Solicitors & Commissioners for Oaths
Authorised and Regulated by the Solicitors Regulation Authority
Ivy Cott
89 Broadway, Kettering, Northamptonshire NN15 6DF
Telephone: 01536 518638 Fax: 01536 516820
Email: hossacks@hossacks.plus.com
Principal: Yvonne Hossack, Solicitor-Advocate (HCCivilP)
SRA No: 370054
To:
Dr Reynolds: Hand delivered
5th November 2011
Dear Dr Reynolds
Re: Vera Waylor
Thank you for being kind enough to talk to me about my client Vera. As discussed, neither her son John nor I are committed to any course of action. Our only concern is to weigh up the competing risks to Vera and to make a decision in her best interests. As neither of us are clinicians we rely on experts to give us advice.
The present problem is that we have a Report from Dr Chris Fox on the mortality risks of moving Vera. His Report is attached and you will note what he says about her physical condition at the time he met her.
What we need to know is whether the risks of Vera transferring back to Bowles Lodge outweigh the mortality risk of moving her. That question pre-supposes that Bowles Lodge could meet her needs and that is the critical question which Kent County Council tell us you have decided in the negative. You, on the other hand, tell us that you have carefully described Vera’s needs to Kent County Council and they told you that they could not meet her needs. I will put these questions to you more formally at the end of this letter and no doubt you will take legal advice if you are concerned in any way. To my mind there is a concern because in his email to me of the 4th November 2011, reproduced in full at the end of this letter, Mr Ian Clark a principal solicitor with Kent County Council says that “it is the clinical decision of your client’s consultant that you would be challenging”.
You will also find attached the completed Individual Needs Portrayal and will see that on the 6th October 2011 Kent County Council said that Vera needed 24hr care in a residential setting but now:
“Mrs Waylor s assessment and deterioration in her general health show that her needs require 24 hour care within a nursing home environment. The multi-disiplinary team at the hospital including her medical team are all in agreement that a nursing home would be the best place to meet her needs”
There are two documents within the Individual Needs Portrayal which have no data attached – I suspect this was because the data was hand-written. These are the Waterlow scores and the Continuing Healthcare checklist. Neither were attached the GP report or the report by Lisa Rose DN of the 6.10.11 nor any data relating to GP feedback regarding recovery from medical conditions, all of which are referred to in the INP.
Please also find attached Kent County Council’s Defence to Vera’s Claim dated the 27th October 2011 and after her latest admission. Please note paragraphs 1, 7 (iii) (a) and (b) from which it is clear that KCC were considering at that time that Vera may be moved because of the level of her dementia. Clearly, as you confirmed in our conversation, this lady does not come within the EMI category.
So now the given reasons for transfer are medical.
On the 3rd November 2011 Ian Clark wrote to my colleague making it clear that the basis of the current defence is “a medical decision” and asks whether I contemplate taking proceedings against the hospital:
From: Ian.Clark@kent.gov.uk [mailto:Ian.Clark@kent.gov.uk]
Sent: 03 November 2011 17:35
To: hossacks@hossacks.plus.com
Cc: Benjamin.Watts@kent.gov.uk
Subject: Vera Waylor
Dear Ms. Edwards,
Thank you for your letter. I should like to receive a copy of your proposed application before responding in detail. I hope that it will be with me in the morning, or that your technical difficulties will have resolved thermselves by then.
The decision that your client required nursing care was made following an assessment to which a Kent County Council social worker contributed, but it is, of course, primarily a medical decision. Have you written to the hospital about this, or are you proposing to, and do you contemplate action against them?
Yours sincerely,
Ian Clark
Principal Solicitor
Community Services Team
Governance and Law
Kent County Council County Hall Maidstone ME14 1XQ
I responded that I could not say without sight of the documents but that I had in other cases injuncted to prevent discharge where there was a dispute as to the receiving facility. I now understand from you that you would certainly not discharge Vera to what may be an unsuitable facility and that there is no question of discharge until what facility should receive Vera is resolved.
Turning now to the INP it seems to me that Vera could not be entitled to Continuing Health Care funding. None of the domains seems to me (and, although a layman, I am a former care provider responsible for contracts involving splits of funding) to fit within a category A save perhaps – and your advice is needed here – if emergency medication were needed for heart failure in advance of an ambulance?
What is not clear to me is which of Vera’s needs are nursing and could not be met by carers albeit at a higher care ratio than may be usual in a residential setting. I do understand from you that were Vera to be cared for in a nursing facility then skilled care may prevent frequent hospital admissions and that each admission carries with it a risk of mortality.
It also seems to me that Vera has been suffering high degrees of anxiety requiring reassurance day and night because of her fear of moving. Please see the data attached regarding mortality in three recent cases I challenged involving four care homes. In the first such case, some 14 years ago, 15 out of 41 residents died in the 12 months post closure. Using ONS data I was able to discern that average yearly mortality over 24 like Local Authority care homes in the same County over the preceding four years was a little over 18%, just under half that in the study group.
My understanding is that experts are agreed that although mitigating factors can be employed, none can alleviate the risk. What is particularly troubling in Vera’s case is that a discharge from hospital to a strange facility will mean that the ameliorating work would be much more difficult to carry out if at all.
What I would like you to consider and advise us on is:
- Whose decision is it that Vera Waylor needs nursing care?
- Is there anything in the INP that a specially trained carer or carers cannot do with input from a District Nurse? If there is then could this need be met by the Local Authority commissioning in additional nursing care?
- Are Vera’s physical symptoms likely to have been increased by her anxiety? If so then could those symptoms settle if Vera were reassured that her home is safe?
- Do you accept that there is a clinical risk if Vera is involuntarily transferred?
- If you accept that there is a risk, then does the benefit of transfer outweigh this risk?
Many thanks for your help doctor
Yours sincerely
Yvonne Hossack
Hossacks
Enc: INP, Dr Fox Report, mortality outcome data, Kent County Council Defence
From: Ian.Clark@kent.gov.uk [mailto:Ian.Clark@kent.gov.uk]
Sent: 04 November 2011 11:25
To: hossacks@hossacks.plus.com
Cc: Benjamin.Watts@kent.gov.uk
Subject: FW: updated INPoct11.doc
Dear Mrs. Hossack,
Thank you for your e-mail sent yesterday evening. I still await the draft of your claim form. I assume that it will make some reference to the cross-undertakings you offer in respect of damages.
I am pleased to hear that, since it is the clinical decision of your client's consultant that you would be challenging, you accept the need to involve the health authority in any proceedings that you might bring.
I attach the Individual Needs Portrayal carried out on your client.
Yours sincerely,
Ian Clark
Principal Solicitor
Community Services Team
Governance and Law
Kent County Council County Hall Maidstone ME14 1XQ
E: ian.clark @kent.gov.uk T: 01622 694392 F: 01622 694266 W: www.kent.gov.uk/Legal
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