrs E’s needs were ultimately a lot higher than first thought, the Surgery did not take any further action. In response to our first draft decision, the Surgery told the Ombudsman that although Medvivo did ring back to let the GP know that Mrs E‘s needs were a lot higher than first thought, Medvivo did not ask them to take any further action. The GP was under the impression that the matter had been urgently referred to the Council for an Occupational Therapist assessment and would be handled from there.
  2. The GP record shows the Surgery contacted the Community Nursing Team earlier in the day who could not provide support with medication prompting. However, the GP never asked this team if it could help with oxygen management. The Community Nursing Team suggested contacting the Older Persons Team. There is no evidence that the Older Persons Team was contacted, as advised on 6 December, until 10 December. The Surgery, in response to the first draft decision, told the Ombudsmen that this Older Persons Team could not have helped with medication prompting and oxygen assistance. This team provides more of a care coordination role and the GP felt Medvivo and Occupational Therapy were a better route to obtain the help Mrs E needed. In addition the GP had been assured by Medvivo that it had sought an urgent referral with the Council. The GP said they had a reasonable belief that this would be appropriate action to take to allow urgent care input and that no further action would be necessary by the GP.
  3. It is understandable that the Surgery, even after being informed that Medvivo could not help, still felt that the Council would organise an Occupational Therapy assessment and that the matter was being handled by the Council. The Surgery has also explained the role of the Older Persons Team. Therefore, I have accepted the Surgery’s explanation and have not found fault in its actions.
  4. Looking at the Council’s actions, it had a responsibility to carry out an assessment of Mrs E’s needs under the Care Act.
  5. Although the needs Mrs E had may not have been met by the Council, it had a duty to arrange an assessment. In addition, the Council could then have referred the matter back to the Surgery, or tried to organise a respite placement. The Council said it offered Mrs E a care assessment. I understand that it was a difficult conversation that was brought to an end by Mrs D but I have found insufficient evidence in the papers provided by the Council of an offer of a care assessment to Mrs D. Mrs D, if she had been offered an assessment for her mother, would, on the balance of probabilities, have been less distressed at what she perceived was a lack of support. In addition, if the Council had gone back to the Surgery the GP would have been aware that Mrs D was still struggling to get support. Mrs D felt she was not going to get any support and her father discharged himself from hospital to help.
  6. The Council has accepted it was at fault for not contacting the Surgery but has not recognised the issue of the lack of assessment. Although the £100 is acceptable for the distress caused to Mrs D, there is a systemic issue here due to a lack of assessment.
  7. Medvivo listened to Mrs D’s concerns, it made the referral to social services and fed back to the Surgery to explain the situation. It can only provide support when it has the resources to do so and oxygen management is not one of the services it offers. Medvivo has reflected on the incident several times and identified how it could have been handled better in the future. Therefore, I have not found fault with Medvivo in this matter.

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Agreed Recommendations

  1. Due to the fault I have outlined above and the impact on Mrs D, I recommend by 2 March 2021:
    • The Council write to Mrs D to acknowledge and apologise for the fault I have outlined above and the impact it had on her. A copy of this letter should be sent to the Ombudsmen. The Council has already offered £100 for the distress it caused and I am satisfied this remedies any injustice caused to her.
  2. And by 2 May 2021:
    • The Council should carry out staff training to ensure it does not fail to offer Care Act assessments in similar cases in the future. The Council should confirm to the Ombudsmen that this has taken place.

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Final decision

  1. I found fault by the Council that led to distress for Mrs D. I did not find fault with Medvivo or the Surgery.

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Investigator's decision on behalf of the Ombudsman

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