Case 200800779 - Carmarthenshire Local Health Board

SUMMARY

Mr A complained that Carmarthenshire Local Health Board (“the LHB”) did not make its decisions clear and failed to commission the necessary care, for his son, Mr B, after the latter was deemed eligible for full NHS continuing care.

Mr B suffered a major brain injury in 2006. He left hospital in 2007. A multidisciplinary team had concluded that Mr B was eligible for continuing care and required stated amounts of physiotherapy, occupational therapy and speech and language therapy.

Some of the package of care was arranged with core NHS services and the LHB commissioned some further input from NHS providers. However, a large part of the package was not provided to Mr B. He did not receive sufficient physiotherapy, occupational therapy and had no speech and language therapy. After a number of representations were made to the LHB, Mr A eventually funded much of the shortfall privately.

Mr A submitted a complaint about the LHB. This was reviewed by the Independent Review Panel. The review found that the LHB had mishandled its response to Mr B’s case in the light of the multidisciplinary team’s assessment of his needs and eligibility for continuing care. The LHB accepted the review’s findings.

Mr A made the complaint to the Ombudsman because Mr B had not received the level of service that he required according to the multidisciplinary team. The investigation by the Ombudsman involved collecting large amounts of documentary evidence, interviewing Mr A, LHB officers and providers of care to Mr B. The Ombudsman also took expert advice from one of his professional advisers.

The Ombudsman found that the LHB’s written decision making was very confusing and that Mr A and NHS providers of care were left unclear about Mr B’s status in terms of continuing care. However, his central conclusion was that the LHB failed to commission sufficient services for Mr B to meet his assessed needs and did so, without adequate justification. As such, Mr B lost out on some of the care he needed and Mr A spent large sums of money when he should not have needed so to do.

The Ombudsman upheld the complaint and made a number of recommendations. These included financial redress to Mr A and Mr B and a new multidisciplinary assessment of Mr B’s needs. The successor body to the LHB, Hywel Dda LHB, has agreed to implement all the recommendations.