Kent and Medway Integrated Care Board

5. Mr T complains about the ICB. Specifically, Mr T complains about the standard of care his late father, Mr E, received between 19 November and 21 November. Mr T raises the following concerns: • the ICB failed to communicate who was in charge of coordinating care and treatment for his father • the ICB failed to contract an appropriate supplier to provide his father’s care and treatment.

6. Mr T says that his father suffered unnecessarily. He tells us that his family’s experience was deeply upsetting and traumatic.

7. As an outcome to his complaint, Mr T is seeking an acknowledgement, an apology, service improvements, and a financial remedy for the failings the family experienced.

8. On 19 November, the ICB received a Fast Track referral for Mr E. Individuals with a rapidly deteriorating condition, that may be entering a terminal phase, may require ‘fast tracking’ for immediate provision of NHS Continuing Healthcare (CHC). The intention of the Fast Track Pathway is that it should identify individuals who need to access CHC quickly, with minimum delay.

9. The referral was made by Mr E’s community palliative care nurse and was accepted by the ICB’s Specialist Assessments and Placements Team (SAPT). The SAPT team then contacted five different providers of domiciliary home care in the Kent area.

10. The ICB’s Fast Track recording form demonstrates a care provider in the Kent area (the care provider) were the only providers who had the required capacity to undertake the requested care.

11. An assessment was carried out by the care provider, who were concerned that they would not be able to safely deliver personal care while Mr E was resting in a double bed.

12. The care provider contacted the SAPT team on 20 November to request a hospital bed and slide sheets be urgently provided, as the care provider were unable to commence care without these items of equipment.

13. SAPT contacted the community nurses on 20 November to request the hospital bed and slide sheets be provided.

14. On 21 November, SAPT staff contacted Mr T to ascertain if the community nurses had assessed and arranged the equipment the care provider had requested.

15. During that conversation, Mr T advised that his father had sadly passed away. Mr T explained that community nurses did visit Mr E on 20 November, but they advised the family that is was sadly too late to provide equipment.

16. During the call Mr T also explained that he had borrowed a slide sheet and a commode from a neighbour. None of this information appeared to have been relayed to SAPT, or the care provider, by the community nursing services so care was not started by the care provider.

Communication

19. Mr T says he is unsure who was responsible for coordinating the different agencies.

20. In its response, on 11 March 2020, the ICB explained its SAPT team were responsible for coordinating Mr E’s NHS Continuing Healthcare once they had received and had accepted the Fast Track referral. It explained that this referral was received on 19 November, and in it SAPT were asked to arrange a personal support care package to meet Mr E’s personal care needs. This was consisting of four calls a day, to be delivered by two care staff.

21. In its complaint response on 11 March 2020, the ICB confirmed that SAPT was responsible for managing Mr E’s NHS Continuing Healthcare. We have seen no evidence that Mr T queried this prior to his complaint, and so we have not seen the ICB failed to provide the information Mr T had requested. In the circumstances, there is nothing to indicate the ICB failed to address this, and there is no further action we need to take on this point.

22. We consider the approach taken by the ICB is in line with the Ombudsman’s Principles of Good Complaint Handling. These principles state public bodies should be open and honest when accounting for their decisions and actions. They should give clear, evidence-based explanations and reasons for their decisions. When things have gone wrong, public bodies should explain fully and say what they will do to put matters right as quickly as possible.

Failure to appoint an appropriate supplier

23. Mr T says he is unsure why the care provider were appointed by the ICB, when it had a policy in place that prevented it from delivering the appropriate care. Mr T says this caused his father unnecessary suffering.

24. In its response on 17 January 2020, the ICB explains the Fast Track referral SAPT received for Mr E, on 19 November, was completed by the community palliative care nurse. The referral advised that ‘no equipment was required prior to the commencement of care’. In its response on 11 March 2020, the ICB explains SAPT were unaware of the policy the care provider had in place regarding caring for individuals in their own bed.

25. The ICB explains that it decided to meet with the care provider to discuss both their practice and decision not to supply care until a hospital bed and slide sheet were provided. In its response, it said SAPT had not previously experienced a provider declining to provide end of life care and support in circumstances such as this. As such, the ICB are not currently referring to this this provider until these concerns have been addressed and assurance gained.

26. We can see the Fast Track referral from 19 November states that no specialist equipment was required to commence care. We can also see that the ICB contacted five agencies, with the care provider advising that it could take the package.

27. We refer to the Kent and Medway ICB constitution which states: ‘the [ICB] remains accountable for all of its functions, including those that it has delegated’.

28. The ICB has acknowledged that the care and treatment provided by its contracted care provider fell short of what it would expect. The ICB has explained what actions it has taken to address this, so that service will be improved in the future. We consider this is a fair and proportionate remedy, in line with the Ombudsman’s Principles of Good Complaint Handling and Principles for Remedy.

29. The ICB has advised us that it has taken the following actions and service improvements to prevent a similar case from occurring: • The community palliative Care team reviewed their practices, and Fast Track referral process for domiciliary care support, to identify whether the need for equipment and support could have been assessed earlier in the process. Following this, the SAPT put a process in place for community occupational therapy assessments for equipment. The process means that if a patient requires community equipment this can be arranged by the SAPT and not by the community palliative care team. This ensures patients are able to get the support they require sooner.

• The ICB’s CHC triage duty-desk introduced a process to monitor the progress of Fast Track referrals for end of life patients. The triage desk is led by a senior nurse who monitors daily patient progress on the caseload. During the daily handover meeting between the clinical team who triage and support end of life Fast Track referrals, and placement officers who commission and arrange packages of care, there are written notes of the discussions and actions to be taken by nurses allocated to each case. These actions include communication with families and their representatives. If the actions are not completed, the senior nurse addresses these at the next handover meeting.

• The SAPT hold regular meetings to discuss contractual service provision with Medway Community Health Care (MCH), who manage the palliative care teams and related services, and HCRG Care (formerly Virgin Care), who manage the community nurse services.

• Additionally, the ICB would like to reassure Mr T that there are robust processes, regarding which providers the SAPT use, and the checks that need to be completed prior to engaging with a provider. The ICB confirms that any provider concerns are acted upon accordingly.

30. We consider the approach taken by the ICB is in line with our Principles of Good Complaint Handling and our Principles for Remedy. These Principles outline that providing fair and proportionate remedies is an integral part of good complaint handling. Where a public body has failed to get things right, and this has led to an injustice, it should take steps to put things right. Appropriate remedies can include apologies, remedial action, and financial remedies. In addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.

31. We can see that the ICB has apologised to Mr T for the care and treatment provided to his father, and for the distress this caused the family. It has also explained the actions it has taken to remind staff of their responsibilities, and will not contract the care provider in the future until it has reconsidered its policy.

32. In his complaint to us, Mr T says he would like a financial remedy to recognise his father’s suffering and the family’s distress.

33. Based on the information we have seen, we consider the impact these events, and the actions of the ICB, would have had on the family. We also consider the inconvenience of having to borrow a slide sheet from their neighbours.

34. We consider Mr T’s father suffered unnecessarily between 20 November and 21 November. We have raised this with the ICB. The ICB has advised us that it recognises Mr T’s father’s suffering and the family’s distress. The ICB has agreed a financial remedy of £450, which is line with our Guidance on Financial Remedy.

35. The ICB has said it will contact Mr T to request details of who the payment should be sent to. Following receipt of this information, the ICB will process the payment.

36. We hope Mr T is satisfied with the action we have asked the ICB to undertake as a resolution to his concerns.

37. We acknowledge the distress Mr T and his family have experienced as a result of the ICB’s failing, and the distress caused while pursuing this complaint. We are grateful for the information Mr T has shared with us that has helped our consideration of his complaint. We hope we have clearly explained the reasons for our decision and that the resolution we have reached with the ICB helps resolve his concerns.

1. We have carefully considered Mr T’s complaint about NHS Kent and Medway Integrated Care Board (the ICB). We were sorry to hear how Mr T and his family have been affected by these events. It is clear the family had a difficult experience at what was already an upsetting time. We appreciate that Mr T’s father’s (Mr E’s) experience was not as good as it should have been. We can see that Mr E’s rapidly deteriorating condition and his sad death, has caused long standing upset to the family.

2. There are elements of Mr T’s complaint where we have not seen any indications that things went wrong. This means that, from the evidence we have considered, it appears that the ICB provided an appropriate explanation to Mr T about who was responsible for the coordination of his father’s Fast Track referral.

3. We have identified indications of service failure in relation to some aspects of Mr T’s complaint, as the service provided to his father was not in line with the standard of service we would expect. We have carefully considered the impact this had, and we have considered whether there is more we would have expected the ICB to do to put things right. Our view is that the ICB has taken some appropriate action to remedy the concerns Mr T has raised. The ICB has also agreed to undertake further action to help put things right.

4. We will explain the reasons for our decision below. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Mr T for sharing his father’s experience with us. It is also important to acknowledge that finding no indications of service failure, in relation to some aspects of this complaint, does not detract from Mr T’s family’s experience, or the upset and frustration these events clearly caused.