The Ombudsman's final decision:
Summary: Miss X complained about problems with specialist equipment provided by the Council and NHS Clinical Commissioning Group. We have not upheld the complaint. We have now completed our investigation.
- Miss X complains about problems with specialist equipment provided by City of Wolverhampton Council (the Council) and Black Country and West Birmingham Clinical Commissioning Group (the CCG). Miss X says that:
- a specialist chair supplied by the Council and CCG does not meet her needs and is causing her injury; and
- the CCG delayed supplying her with a specialist bed.
The Ombudsmen’s role and powers
- 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)
- When investigating complaints, if there is a conflict of evidence, the Ombudsmen may make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened.
- 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).
- 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.
- 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)
How I considered this complaint
- We have considered information Miss X has provided by telephone. We have also considered written information provided by the Council and CCG. This includes records of communication with and visits to Miss X, and details of the chairs she has had for the past six years.
- Miss X, the CCG and the Council have had an opportunity to comment on a draft version of this decision. We considered any comments we received before making a final decision.
What I found
- The CCG had no direct involvement in assessing Miss X’s needs for a specialist chair or supplying the chair. However, it funded the chair jointly with the Council. The Ombudsmen therefore consider both the CCG and the Council responsible for the chair’s suitability for Miss X’s needs.
- The Council has supplied seven specialist chairs to Miss X since 2016. Miss X found her previous specialist chair too uncomfortable. The Council replaced it in July 2020 with the chair that is the subject of this complaint. The Council says it tried to ensure Miss X’s clinical need was met and that Miss X also asked for the following elements, which she had liked in previous chairs:
- inflatable cushion;
- motorised and extending leg rest;
- increased firmness in back cushions;
- higher leg elevation; and
- narrow arm rests.
- the chair expert advised that a gel seating material was the most suitable for Miss X;
- Miss X was adamant inflatable cushions were the most comfortable for her; and
- the Council agreed that an inflatable cushion would meet Miss X’s pressure needs, although it was not the professionals’ choice. It therefore accepted
Miss X’s request for the chair to include an inflatable cushion.
- pressure relief;
- postural support; and
- allowing leg elevation to address lymphoedema (a long-term condition causing swelling, usually in the arms or legs) needs.
- Miss X should not use the chair in the standard upright position with leg elevation;
- children were not to sit on the arms of the chair; and
- she should reposition herself in the chair regularly and stand from the chair and move around every hour.
- concluded that some extra padding they had added when they delivered the chair to increase Miss X’s comfort meant that her bottom could not go right back into the chair;
- removed the extra padding;
- adjusted the seat, padding and base of the chair;
- advised Miss X on the correct seating position and concluded that once she was in this position, she had full postural and pressure relieving support,
- told Miss X the chair would take two weeks to settle; and
- told Miss X they were confident the chair met her needs and any further discussions about the chair would need to be with the district nurses if there was a change in her circumstances or her pressure areas deteriorated.
- told Miss X the Council would do nothing further about the chair unless there was clinical evidence from her GP or district nurses that the chair was unsuitable; and
- encouraged her to make a complaint if she remained unhappy.
- examined the chair and found no fault with it;
- oiled the chair mechanism;
- arranged for the chair expert to visit and review a cushion that had become flattened;
- asked the district nurses about changes to Miss X’s needs;
- offered Miss X an urgent social care needs assessment with a view to supporting her with carers. She declined this;
- offered Miss X carer’s assessments for her adult children who were supporting her. She declined these;
- offered Miss X a gel insert for her chair, which the OT and chair expert considered would better meet her needs for pressure relief. At first, she declined this, but later accepted it; and
- advised Miss X on how to use the chair to elevate her legs properly.
- There was no fault in the way the Council and CCG provided Miss X’s current chair or how the Council responded to her concerns about it. This is because there is evidence the Council:
- properly considered Miss X’s needs along with her preferences when sourcing the chair;
- responded appropriately to Miss X’s concerns about problems with the chair after she received it in July 2020;
- followed the correct process and provided a reasoned explanation when it decided in September 2020 that the chair meets Miss X’s needs;
- explained to Miss X and the GP and nurses who see her regularly what needs to change for the Council to consider replacing the chair and how medical professionals can ask for a new assessment;
- continued responding to Miss X’s concerns about possible faults with the chair; and
- explained to Miss X how she could complain.
- District nurses (who are not the subject of this complaint) made two referrals to the CCG for a specialist bed for Miss X: one in 2016 and another in 2021.
- In December 2016, the district nurses emailed the CCG with a referral. The CCG responded eleven days later, as follows.
- The CCG’s funding panel had discussed the request and noted the rationale for the bed was to help Miss X move and reposition herself.
- The CCG wanted the district nurses to clarify why Miss X needed such a specialist mattress when she was not bed-bound. The CCG also asked for “2-3 quotes”.
- Miss X complained about a specialist chair and bed provided through the Council and CCG. We have not upheld this complaint. We have now completed our investigation.
Investigator's decision on behalf of the Ombudsman