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Black Country and West Birmingham Clinical Commissioning Group (20 007 956a)

Category : Health > Community hospital services

Decision : Not upheld

Decision date : 17 Feb 2022

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.

The complaint

  1. 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.
  2. Miss X says she is in pain and distress, and suffering pressure sores, because of problems with the chair. She also says she cannot have a much-needed operation until she has a suitable bed.
  3. Miss X would like to have a new chair and bed in place as soon as possible. She would also like to the Council and CCG to put in place service improvements.

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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. 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. 
  3. 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).
  4. 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.
  5. 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. 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.
  2. 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.

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What I found

Chair

What happened

  1. 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.
  2. 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.
  3. An occupational therapist (OT) from the Council and a chair expert from the company that supplies the chairs assessed Miss X’s needs.
  4. The Council says:
    • 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.
  5. The Council and CCG agreed to jointly fund the chair because it met Miss X’s social care needs as well as her medical needs in the form of:
    • pressure relief;
    • postural support; and
    • allowing leg elevation to address lymphoedema (a long-term condition causing swelling, usually in the arms or legs) needs.
  6. The chair was made specifically to meet Miss X’s clinical needs. The Council’s records show the OT and chair expert delivered the current chair to Miss X, showed and told her how to use the chair correctly, and left written instructions with her. The Council says it also gave advice that:
    • 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.
  7. The Council says it advised Miss X to tilt the chair when elevating her legs because elevating without tilting can squash the parts of the body involved in breathing. The Council considers that failing to tilt the chair when elevating her legs is the cause of Miss X’s discomfort and the injuries she refers to.
  8. In August 2020, Miss X complained to the Council that the chair was uncomfortable and not providing back or neck support. The Council’s OT and the chair expert visited her and looked at how she was using the chair. They:
    • 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.
  9. Miss X contacted the Council again in September 2020 because she was dissatisfied with the comfort and support from the chair. Miss X told the Council’s OT that the seating position caused problems with her lungs and shoulders, her pressure areas were breaking down, and the chair was cutting her legs. The OT:
    • 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.
  10. In October 2020, the district nurses contacted the Council stating that Miss X was struggling with her chair and foam was coming out of it. Miss X’s GP also contacted the Council to ask for an assessment of the chair as Miss X was finding it uncomfortable. The Council closed the GP’s referral because the GP did not have a medical concern about the chair. The Council contacted the district nurses to ask how Miss X’s needs have changed. The district nurses told the Council there had been no change in Mrs X’s skin condition and that she was not always allowing them to visit weekly as planned. The Council therefore also closed the referral from the district nurses. It asked them to get in touch again if they had any more concerns.
  11. Miss X complained to the Ombudsmen in November 2020. We asked the Council to respond to her complaint first. She was dissatisfied with the Council’s response and complained to us again in February 2021. Records show that, between November 2020 and February 2021, the Council:
    • 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.
  12. The Council’s records show Miss X was fully aware of the contact numbers for its community equipment store and OTs.
  13. The Council considers that it has exhausted every option for meeting Miss X’s needs for a chair. It considers her current chair to be suitable for her needs, but will accept any new referrals from her medical team to review her needs and its recommendations. It has agreed this approach with Miss X’s GP and district nurses. It also recognises that it will need to review and possibly replace Miss X’s pressure relief within three to five years.

My findings

  1. 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.

Bed

  1. 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.
  2. 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”.
  3. In January 2017, the CCG emailed the district nurses chasing the clarification and prices. It said that it would close the case if it did not receive this information. The CCG did not receive a response, so it closed the case.
  4. The CCG was entitled to ask for more information and to close the case when it did not receive this. This was not fault.
  5. The CCG received another request to fund a specialist bed on 6 April 2021, from a hospital which was planning on operating on Miss X.
  6. The CCG approved this request within three days. This is because doctors who were planning on performing the surgery had said that the bed needed to be in place before the surgery happened, so they could plan for a safe discharge from hospital.
  7. There was no fault in the way the CCG dealt with this second request for specialist bed funding.
  8. The CCG informed us that it delivered the bed in the Summer of 2021, but that installation had been delayed while waiting for Miss X to clear enough space in her bedroom.

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Final decision

  1. 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.

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Investigator's decision on behalf of the Ombudsman

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