Decision report 201202915

Summary

Mrs C's daughter (Miss A) has a rare disorder affecting her joints. Since 2010, Miss A has had the support of iCare (a subsidiary of the health board) a respite service for children and young people with complex needs. The care is delivered at home and, to qualify, clients need to meet six health indicators. Mrs C complained that, despite her daughter's condition being unchanged, she was told that Miss A would no longer qualify as her points score had reduced to five from six.

In investigating this complaint, we looked at all the available information, including the complaints correspondence and Miss A's relevant medical records. We also asked the board to provide more information about what had happened. The board in their comments said that they no longer provided Miss C with any health intervention and that she was continent. They added that she could move independently in her electric wheelchair. The board said that Miss C's points had reduced to reflect the change in her mobility.

Our investigation confirmed that Miss C's condition was unchanged and that it would not improve. We found that she was not continent although her incontinence was managed with the use of pads. The level of support from other agencies had been the same since 2010. We found that it was not clear what health intervention had ever been provided to Miss C. Furthermore, Miss C had had the use of an electric wheelchair for many years which she had been able to operate herself.

Although we agreed that it was for the board to set qualifying criteria in the face of competition for finite resources, the assessment of individuals under these should be transparent and ensure visible fairness to all. No guidelines had been provided to show how the staff concerned assessed Miss C's health needs. We upheld the complaint and made a recommendation to address this.

Recommendations

We recommended that the board:

• create appropriate guidelines for the assistance of staff when assessing care requirements and reassess Miss C accordingly.