Case 200701674 - Cardiff & Vale NHS Trust and Health Commission Wales

Introduction

This report has been prepared under the Public Services Ombudsman (Wales) Act 2005 and the Health Service Commissioners Act 1993, as amended. To protect the privacy of those involved, details that might identify individuals have been omitted so far as that can be done without impairing the effectiveness of the report. The report accordingly refers to the complainant as ‘Mrs S’, and her daughter as ‘Miss S’.

Mrs S’s complaint concerns events that span the jurisdictions of the Public Services Ombudsman for Wales and the Health Service Ombudsman for England. Using provisions in their respective statutes, both Ombudsmen have agreed that a joint investigation leading to the production of joint conclusions and proposed remedy in one report seemed the most appropriate. Mrs S has agreed to this approach. Under paragraph 12 of Schedule 1 to the Health Service Commissioners Act 1993, the Health Service Ombudsman for England gave authority for the relevant staff of the Office of the Public Services Ombudsman for Wales to carry out some of her functions in respect of the investigation.

The report is published by the Public Services Ombudsman for Wales under section 25 of the Public Services Ombudsman (Wales) Act 2005.

The report is preceded by a summary.

Summary

Mrs S’s adult daughter, Miss S, lived in south Wales. However, while staying with a friend in the south west of England, she became depressed and developed anorexia nervosa. She came under the care of Plymouth Teaching Primary Care Trust (the PCT), initially as an out-patient and then, from October 2006, as an in patient. In October 2006 the PCT approached a consultant psychiatrist in Miss S’s home area (the Welsh Consultant) employed by Cardiff and Vale NHS Trust (the Trust) to ask him to take over her care. He declined. Miss S’s condition deteriorated further and she was referred to the local specialist NHS eating disorders unit (the EDU). The referral was accepted, subject to funding, and an application was made to Health Commission Wales (HCW) for this. HCW refused to fund the admission, principally on the grounds that Miss S had never been assessed by the services in Wales, and because no follow-up plan had been put in place for when she was discharged. Mrs S then elected to have Miss S admitted to a private eating disorders centre, where she, together with her daughter, funded Miss S’s care.

Mrs S complained to us on behalf of Miss S that the NHS should have funded Miss S’s care. She complained that the family had been forced to take action as Miss S’s condition was serious and deteriorating, and because it appeared that the question of which NHS body was responsible for funding was unlikely to be resolved quickly. She commented that it was out of the question for Miss S to have travelled to Wales for assessment, given her poor condition. Mrs S said that because of all this, she and her daughter were forced to use their life savings to pay for private treatment.

The Ombudsmen found maladministration or service failure in the following respects:

• HCW adopted an excessively inflexible approach to the request to fund Miss S’s in-patient care. In particular, HCW:

• failed to take into consideration all relevant factors (including that Miss S was not at home when she became ill and her only sources of social support were outside Wales);

• failed to take into consideration the valid opinion of an English Consultant when it was reasonable to do so;

• insisted that a detailed discharge or follow-up plan was in place when it was not reasonable in the particular circumstances to do so; and

• failed to communicate adequately its conditions for funding.

• The Trust unreasonably refused the request to take over Miss S’s care in October 2006.

• The PCT failed to provide short-term funding for Miss S’s treatment and thereby placed her at clinical risk.

The Ombudsmen concluded that the maladministration and service failure identified above caused Miss S and her mother injustice and hardship: they were clearly caused significant distress by the failure to resolve the funding issues appropriately and expeditiously as Miss S’s condition deteriorated rapidly, and they each spent considerable sums of money paying privately for treatment which the NHS should have funded.

The Ombudsmen recommended that HCW reimburse Mrs S and Miss S the money they had paid (approximately £31,000) for Miss S’s care, together with the interest they would have received had it remained in their accounts. They also recommended that all three bodies pay Miss S and Mrs S £250 each to recognise the distress they had been caused. The Ombudsmen also made a number of procedural recommendations which were addressed to HCW.

This investigation also identified a number of general concerns about the adequacy of provision for patients with eating disorders in the Cardiff and Vale area, and in Wales in general. The Ombudsmen therefore recommended that the Trust carry out an urgent review of the provision for eating disorder patients in its area, in conjunction with the relevant local health boards. The Public Services Ombudsman for Wales also recommended that the Welsh Assembly Government gives consideration to carrying out a Wales-wide review of the adequacy of provision for the treatment of eating disorders in Wales, both from an out-patient and in patient point of view.

HCW, the Trust, the PCT and the Welsh Assembly Government have agreed to accept the Ombudsmen’s recommendations.