A cancer patient with learning disabilities who died after contracting Covid-19 was let down by the care he received at the start of the pandemic, a review has found.
A so-called learning lessons review found that not enough had been done to ensure ‘Stephen’ was shielded because of his vulnerability to the virus and the risk he could fall severely ill.
The 56-year-old, from Middlesbrough, was meant to have shielded for three months following Government advice that was issued at the time, but was taken out into the community “for a walk around the block for some fresh air” by domiciliary care staff contracted to look after him three days after the advice was received.
The review said more could have been done to anticipate and put in place contingency plans for shielding and to ensure secure and robust communication channels with Stephen’s family.
It said an effective working relationship was not developed by the partner organisations involved in his care and complaints by his family weren’t all responded to.
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They were said to have had ongoing safeguarding concerns about his care and treatment in the months prior to his death, alleging that there were insufficient care workers helping him at home and that medication recording errors had been made.
Stephen, whose cancer treatment had been delayed, contracted covid in March 2020 and received hospital treatment, but did not immediately return home to his shared supported living accommodation when discharged for fear he might infect other tenants.
Instead he was moved to single temporary accommodation, before being moved to another property.
His condition gradually worsened and he was readmitted to hospital before his death in May of that year.
Middlesbrough Council said it accepted the findings of the 26-page review and was committed to making the improvements that had been recommended.
The review found that specialist health support workers, who could have helped Stephen, had been reallocated to mainstream work.
Meanwhile, a continuing care team and the local council had “different perceptions” of the effectiveness of the transfer of commissioning responsibilities between them.
The review said there was a need for them to work together to review the information required and how handovers should take place.
Stephen – not his real name – was described as having the mind of a five to six year-old and he could not read and write.
Nonetheless he was a “fun and very sociable man” who loved buses and trains and being out and about.
The review recognised that the events surrounding Stephen took place against the backdrop of the coronavirus pandemic and the uncertainty and changing demands that this entailed.
Councillor David Coupe, Middlesbrough Council’s executive member for adult social care, said: “We fully accept the findings of the learning lessons review, and we are committed to making the improvements highlighted in the report.
“These include smoother care management transition for those awarded NHS continuing healthcare funding.
“We are confident that current safeguarding practice adheres to the policies and procedures of the Teeswide Safeguarding Adults Board (TSAB) and meets the requirements of the Care Act 2014.
“A multi-agency action plan will now be developed in response to the review and we will work closely with the TSAB to ensure its effective and timely implementation.”
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