Summary: The Ombudsmen will not investigate Mr A’s complaint about treatment and care from the Practice and Council in 2016. This is because the complaint is late and I have not seen sufficient reason to accept it now.

The complaint

1. The complainant, whom I shall call Mr A, complains about the treatment and care provided to his mother, Mrs C. Mrs C has a background of mental health issues, as well as osteoporosis which can affect her mobility. Mr A says that since Mrs C experienced back problems in late 2016, she has not received the support she needs from either the Council or the GP Practice.
2. Mr A also complains the social worker should have referred Mrs C for an NHS continuing healthcare (CHC) assessment in 2016. Mr A says that as a result, Mrs C has been denied the nursing care she should have had, and that she needs more than basic social care, including more support with her physical and mental health.
3. Mr A said that because of the lack of support, he provides full-time care for Mrs C, so this situation has had an ongoing impact on both of them.
4. As a result of his complaint, Mr A would like Mrs C to get the support she needs.

Back to top

The Ombudsmen’s role and powers

5. 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, and Health Service Commissioners Act 1993, section 18ZA)
6. The Ombudsmen will not generally investigate a complaint unless they are satisfied the matter has been brought to the relevant organisation’s attention and that organisation has had a reasonable opportunity to investigate and reply to the complaint. (Local Government Act 1974 section 26(5), as amended, and Health Service Commissioners Act 1993, section 9(5))
7. The Ombudsmen cannot investigate late complaints unless they decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to the Ombudsmen about something an organisation has done. (Local Government Act 1974, sections 26B and 34D, as amended, and Health Service Commissioners Act 1993, section 9(4).)

Back to top

How I considered this complaint

8. During my consideration of this complaint, I spoke to Mr A and read the information he sent me. I also looked at the complaint responses and correspondence with the Council and GP Practice.
9. I also considered Mr A’s comments on a draft version of this decision.

Back to top

What I found

Background

10. At the time of the events complained of, Mrs C had a history of mental health issues and osteoporosis. In August 2016, she was reviewed by the Practice as she had back pain and mobility problems. She was diagnosed with a back strain and given pain relief. In September 2016, a falls assessment was arranged and a referral made to the rapid response team (a community nursing service managed by an acute trust). On 15 September, Mrs C was reviewed by a mental health nurse, who documented concern about Mrs C “not receiving further diagnostics for her back”.
11. Mrs C attended an assessment for a bath hoist at the Better Living Centre (run by the Council). However, Mr A said the occupational therapist at the Centre declined to review Mrs C as she did not have a diagnosis for the cause of her back pain.
12. Soon afterwards, Mrs C was admitted to hospital with continuing back pain, and was diagnosed with a spinal fracture resulting from osteoporosis. Mr A said Mrs C was discharged without a discharge planning meeting or any reablement care.
13. Following Mrs C’s discharge from hospital, some short-term care was put in place at home, and a social worker visited in November 2016. Mr A explained that at the time, he understood that the social worker completed a needs assessment. He also said he recalled the social worker saying Mrs C’s needs could not be met by adult social care, because her needs were related to her physical and mental health.
14. However, in its later correspondence with Mr A, the Council said Mrs C did not have a needs assessment. It said the social worker offered Mrs C an assessment but she declined it. The Council apologised to Mr A if this differed from his understanding of what had happened. The Council referred to the social worker providing “information and advice”. It said Mrs C told the social worker she would continue to use the domiciliary care she was purchasing herself, alongside support from the mental health trust, to meet her needs. The Council said it had little information about Mrs C’s needs at that time and so could not investigate the complaint “effectively and fairly”. The Council referred Mr A to the local clinical commissioning group regarding his complaint about CHC.
15. In November 2016, Mr A met with the Practice to express his concerns over the decline in Mrs C’s physical and mental health. Mrs C was reviewed again by the Practice and also by a mental health team. She was seen again by the Rapid Response team. Mr A said that the rapid response nurse had told him Mrs C should not have been left in that condition. Mrs C was also reviewed by a dietitian.
16. Subsequently, Mr A acted as a live-in carer to Mrs C, with some private domiciliary care. Although he did not complain formally to the Council, in October 2018, Mr A raised his concerns through a survey carried out by a local carer’s forum. Having heard nothing in response, he followed up with the Council in May 2019, and received an initial response from its adult social care Head of Service. The response said the Council was not able to investigate what had happened in 2016 as the events were too long ago to offer a full response.
17. However, correspondence between Mr A and the Head of Service continued and, as noted above, some of his questions were answered informally, although the Council said there was a lack of records to investigate fully. The Council also offered Mr A a referral for reassessment for Mrs C, and a multi-disciplinary meeting involving the Council, Trust and CCG. However Mr A declined the meeting, as he felt it was offered in his capacity as a member of the carer’s forum, rather than as a way of addressing his individual concerns.
18. As noted above, Mr A had some meetings and discussions with the Practice about his concerns about Mrs C’s care. However these were not handled as formal complaints and no minutes were taken. In September 2019, Mr A met with the Practice and received a written response to his complaint, focusing on his concerns from 2016, and stating the Practice considered it had provided appropriate care and treatment at that time.
19. I also note that a CHC checklist was completed for Mrs C more recently, and that the CHC process is continuing.

My analysis

GP Complaint

20. In most cases we expect complaints to be made to us within 12 months of a person becoming aware of the issue(s) they wish to complain about.
21. In some circumstances we may still be able to investigate even if a complaint is made to us ‘late’. However, in Mr A’s case, my current view is there are insufficient reasons to consider his complaint about events of 2016 now. In reaching this view, I have considered Mr A’s reasons for not complaining to us sooner and whether it would still be possible to obtain the evidence needed to investigate the complaint fairly.
22. Mr A explained he has significant caring responsibilities and that it was complicated to establish which organisations provided which services to Mrs C. However, Mr A was aware at the time that he was dissatisfied with the Practice’s care and treatment of Mrs C. It is documented by the specialist nurse practitioner who saw Mrs C in September 2016 that Mr A was “very unhappy with the service he had had”.
23. Mr A also raised his concerns at that time with the Practice, attending a meeting to discuss Mrs C’s care in November 2016, and writing to the Practice to outline some of Mrs C’s health issues and ask for assistance. However these contacts were not handled as formal complaints, so the Practice did not respond to his concerns as such, and nor did it take minutes of the meeting. I understand Mr A did not want to complain formally because of the longstanding relationship between the family and the Practice, and previous good treatment they had received. I also appreciate that it was difficult for him to find time to make the complaint because of his caring responsibilities.
24. However, as he was aware of the issues at the time, and was able to approach the Practice about them, my current view is that he could have also made a formal complaint at the time. The Practice has since provided a formal response to Mr A’s complaint about matters from late 2016, based on details from Mrs C’s GP records.
25. Although the GP records from the period are still available, Mr A says these are inaccurate and incomplete. Mr A has his own notes on what happened but, over three years after the events took place, it is unlikely the Ombudsmen would now be able to add anything to the response already provided by the Practice.

Council Complaint

26. Mr A raised his concerns with the Council in October 2018 in his carer’s survey, soon after he heard about CHC. He complained the social worker should have referred Mrs C for CHC assessment when she was seen in November 2016. He also said reablement care should have been put in place following Mrs C’s discharge from hospital in 2016.
27. Mr A’s complaint about a lack of reablement is late. As his concerns about reablement seem to have been discussed during Mrs C’s hospital admission, my view is Mr A would have been aware of the problem then and could have raised his concerns sooner. I have not seen sufficient reason to consider this matter now.
28. Regarding the social work visit of November 2016, Mr A said he could not have complained she did not refer for a CHC assessment at the time, because he was not aware of CHC until 2018. I accept this is a reasonable explanation for not complaining about this at the time.
29. However, when the issues raised occurred some time ago, in deciding whether or not to investigate, we also need to consider whether records are available which would enable us to conduct an investigation. As noted above, in its correspondence with Mr A in 2019, the Council said that a needs assessment did not take place, as Mrs C declined it. I recognise that Mr A disputes this, but the Council said that it holds little detail on Mrs C’s needs or situation at the time. Because of this lack of records, and the time that has passed since the event, it is unlikely an investigation by the Ombudsmen could add to the explanation already provided by the Council about what happened when the social worker visited.

Mrs C’s electronic health record

30. Mr A complained to the Practice about gaps in Mrs C’s electronic health record. He said items missing included letters from secondary care to the Practice, which should have been part of Mrs C’s records. He had also made a subject access request, and although he had received paper and electronic copies of the record, both had information missing.
31. I recognise that Mr A considers the Practice has not provided full records in response to his subject access request. Mr A may wish to take this matter to the Information Commissioner’s Office (ICO), which is better-placed to handle this part of the complaint, as it deals with complaints about information rights.

Back to top

Summary

32. Mr A’s complaint about the Practice’s actions in 2016 and the Council not providing reablement care is late. Although I recognise Mr A’s strength of feeling about what happened, I have not seen sufficient reason for us to investigate his concerns now.
33. Regarding Mr A’s concerns that Mrs C was not referred for a CHC assessment, I accept he only became aware of CHC in late 2018 and so was not able to make his complaint about lack of CHC assessment earlier. However, the lack of records and passage of time means it is unlikely we could add to the response he has already received from the Council.

Back to top

Final decision

34. The Ombudsmen will not investigate Mr A’s complaint because it is late, and I have not seen sufficient reason to consider it now.

Investigator’s decision on behalf of the Ombudsmen

Back to top

Investigator's decision on behalf of the Ombudsman