The Ombudsman's final decision
Summary: We will not investigate this complaint about the Care Provider’s failure to seek medical intervention. There is an independent investigation ongoing which is likely to provide the outcome Mrs X seeks and it is not proportionate for us to also consider the matter at this time.
The complaint
Mrs X complained the Council-commissioned care home in which her mother (Mrs Y) resided failed to act on her requests for medical intervention. Mrs X says Mrs Y showed signs of infection and complained of pain, but there was a delay of two and a half weeks before the Care Provider sought medical intervention. Mrs X says Mrs Y then died of multiple organ failure caused by sepsis. Mrs X says the care provider is responsible for Mrs Y’s death, and the family have suffered significant distress. Mrs X wants a proper investigation and answers.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide: we could not add to any previous investigation by the organisation, or further investigation would not lead to a different outcome, or there is no worthwhile outcome achievable by our investigation.
(Local Government Act 1974, section 24A(6), as amended, section 34(B)) The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6) We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council or care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
How I considered this complaint
I considered information provided by the complainant.
I considered the Ombudsman’s Assessment Code.
My assessment
Mrs X’s mother moved into a care home after she had suffered a fall. Mrs X says Mrs Y complained of pain and the family noticed signs of infection. The family asked the care home to seek medical intervention. It agreed, but did not then follow up on the request. Mrs Y was admitted to hospital in late 2023 and subsequently passed away.
Via its internal complaints process, the Care Provider acknowledged it had been at fault and had missed two opportunities to seek medical advice. It told Mrs X the responsible staff members were no longer working at the care home, and apologised to her. The Council developed an improvement plan with several recommendations for the Care Provider.
Before we can consider a complaint, we must be sure the organisation has had the opportunity to respond to the complaint. Normally, the Adult Social Care complaints process would be one stage only. We do not require complainants to pursue further stages before bringing complaints to us, and doing so can serve to delay matters and reduce the likelihood that we can come to sound conclusions. However, in this case Mrs X requested the Council escalate the complaint. It has since arranged a further independent investigation.
Given this, it is not proportionate for us to consider the matter further at this time. An independent investigation is likely to provide the outcome Mrs X told us she seeks. I do not believe we could achieve anything of significance by investigating the matter at this time given this alternative process has started.
Should Mrs X remain dissatisfied following the independent investigation, it is open to her to complain to us again. We normally require complaints to be brought to us within 12 months of the person becoming aware of the matter, but we have discretion to extend this where the complainant could not reasonably have complained sooner. In this case, that 12 month period will expire in August 2024. Mrs X provided evidence to us which indicates she complained to the care provider promptly after her mother’s death. Due to subsequent review processes by the Council and then delay in the care provider’s complaint-handling which necessitated chasing by Mrs X, she did not receive a final complaint response from the care provider until April 2024.
We are likely to extend the 12 month timescale in this case, because on the current information, the complaint-handling appears to have been delayed by six months. Therefore, Mrs X should contact us again without delay if she remains dissatisfied on receiving an outcome or if there is significant delay in the process. I would suggest it would be reasonable for Mrs X to contact us by February 2025 at the latest, but sooner if possible, if she wants to bring the complaint to us.
Final decision
We will not investigate Mrs X’s complaint, because there is an independent investigation ongoing which is likely to provide the outcome Mrs X seeks and it is not proportionate for us to also consider the matter at this time.
Investigator's decision on behalf of the Ombudsman