COMPLAINT RECEIVED FROM MR LEONARD BEDDOWS WITH REGARD TO

ELDERHOLME CARE HOME

-
FINAL REPORT
lntroduction
Mr Beddows first raised concerns in 2008 regarding the care provided to Mrs D Beddows at
Elderholme Care Home which were resolved at the time. Mr Beddows raised further
concerns with the home in 2009 and via a formal complaint with Wirral PCT in 2011 that
remain unresolved.
Two investigations have been undertaken into Mr Beddow' s complaint
-
an Independent
Review* in February 2013 and a further investigation** in November 2013.
The purpose of the Independent Review was to determine if there was any evidence to
indicate that Mrs Beddow' s clinical care fell below expected standards during her residency
and review the actions taken by the Continuing Health Care Services in respect of its
commi ssi oni ng responsi bi l i ti es.
Several recommendations were identified as a result of this Report which included:
1. An acknowledgement from the PCT that the care
plan for Mrs Beddows should not be
altered, without a formal review of her care needs by the appropriate professionals, and only
when a formal review be indicated because there is a change in need identified
2. A review of the Care Home records at Elderholme to ensure the daily records are being
completed in line with the identified care plans of patients
3. A review of the record keeping of the CHC Team and entries on the data base
4. Training and development in relation to commissioning responsibilities of the PCT andior
CHC Team and the PCT' s responsibilities concerning the National Framework for NHS
Continuing Health Care.
5. An investigation into the response of Elderholme Nursing Home to Mr Beddow' s
complaint. This should include a review of the Home' s Complaints Policy.
6. A review of the payments made by Mrs Beddows in relation to her care. lt is clear that Mrs
Beddows care needs have not changed since discharge from Wirral Neuro- Rehabiliation
Unit. lt is not clear that all care costs have been met by the NHS.
*lndependent
Review of Health Aspects of complaint received by NHS Wirral from Mr Leonard
Beddows in regard to Mrs Doreen Beddows. Lorraine Norfolk Clinical Lead NHS Merseyside. 3'd
February 2013.
*"
Confidential Report on Complaint Received from Mr Leonard Beddows with regard to Mrs. Doreen
Beddow' s Healthcare During Her Residency at Elderholme Care Home. Mary Barlow, Clinical Quality,
Safeguarding& Performance Lead, Continuing Health Care/Complex Care Services, Cheshire and
Merseyside Commissioning Support Unit
A further investiqation and report was completed in November 2013 following
discussion with Mr Beddows which aimed to:-
1. establish that all the recommendations made from the first report had been
acknowledged and identify what actions had been undertaken as a result of these
fi ndi ngs;
2. examine the complaint processes for all relevant parties involved in relation to the
complaint made by Mr L Beddows with regard to Mrs D Beddows.
Terms of Reference for Final Report:
To investiqate and Explicitlv Respond to the Followins Matters Outstandinq from Both
Reports.
1) that Elderholme should have delivered Mrs Beddow' s care as stated in the care plan
and as agreed with Mrs Beddow' s Consultant;
2) that the home changed the care plan, specifically a reduction in the frequency of
observations, without the change being endorsed by GP/Consultant;
3) that Elderholme did not respond appropriately to Mr Beddow' s Complaints regarding
a) adherence and changes to Mrs Beddow' s care plan b) the Care Home Manager
HW.
4) To address the outstanding issues around appropriate funding of Mrs Beddow' s care
package by the NHS.
Background
-
Brief Timeline of Events
Mrs Doreen Beddows was transferred to the Walton Centre in June 1999 for acute
management having suffered a catastrophic intra-cerebral haemorrhage. She
underwent craniotomy and evacuation of the haematoma the same day as her
collapse. Her best post-operative neurological status was flexing to pain. Her
recovery was complicated by several chest infections. She was admitted to
Elderholme Nursing Home in October 2000 following discharge from Wirral Neuro-
Rehabi l i tati on Uni t.
At this time Mrs Beddows was described as being in a vegetative state and although
she experienced some spontaneous eye opening there was no evidence of
purposeful response to stimuli. She had a supra-pubic catheter and Percutaneous
Endoscopic Gastrostomy (PEG) feeding tube in place. She was diagnosed with
epilepsy and suffered seizures. Her care needs were clearly identified at this time
and management of care was prescribed by Specialist Registrar and Ward Manager.
Mrs Beddows required splints and passive exercises for her limbs to prevent the
development of contractures. She required the administration of multiple
medications and feeds; and monitoring of symptoms by a registered nurse, She had
a tendency to bite her lower lip and required oral hygiene. Repositioning was a
critical element to her care as she experienced vomiting if she was repositioned too
l
quickly after a feed and problems with breathing due to poor neck posture. She
required 3 people for all repositioning to ensure effective head control. Her optimum
time in a wheelchair was 4 to 5 hours. She also experienced excessive salivation.
She required careful monitoring of her bladder, bowels and skin integrity, and
required the use of anti-embolism compression stockings on a daily basis.
She was identified as requiring hourly monitoring for pain, signs of catheter
bypassi ng and si gns of detached PEG tube by a qual i fi ed nurse. She requi red the
supervision of a qualified nurse during all transfers between bed and chair, and
duri ng her weekl y submersi on bath.
Mr Beddows raised concerns with the Matron of Elderholme Care Home in April 2008
regarding his wife' s care, which were resolved following a meeting with the care home.
The Continuing Health Care Services reviewed Mrs Beddows in 2008 and the outcome
confirmed Mrs Beddows remained eligible for Continuing Health Care funding.
In May 2009 a meeting took place between the Assistant Home Manager, Mr Beddows and
the GP Dr Meyer. There is no record of the purpose of this meeting and the minutes made
by the GP reflect this.
On 11th September 2009 Mr Beddows wrote a letter of complaint to the Chairman of
Elderholme Nursing Home, Mr Rourke, about the treatment he had received from the
Matron. Mr Rourke responded on 8th October 2009 confirming reason for the
meeting and that the care staff would attempt to meet the targets of checking Mrs
Beddows every hour but stating that sometimes other demands on the corridor may
sometimes cause a delay.
Throughout 2010 there was on-going dialogue between Mr Beddows, the PCT and
Elderholme with reference to Mr Beddow's concerns regarding Mrs Beddow's care plan and
hourly health care checks. There is no evidence of any change in Mrs Beddow' s health care
needs and in November 2010, following a further review of her health care needs, Mrs
Beddows remained eligible for Continuing Health Care. During this meeting Mr Beddows
raised his concern that a recommendation for Mrs Beddows to be referred to Dr Pinder had
not been actioned.
In July 2010 Mr Beddows requested a copy of Elderholme Care Home' s Complaints Policy
and there is further reference made to Mr Beddows expressing concern that his complaint
was not being dealt with appropriately.
In 2011 Mr Beddows wrote to the PCT stating he had made one complaint to Elderholme
Care Home which he believed had never been investigated and he requested an
investigation by someone with medical knowledge
On the 1Oth April 2A12 a request was made by the PCT and Social Services to Elderholme
Care Home requesting an investigation and concerns raised by Mr Beddows. There is
evidence of a subsequent telephone call and letter in response to this request. The letter
was sent to the NHS Wirral Senior Complaints officer on 16th April.
)
ln June 2012both the PCT and Social Services wrote to Mr Beddows confirming their
agreement to commission an independent review to examine the safeguarding concerns and
' eviction'
of Mrs Beddows. There is a
joint
apology given to Mr Beddows in
acknowledgement of the distress caused to him.
There i s no evi dence i n the records that El derhol me Nursi ng Home made a response
to the letter from the PCT.
Mr Beddows' Outstandi nq l ssues of Compl ai nt
Gomplaint Elements 1& 2: That Elderholme should have delivered Mrs Beddow' s care as
stated in the care plan and as agreed with Mrs Beddow' s Consultant; that the home changed
the care plan, specifically a reduction in the frequency of observations, without it being
endorsed by GP/Consultant;
Findings: LN' s report states the following:-
' The
care plan for Mrs Beddows was prescribed in her discharge plan from neurological
services, and has been reinforced as appropriate by the previous Matron in her response to
Mr Beddows i n 2008.'
LNs' review identified that due to poor record keeping it was not possible to evidence that
care was given in accordance with the care plan. She states:-
' lt
is the opinion of the
reviewer that due to the lack of consistent record keeping clinical care was compromised
and fell below expected standards' .
In 2008 the Matron of Elderholme wrote to Mr Beddows and agreed to provide hourly
observations in accordance with Mrs Beddow' s care plan. The Nursing Home Care records
from May 2010 indicate that the care plan changed from hourly observations required to
' continue
as much as possible' ; by June 2010 the care plan no longer states hourly checks
required. There is no evidence available that this change was endorsed by Mrs Beddow' s
GP or Consultant.
LN' s report states that the
' Care
plan should not have been altered (ie hourly checks
stopped) without an assessment of Mrs B' s care needs.' In addition, the report states that in
January 2010 the' PCT CHC nurse recorded in the Elderholme notes the recommendation to
the GP that Mrs Beddow' s care needs to be reviewed. This recommendation was also
recorded in the PCT records.' The report further states that in the PCT response to the MP
on July 1l^ 2011 the comment that (there was) no record of a recommendation of refenal
was therefore incorrect.'
Mr Beddows wrote to the PCT regarding the amended care plan in September 2011 but
there was no reply.
ln response to a further letter to the PCT on 2719/11 the CHC Manager stated that it was
' inappropriate
for the PCT to direct care given.' lt is the view of the author that this was
incorrect given the PCT' s responsibilities as a commissioner of Mrs Beddow' s care package.
5
LN's report states that in May 2010, Mr Beddows informed the PCT that Matron had
advised him that hourly checks would no longer be implemented and referred to the
home not getting extra payments.
The report states:
'As
Mr Beddows understood a referral was being made to Dr
Pi nder he spoke to the GP because he thought an updated nursi ng needs
assessment could be undertaken. The GP confirmed that he had not received a
referralfrom the home to contact Dr Pinder. Mr Beddows states that GP Dr Meyer
spoke to Matron the same day and that Matron reinforced to him that the hourly
checks would not be continued as the care plan had been written by the previous
Matron and she did not have to follow it. Mr Beddows also states that the Matron
informed Dr Meyer that she had not asked the GP to refer Mrs Beddows to Dr
pinder
because after further discussion with other nurses they felt a referral to Dr Pinder
was unnecessary as Mrs Beddow's care needs had not changed. Dr Meyer told Mr
Beddows that he agreed with the Matron. LN was unable to establish from the
records if the GP agreed with Matron that a referral was not required and/or that Mrs
Beddows care needs had not changed. The records reflect that Mrs Beddows care
needs had not changed and therefore there is no indication that a change in care
plan
was required.
LN's report concluded that
'until
a review established that a change in care plan
was
required the existing plan should remain unchanged. The PCT should have insisted on this.'
In addition, in a letter written to the PCT by Mrs Beddow' s GP Dr Meyer, on 4th July 20' t 2, he
states the following:-
5) Heather ward complaincd
to me that Mr. Beddows,
was insisting
on his rvife
being
checked
every
how' Mr. eeddows
s.iJ trrit
irliir- i" ih3 care plan
but was not al*ays
done'
I was invited.to
a meeting arronged
between
G cgc re8m,
Elderholrne
ard Mr.
Beddows
callcd to discuss
lo'rli.r,tor.ing
which
nrJu.J"
,loo,fr;'ff#iirorn..
I could
not attend
but I was sent a copy
of
g.
[i1ut.s.
& p"gu
three. paragraph
E Heather
s'ard
savs
'.u'l
aiways
check
ilu,iy.-."nd
iT
;:r;;;"0,
,o
pudi;;
fi;t
[NHS)
says
o'can
evaluations
!: S.l:
showing what care nai Ueen delivered...
On page 4 paragraph
5
Heather
ward states
"wilr do wtaitras
been agree;',.--'
--
I have
seen the letter fiom
Elderholme
written
sometime.lftei
the
meeting in which
they
sugg$t that checking
l\ttrs. Beddows
w.iren giving
iur **oi"uti";Ib;;;iG
per
24 tus. is considered
regularenough'.ln
my opinion u puti"ii
h iG;, Beddows,s
concrition
in abed
with detachable
side rsils is
"t
rist anu
gitulrline roui ii*., per
24 hrs is insufficient.
ln
March z0r r tr ssw scvcre.
bruising to turtr. a"aio;'s"fuot'which;;;;;xprained
by
staffbut
was
consistent
with havirig
been trapped
in the side rairs of the bed.
This clearly indicates that the minutes evidence HW's commitment to check Mrs Beddows
hourly, CHC Nurse's request for evidence of care given and HW's subsequent agreement to
comply with this request.
6
Compl ai nt El ements 1 &2
-
Goncl usi ons
.
Elderholme should not have changed the care plan without a review of Mrs Beddow' s
care needs by the GP or Consultant; evidence clearly indicates that this happened.
r
There is evidence in the GP' s letter of minutes of meeting between Mr Beddows,
CHC Nurse and HW, Matron of Elderholme in which HW says
' will
always check
hourly' - however, there is no evidence this was acted upon; Elderholme therefore
failed to deliver the care package as proscribed by the PCT and from the GP' s
perspective presented a risk to Mrs Beddow's safety.
.
There is evidence in the nursing home and PCT records that the CHC Nurse
recommended referral to the Consultant; however this was not done by Elderholme.
o
The PCT failed:
a) to acknowledge its responsibility as commissioner of Mrs Beddow' s care package
by stating that it was inappropriate for the PCT to direct care given, failing to
follow up the request for a consultant referral;
b) by providing incorrect information in its letter to MP of 11th July 2011 regarding
PCT records related to the request for a consultant referral.
Complaint Element 3: That Elderholme responded inadequately to Mr Beddow' s
Complaints regarding a) changes and non-adherence to Mrs Beddow' s care plan and
b) the Care Home Manager HW.
Fi ndi ngs:
Mr Beddows states in his letter to Wirral PCT on 8th December 2011 that he has made six
complaints to the home in eleven years and all but one concerned failure to adhere the Care
Plan. He states that since 2009 he had made one complaint about the Matron giving his
wife' s GP false information and being aggressive towards him.
LN' s report identifies the following:-
' Mr
Beddows initially raised concerns with the Matron, Christine Whiteside, at
Elderholme Care Home about the standard of care for his wife in April 2008. He
eventually wrote to Matron on 16th May 2008 following her invitation to make an
appointment to meet. A meeting was held on 20th May 2008, and the Matron wrote
to Mr Beddows on 22nd May 2008 to clarify the outcome of their meeting. All issues
raised were discussed, clarified and a clear plan of action was agreed.'
There is a theme running throughout LN' s report re-concerns being expressed by the
home to the PCT regarding perceived inadequate funding for Mrs Beddow' s care
package. During a visit to the care home on 24th October 2008, Nurse Assessor from
the Continuing Health Care Team, Alison Aldcroft, was approached by Mr Beddows.
She recorded that Mr Beddows informed her that he was aware of the funding issues
and raised concern that the care of his wife may be affected. Mr Beddows
expresses this concern on a number of occasions in subsequent years.
LN' s report describes how
' on
11th September 2009 Mr Beddows wrote a letter of
compl ai nt to the Chai rman of El derhol me Nursi ng Home, Mr Rourke, about the
''t
I
treatment he had received from the Matron. He stated he remained upset by the
events earlier in the year and felt his relationship with the Matron was not
satisfactory and that he was entitled to receive dignity, respect and kindness from
the Matron. He requested an explanation to the events discussed at the meeting in
May (2008) with particular reference to the manner in which the meeting was
convened and the attitude of the Matron. Mr Rourke responded to this letter on 8th
October 2009. He confirmed that the meeting had been called because they had
received a complaint from a member of staff and also because Mr Beddows
'was
continuously querying and questioning the care of the professionals at the home'.
Mr Rourke confirmed that the care staff would attempt to meet the targets of
checking Mrs Beddows every hour but stated that sometimes other demands on the
corridor may sometimes cause a delay. He went on to explain that the home
'receives
the same payment for Mrs Beddows as for every other patient on the
corridor and therefore their care must be realistic and proportionate'. Mr Rourke also
stated that he'doubted the care for Mrs Beddows would be better in any other home
but you are free to transfer her if you so wish. For the future, I trust you will desist
from the constant interfering with the professional care of your wife, and should you
have a point to make or suggestion then it should be directed to the Matron only, and
i f thought fi t, Mrs Beddow' s GP.
On 28th October 2009, Mr Beddows and Matron met in an attempt to resolve the on-
going issues. There is no evidence in the records to support that the issues were
resolved at this time.
There is a copy of a letter dated 1" July 2010 in the records written by Mr Beddows
to the care home. He asks for clarity as to whether the letter he received from the
home dated 8th October is the home's full response to his complaint. He requested a
copy of the home's complaints procedure and reiterated his concerns. There is no
record of a response from the care home to this letter in the PCT files.
On 30th November 2O1O a review by the CHC Team was undertaken. Prior to this
various email and letter correspondence was sent to the PCT in which Mr Beddows
indicated that there remained issues with how his wife's care was being managed.
He also outlined concerns in terms of the relationship between care and the care
fees. He also identified the remaining outstanding issue of complaint with regard to
the recommendation that a referral be made to Dr Pinder and the subsequent
decision not to do so by the Matron. He felt that this issue remained unexplained.
Mr Beddows received a letter from the Director of Elderholme Nursing Home, Mr
Woods, on 23'd December 2010 outlining the basis of a discussion held in relation to
Mrs Beddows. lt is assumed that the discussion referred to was that between Mr
Beddows, Mr Bri an Woods, Di rector of El derhol me, and Mr Bri an Rourke, Chai rman
of Elderholme in December 2010. Mr Woods indicated that his understanding of the
7
mi nutes from the meeti ng i n Jul y 2010 was that the hourl y checks coul d be
dispensed with, and that Mr Beddows agreed to this. He suggested further
discussion with the Matron and the PCT staff should any further clarification be
requi red.
Mr Beddows wrote to his MP, Alison McGovern 28th December 2O1O in which he
referred to the December meeting with the care home director and chairperson. Mr
Beddows seemed assured in his letter that the nursing home would reinstate the
care plan in relation to hourly checks of his wife's needs. However, he did express
some concern that his complaint was not being dealt with properly.
ln addition, referring to a recent review carried out by CHC nurses, Mr Beddows
stated that the nurses felt that the difficulties with the Matron were related to
differences in personalities. He stated in his letter that he did not agree with this and
gave an example of how the inconsistency in monitoring his wife can affect her care.
Mr Beddows stated he felt he had exhausted the complaints policy of the care home,
and had received no support from the Care Quality Commission or the Local
Authority. Toward the end of his letter Mr Beddows refers accurately to the
descriptions of previous statements made to him in letters from the nursing home.
f n a letter to his MP dated 9th May 2011 Mr Beddows stated that he had only made
one direct complaint to the care home in September 2011 and that related to the
alleged behaviour of the Matron toward him. Mr Beddows describes examples of
responses made to him by the care home accurately. He outlines the areas of his
concern and his dissatisfaction with the Care Quality Commission's and Local
Authority's response to his complaint.
On 16th May 2011 the PCT i s asked to provi de a response to MP Al i son McGovern i n
relation to the issues outlined in Mr Beddow's letter. A letter of response dated 11th
July 2011 stated that information has been gathered from Mrs Beddows GP and also
the relevant Heads of Service in NHS Wirral and Wirral Community NHS Trust. The
letter outlined the instructions given by the Dietetic Service in relation to a call from
the care home. The RGN at the home had contacted the service as she was
concerned that the fluid intake was too high in relation to fluid output. lnformation
was also provided in relation to the continence service and its response to issues
related to the supra-pubic catheter. Both services clarified that they did not make
any complaints about Mr Beddows. Dr Meyer provided a response that stated he
was happy with the care the home was providing to Mrs Beddows. He also indicated
'great
respect' for Mr Beddows in overseeing his wife's care and remarked that Mr
Beddow's concern to do the very best for his wife was commendable. Confirmation
was also provided in relation to reviews undertaken by the CHC Team and that no
complaints had been received in relation to the medical care given to Mrs Beddows.
q
However, the confirmation that there was no record of a recommendation made to
refer Mrs Beddows to Dr Pinder was inaccurate. There is evidence that this was
recorded on both the nursing home notes and PCT records electronically and in the
case file. ln fact, this recommendation delayed the case being prepared for panel as
Pauline Hurst wished to have the information from the outcome of this referral to
complete her presentation.'
ln Dr Meyer' s letter to Wirral PCT on 4th July 2012 he refers to a meeting in July 2011
,
called
by the Care Home Manager to discuss Mr Beddow' s expectations. In Dr Meyer' s view, it was
apparent that Mr Beddows was not aware of the reason and it was very intimidating for him.
He also states that it was apparent that Mr Beddows did not expect to be present when the
GP visited in spite of the Care Home Manager' s assertions to the contrary. He further
accepts Mr Beddow' s statement that the Care Home Manager was aggressive stating she
' sat
close to him, interrupted him on several occasions without letting him complete his
sentences... spoke down to hi m.' Dr Meyer reports that he' di d i ntervene when he (Mr
Beddows) became quite upset over the accusations that were being made' and
subsequently called an end to the meeting.
Dr Meyer' s letter further states that the Care Home Manager (HW) informed him that the
Dietetics Department had made complaints that Mr Beddows was interfering in care of his
wife. From the PCT letter dated 11th July it is confirmed that Elderholme informed the
dietetics department that Mrs Beddows was passing too much urine. However, Dr Meyer
states he was not informed of this and further expresses the view that if Mrs Beddows was
passing
too much urine he would have expected to see this accurately recorded on a fluid
balance chart; he notes that the only such chart he has seen at Elderholme recorded fluid
input only. He goes on to confirm that no complaints were made to him from the Dietetics
Department and notes that the PCT letter of 11th July confirms no complaints were made at
al l .
Dr Meyer' s letter states that the Care Home Manager complained to the GP that' Mr
Beddows had been insisting on three people to transfer his wife' ; Dr Meyer verifies that this
is the requirement in original discharge letter from Walton Neuro Rehabilitation Centre.
Dr Meyer reports that on Sth September 2011 when he visited Elderholme the Care Home
Manager asked him to countersign a
' Do
Not Attempt Resuscitation' form. Dr Meyer reports
he asked the Manager if she had obtained Mr Beddow' s consent which she confirmed so he
duly signed the form. Mr Beddows later telephoned Dr Meyer and informed him that the
DNAR form had not, in fact, been discussed with him. As a result Dr Meyer telephoned
Elderholme and instructed them to destroy the form and confirmed the instruction in writing.
On 26th September Mr Beddows wrote to Mr Khan (Head of CHC PCT) via email
asking for a response to his earlier letter by 2no October 2011. In his response dated
27th September 2011, Mr Khan wrote that the PCT are happy that Mrs Beddows is
appropriately placed at Elderholme and acknowledges the point of tension about
how the care is delivered.
He stated that it would be inappropriate to direct how the care is given by the home
and informed Mr Beddows that the matter did need to be dealt with by himself and
the home.
/ d
ln November 2011the PCT received a letter from Lawson Stebbings, Chief Executive
Officer, Elderholme Nursing Home informing them of formal notice given to Mrs
Beddows citing her husband's conduct as the reason for this. A strategy meeting
was held and the PCT met with Mr Beddows, along with Local Authority Colleagues
on 18th November 2011. On 23' d November2011 the PCT recei ved an emai l from
the MP Alison McGovern's office to inform them that Mr Beddows does not feel he is
getting support from the PCT.
On 25th November 2011 Mr Beddows solicitor wrote to Elderhome to request a
withdrawal of the eviction notice and stating that they will seek Court of Protection
and decision by a High Court Judge. A request for a written decision is made by 28th
November 2011. A response i s made by El derhol me Nursi ng Home the same day
stating the eviction notice is irrevocable. Mr Stebbings states that
'in
the light of an
independent advocate being appointed for Mrs Beddows and the involvement of
Wirral Social Services the demands of the solicitor are unnecessary and premature
as are the suggested recourse to the courts.'
Mr Khan, PCT, spoke to GP Dr Meyer on 28th November 2011 in relation to Mrs
Beddows and the potential move to another care home. Dr Meyer felt that Mrs
Beddows would become distressed by a move. Dr Meyer explained that whilst Mrs
Beddows was diagnosed as being in a Persistive Vegetative State she did respond
to touch, was fami l i ar wi th her surroundi ngs, and di d respond to si mpl e questi ons by
blinking her eyes. Although Dr Meyer felt it would not be in her best interests to
move, she was medically fit to move. Mrs Beddows transferred to Vale Court
Nursi ng Home on 6th December 2011.
MB's report examined Elderholme's records of complaints and states that lhe last
complaints were logged0810112013 and 2210312011 both were resolved.' However, Mr
Beddows wrote a letter of complaint in September 2011 which appears to have not been
recorded by the home. Given the apparent constant dialogue and correspondence between
Mr Beddows and the home regarding his concerns around Mrs Beddow's care plan this is a
significant gap in the home's records.
MB's further states that
'in
examining the complaint processes involved in relation to the
complaint made by Mr L Beddows with regard to Mrs D Beddows in April 2008 the lack of
evidence available would suggest this was not managed in an appropriate manner.'
However, it is the view of the author of this report that MB was referring to Mr Beddow's
complaint made in September 2011 rather than April 2008.
MB concludes that' there have been substantial improvements in the complaints process (at
Elderholme) since the original date which is also acknowledged by both CQC and Social
Services in subsequent monitoring visits and reports.'
i t
Compl ai nt El ement 3
-
Concl usi ons
Mr Beddows states in his letter to Wirral PCT on 8th December 2011 that he has made six
complaints to the home in eleven
years and all but one concerned failure to adhere the Care
Plan. On reviewing the evidence it appears that:-
r Elderholme have failed to acknowledge that Mr Beddows was correct in requesting
that the home adhere to the care
plan as agreed with her Consultant and/or GP;
o Whilst the home appears to have been proactive in arranging meetings with Mr
Beddows to resolve his concerns it appears to have failed to adhere to commitments
made at those meetings.
o
there is evidence from Dr Meyer that one meeting in particular was managed
poorly
by Elderholme in that Mr Beddows did not know the
purpose of the meeting and the
Matron, HW, reportedly behaved in an aggressive manner towards Mr Beddows,
interrupting him and speaking down to him. Dr Meyer reported that he had to call an
end to the meeting.
r There is evidence that some held the view, including the PCT, that there was a clash
of
personalities and tensions between Mr Beddows and the Matron HW although
there is evidence Mr Beddows disagreed with this'
o There is evidence from the GP Dr Meyer, that the Matron HW made unsubstantiated
accusations that
professionals involved in Mrs Beddow' s care had complained about
Mr Beddows;
r There is evidence that the Matron HW complained to Dr Meyer that Mr Beddows was
insisting on three
people to transfer Mrs Beddows when this was a requirement in the
discharge
plan from walton Neuro Rehabilitation centre'
o There is evidence that the Matron HW informed the GP Dr Meyer that Mr Beddows
had consented to a
' Do
Not Attempt Resuscitation' order; Mr Beddows subsequently
denied having
given consent.
. lt is the view of the author that it was inappropriate
for Elderholme
to insist
that Mr Beddows raised his concerns with the Matron, HW, when she was the
source of one element of his complaint and there was evidence
the
relationship between them had broken down'
o The
pCT
failed to intervene and resolve Mr Beddow' s complaints
regarding
Elderholme
which, as commissioner
of Mrs Beddow' s
package of care, it should
have done.
o Elderholme appears to have incomplete complaints records since Mr Beddow' s
complaint of September 2011 does not appear in it' s records.
Gomptaint Element 4: To address the outstanding issues around appropriate
funding
of Mrs Beddow' s care
package by the NHS'
There are a number of references in the evidence that from June 2008 up to the date of
discharge from Elderholme, there were
points of contention between the home and Wirral
PCT around whether the funding for Mrs Beddow' s care
package was adequate to meet her
IL
needs as identified in the care plan.
There are also a number of references to Mr Beddow,s
concerns that this was having a detrimental effect on her care.
The evidence indicates that Mr Beddows first raised concerns with a CHC Nurse Assessor
that the care of his wife may be affected by the funding issues in October 200g. She
reassured him that the review of care needs which took place
on 1Oth November 200g would
identify all care needs. The outcome of the review clarified that Mrs Beddows remained
el i gi bl e for NHS Conti nui ng Heal thcare fundi ng.
At a meeting in May 2009, the Matron made reference
to the level of care for Mrs Beddows
in relation to the number
of residents in the home, and in comparison to a patient
in intensive
care.
Evidence indicates that the care home continued to raise concerns about payments
for Mrs
Beddow' s care during 2009 including a letter from the Director of Elderholme who stated
,Mr
Beddows continues to insist that the protocol
laid down by Walton Neurological
Unit is
executed to the letter. Furthermore,
he insists he is present
whenever
any procedure
is
carried out on his wife and is at pains
that his requests are made within the agreement
before his wife came to us. For example, it takes lTzhourswith
him present
to bath his wife
where he insists Care Assistants and Registered Nurses are present
on each occasion.
Therefore, in each case, I believe Elderholme is entitled to a reasonable
increase in fees
bearing everything in mind and I trust you
will take a personal
interest in this request,. The
PCT wrote to the care home on 20th August 2009 and confirmed the funding arrangements
for Mrs Beddows as correct.
In a letter to Mr Beddows in october 2009, Mr Rourke Chairman of Elderholme, confirmed
that the care staff would attempt to meet the targets of checking Mrs Beddows every hour
but stated that sometimes other demands on the corridor may sometimes cause a delay. He
went on to explain that the home
' receives
the same payment
for Mrs Beddows as for every
other patient
on the corridor and therefore their care must be realistic and proportionate,.
ln May 2010, Mr Beddows wrote to the PCT, via email, following a conversation with Matron
HW' Mr Beddows stated that Matron wanted to discuss the issues of hourly checks and
subsequent recording on charts and expressed concern that the care needs of his wife are
being compared to other residents in the home and the fees that are paid.
On 1Oth June 2010 the Director of Elderholme,
Mr Woods, wrote to Mr Beddows in relation to
the care fees and stated that the original funding for care was transferred from Arrowe
park
to the Primary Care Trust in 2008 so that from this point
Mrs Beddows care was funded
through NHS Continuing Health Care. Mr Woods informed Mr Beddows that if he wants
additional care for his wife then he should
' make
out a case and submit his findings to the
Primary Care Trust as the purchasing
authority.' A copy of the letter was sent to
pauline
Hurst at the PCT vi a emai l on 13th June 2010.
Compl ai nt El ement 4: Concl usi ons
'
There were clearly unresolved tensions between Elderholme Nursing Home and
Wirral PCT regarding
whether the level of funding for Mrs Beddow's care package
was sufficient to meet her needs.
t i
.
Wirral PCT did not adequately address the funding issues with Elderholme; the PCT
should have facilitated a timely resolution informed by an up to date care plan which
had been signed off by the Consultant;
o
As a result of the PCT' s poor management of this situation, Mr Beddows was left to
engage directly with Elderholme to ensure appropriate levels of care were provided.
Report Recommendations :
r
That Wirral CCG write a formal apology to Mr Beddows for the above failings of the
predecessor PCT which undoubtedly contributed to the distress experienced by Mr
Beddows;
o
That Wirral CCG, as commissioner of existing packages of care at Elderholme Care
home, meet with Senior Representatives at Elderholme Care Home to discuss the
findings of this report and agree what action they need to take to resolve
Mr Beddow' s complaint and bring closure.
Yvonne Lochhead
Head of CHC/Complex Care
Cheshire and Merseyside CSU
February 2014.