The ICB declined the checklist dated 15 June 2023
13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
14. Section 122 of the National Framework outlines who can complete the checklist tool. It says it can be completed by a variety of health and social care practitioners, trained in its use, for example a GP, registered nurse or social worker.
15. Mr O’s representative says a community nurse completed the checklist, and the representative in attendance only populated the form on her behalf because she did not have a checklist document. They say the community nurse reviewed the information in the checklist to verify its accuracy before signing and submitting this to the ICB.
16. We understand that the community nurse meets the requirement of being a healthcare professional, in line with the National Framework. However, verifying the form is different to the healthcare professional assessing Mrs O’s needs and completing the form themselves, detailing the needs in their own words. The nurse stated in the covering email that the checklist was completed by the representative, confirming Mrs O was not known to her team but that ‘it was advised the form had to be submitted by a healthcare professional’. This indicates she sent the form as a formality rather than that she had assessed Mrs O. It does not indicate she completed the form, as the National Framework states must happen.
17. The representative says the ICB allocated this community nurse so they must have been trained in completing a CHC checklist. We have not been able to verify if that was the case. But even if it was, this does not mean the checklist was completed in line with the National Framework. We have not looked at whether the ICB had sent the nurse to do the checklist or whether the nurse should have known more about the process. That is not part of the complaint to us.
18. Regardless of the healthcare professional’s experience in completing checklists, and being trained in the use, the checklist document itself strongly indicates the nurse had little involvement in the completion of the form. They signed it stating they were only ‘present throughout assessment’ but said it had been completed by the representative. This does not suggest the nurse did the assessment, but simply that they were there. The ICB said it spoke to the nurse directly and they ‘firmly established they did not complete the checklist’.
19. We understand Mr O’s frustration that the ICB declined the checklist on this basis. Based on the evidence available, the ICB had genuine, justified concerns that the checklist was not completed in line with the National Framework.
20. We have also considered the ICB’s second reason for declining the checklist, that the person completing the checklist had not obtained appropriate consent, or documented a best interest decision if it proceeded on that basis. Our Principles of Good Administration say public bodies must follow their own policy and procedural guidance, whether published or internal. The ICB was following the National Framework when it was checking the correct process had been followed, including whether consent had been obtained, and if not whether a best interest decision had been appropriately completed and recorded in line with paragraph 89. Where someone has authority to make the decision, for example with Power of Attorney, the assessor should request sight of a copy to confirm this. There is no indication the nurse did this at the time.
21. The ICB says on receiving the checklist from the nurse, it was not provided with consent or a signed form of authority for the representative to act on Mrs O’s behalf or any Power of Attorney relating to Mrs O, indicating who could act on her behalf if she lacked capacity. It says it only received this on 10 July from Mrs O’s representative following an email exchange. This should have been something the assessor considered at the outset before proceeding with the checklist.
22. There is no indication consent was established before the ‘assessment’ went ahead. Mr O says they had made a best interest decision. But the nurse did not document this so it is not clear how the decision around capacity and consent was reached beforehand. This is not in line with the National Framework. Therefore we can again see the ICB had genuine and justified reason to question the consent and decline the checklist on that basis.
23. Overall, when we weigh up the evidence, we have not seen indications of failings by the ICB. We think it was right to question the process. It appears to have acted in line with our principles and the National Framework.
24. We hope our decision does not in any way diminish the impact on Mrs O at the time, and her family, of not having not having a completed assessment. We understand this was frustrating for Mr O and that unfortunately this matter was not resolved before Mrs O sadly died.