Summary: Mr C complained about the time taken for Mrs Y’s carers to be trained to take over applying leg wraps from the practice nurse. He says this caused him time and trouble because he had to regularly take Mrs Y to the nurse at the GP’s surgery for this. We find the Care Provider did not follow up the training as soon as it could have done but this was not sufficient to say it caused injustice.

The complaint

1. The complainant, whom I shall call Mr C, complained that it took too long for his mother’s (Mrs Y’s) care provider, to organise training for care workers on how to apply her leg wraps. Mr C says this resulted in time and trouble to him, because he had to regularly take Mrs Y to the nurse at the GP practice instead.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
4. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)

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How I considered this complaint

5. I considered information from both Mr C and the Care Provider.
6. Mr C and the Care Provider had an opportunity to comment on my draft and revised draft decisions. I considered their comments before making a final decision.

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What I found

7. Mrs Y lived at home and was supported by her sons who were both involved in these events. I have referred to Mr C and his brother collectively as Mr C throughout this decision as they were both involved and it is not necessary to differentiate.
8. Mr C asked Mrs Y’s care provider, Sarah’s Carers, to provide support with Mrs Y’s leg wraps from March 2021 onwards. He said the nurse at Mrs Y’s GP practice confirmed she was happy to train Mrs Y’s team of care workers but nobody from Sarah’s Carers contacted her to arrange this. Mr C continued to take his mother to the GP practice once or twice per week to manage this.
9. An email dated 19 March 2021 sent to Mr C, said Mrs Y’s care workers would need training from a district nurse to apply Mrs Y’s leg wraps, as they are a specialised garment. This came from one of the current owners of the LA Carers Limited, who worked for Sarah’s Carers at the time. On 24 March 2021, an email to Mr C about this came from the LA Care email address although others continued to come from Sarah’s Carers.
10. The leg wraps for Mrs Y arrived at the end of March 2021. Mr C told Sarah’s Carers that the practice nurse said a care worker could attend a bandaging session to see how she does it. In response, Sarah’s Carers said it was trying to get more information from the district nurses about getting training for the care team. They explained the care team would have to have formal training that would need to be signed off. As such, it would be best if the training would be provided officially by the district nurses.
11. On 17 May 2021, LA Carers Limited (the Care Provider) officially took over Mrs Y’s care following its purchase of the care agency previously known as Sarah’s Carers. The Care Provider is keen to establish that it was not responsible for the initial stages of these events. However, the initial stages are important for context and since this period could not be construed as a time of delay, it is not necessary to clarify who was responsible.
12. In June 2021, the nurse at the surgery told Mr C that the NHS Continuing Healthcare (CHC) team advised it had given the Care Provider details of a private trainer. It said the Care Provider “seemed reluctant” to take this part of the care on. There is no evidence to support that the CHC team had given the Care Provider this information. Nor is there any evidence that the Care Provider was “reluctant” to complete training or take over the care.
13. The care of Mrs Y’s legs requiring application of wraps was the responsibility of the NHS. Even if the Care Provider had been trained and taken over applying the wraps, this would still be subject to approval by the NHS and monitoring of competency. The ultimate responsibility would have remained with the NHS.
14. The NHS Continuing Healthcare (CHC) team told the Care Provider on 23 July 2021 that its admin team would organise some training dates as soon as possible. The Care Provider received an email three days later from CHC with a training referral form attached. The email said CHC would send this to its nurse trainers as they were not sure the practice nurse would have capacity to train the care team. The Care Provider completed the form and returned it to the CHC by email the same day.
15. The Care Provider said it did not hear anything further from the CHC until April 2022. It accepted this delay because, due to the ongoing Covid-19 pandemic, face to face training was not allowed. The practice nurse was still wrapping Mrs Y’s legs as needed, so there was no risk.
16. The Care Provider told me Mr C had said the practice nurse proposed that the entire care team could come to the practice to receive the training in one go. However, it said it risk assessed this and decided it would not be in the best interest of the business. It said the practice nurse never contacted them directly about this.
17. The records show that Mr C did not raise this with the Care Provider as an issue during Mrs Y’s care review in December 2021.
18. The CHC team explained that due to the COVID-19 pandemic, there had been a very long delay with all training referrals.
19. A nurse practitioner agreed in May 2022 to provide training. The Care Provider told Mr C that the NHS said it could not explain why they had not replied to the training request forms the Care Provider had sent in July 2021, but the CHC team believed the forms must have got lost somewhere at their end. The CHC team acknowledged this and apologised.
20. The Care Provider continued to chase the CHC team. The training happened on 30 June 2022, but the support could not start until the funding had been put in place. CHC had not done this by 22 July 2022, when Mr C gave notice to the Care Provider to end their support.

Analysis

21. Sarah’s Carers took the right steps in 2021 in response to Mr C’s request for it to take care of his mother’s leg wraps and submitted a ‘shared care’ training referral. It was not appropriate for Sarah’s Carers or the Care Provider to contact the nurse at the surgery to make informal arrangements. After it sent this referral in July 2021, it did not chase the CHC until April 2022 (8 months later). We know CHC were under pressure and there had been long delays with referrals. Repeated chasing under such circumstances is not helpful. I consider it would have been best practice to follow up after maybe three months or so. However, the Care Provider was not in control of CHC’s availability, and we do not know whether chasing sooner would have reduced the waiting time. I cannot therefore say this caused any injustice.
22. In April 2022, the Care Provider tried to organise the training with the CHC as soon as possible. Despite the Care Provider’s continued chasing, this still did not achieve training until the end of June 2022 and still no funding. The Care Provider could not take over this aspect of care without funding formally agreed and in place. I found no injustice here.
23. The Care Provider responded to Mr C’s ongoing concerns about the training by raising a formal complaint, which is good practice in such circumstances. However, Mr C found this unhelpful and rather than help, it inflamed the situation. Mr C said this complaint was not asked for by the family. However, he subsequently brought his complaint to the Ombudsman.
24. The Care Provider did not signpost Mr C to the Ombudsman at the end of its complaint process. It is good practice to include this information in its final response to a complaint. However, this information was available to Mr C within the Care Provider’s information held in Mrs Y’s home. The Care Provider signposted Mr C to this and therefore I find no injustice here.
25. While the Care Provider did not deal with these events perfectly, it was not sufficiently flawed to cause injustice. Although its relationship with Mrs Y seems to have been good, its relationship with Mr C was tense and, on the balance of probability, this led to an unnecessary escalation of concerns.

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Final decision

26. I have completed my investigation and do not uphold Mr C’s complaint.

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Investigator's decision on behalf of the Ombudsman