El Defensor del Pueblo, Ángel Gabilondo, se ha reunido este miércoles con la presidenta de la Asociación Mareas Blancas, Mª Carmen Esbrí.

Durante el encuentro se ha abordado el estado de la sanidad pública en España, y en especial en Madrid, así como los principales problemas a los que se enfrenta.

La institución inició en diciembre de 2022 una actuación de oficio con todas las comunidades autónomas para solicitar medidas urgentes para afrontar las carencias existentes en la Atención Primaria, que dificultan el acceso de los ciudadanos a este servicio sanitario esencial.

El Defensor del Pueblo se interesó especialmente por la falta de facultativos en los centros de salud y ambulatorios y las condiciones laborales de los profesionales sanitarios. La actuación iniciada por la institución requería, entre otras cosas, información sobre las plantillas existentes en Atención Primaria en los últimos dos años, recursos disponibles, retribución media del personal sanitario y datos sobre tiempo medio que han de esperar los pacientes para ser atendidos, así como el tiempo medio que se les dedica.

La Marea Blanca es un conjunto de colectivos que se movilizan en toda España en defensa de la sanidad pública.

A la reunión también asistió Marisa Torres, portavoz de la Mesa en Defensa de la Sanidad Pública de Madrid-Marea Blanca. Asimismo, por parte de la institución estuvo presente la directora de Gabinete el Defensor del Pueblo, Isabel Aymerich, y el responsable del Área de Sanidad de la institución, Rafael Muguruza.

The Commissioner for Health, Prof. Ray Galea, has published a letter urging the Permanent Secretary in the Ministry for Health and the President of the Malta Union of Midwives and Nurses (MUMN) to resolve their ongoing dispute to protect patient care.

The letter emphasises the importance of balancing worker rights and employer responsibilities and encourages both parties to prioritise patient welfare. The Commissioner for Health is extending his offer to facilitate a prompt and fair resolution, ensuring that the interests of all stakeholders are fairly represented. The Commissioner also calls for an equitable agreement that considers the needs of patients and their families.

11.04.23 – Letter sent by the Commissioner for Health 

A young person spent three years in unnecessary pain because delays by Lambeth council meant they could not have a crucial operation, a Local Government and Social Care Ombudsman investigation has found.

The child has significant medical needs and uses a wheelchair. The child was living in a property secured by London Borough of Lambeth with their mother and sibling. An Occupational Therapist (OT) told Lambeth council the property was not suitable for the child in 2019.

The property could not accommodate the child’s wheelchair so it had to be left outside, and the child found it difficult to move around inside without it. And because it was so unsuitable specialist equipment for carrying and lifting the child could not be installed, and the special bed and supportive seating they needed to relieve pain and keep them safe when eating, drinking and sleeping could not be put in place.

The property was so unsuitable, medical specialists said the child could not have a key operation until they were in more appropriate accommodation.

Despite being told how unsuitable the accommodation was repeatedly by the family, their school, social workers, occupational therapists, and the child’s medical team who raised safeguarding concerns, the council did not take any action.

The OT told the council the child’s health was deteriorating: they were in constant pain, needing medication and injections and added: “the long-term impact of [them] being unsuitably housed means [they] will have no bones in [their] hips to keep [their] legs in place. This will make it more difficult to support [them] with manual handling and positioning. [They] will also never be able to be supported in standing.”

The family was finally rehoused in a suitable property in October 2022. By the time they were rehoused, the original operation was no longer an option.

The Ombudsman investigation found numerous significant faults with the way the council dealt with the family’s housing situation. The council should have accepted it had a duty to the family in April 2019 but delayed making this decision for nine months. Additionally it took 21 months too long to accept it had a main housing duty to the family and failed to look for more suitable accommodation for them. The Ombudsman’s investigation also criticised the council’s poor communication with the family and the poor handling of their complaint.

Nigel Ellis, Local Government and Social Care Ombudsman Chief Executive, said:

“This family spent three and a half years in accommodation that was quite obviously unsuitable to everyone but the council.

“While I appreciate the family needed quite specific accommodation which would be difficult to source, we have found no evidence the council made any efforts to find anything suitable for much of the three years they were in the property.

“As a result the child and their mother were put to a significant and avoidable risk of harm over a prolonged period.

“The council has now agreed to a wholescale external review of its housing service, which I hope will go some way to preventing situations like this from happening to other vulnerable families.”

The Local Government and Social Care Ombudsman remedies injustice and shares learning from investigations to help improve public, and adult social care, services. In this case the council has agreed to apologise to the family and pay them a combined £20,000 for the time spent in unsuitable accommodation at avoidable risk of harm, pain and lack of dignity they suffered.

The Ombudsman has the power to make recommendations to improve processes for the wider public. In this case the council has agreed to commission an independent external review of its homelessness service

We have today issued a public interest report regarding shortcomings in medical and nursing care received by a patient with bowel care needs, who later died.

About the complaint

We launched an investigation after Mrs A complained about the care her sister, Ms B, received from Betsi Cadwaladr UHB when in Ysbyty Glan Clwyd (“the Hospital”) between May 2019 and May 2020. Ms B sadly died in May 2020.

Ms B who was aged 60 at the time of her death was a wheelchair user with long-standing health conditions who needed regular care to be delivered by nursing team.

Mrs A was concerned about delays in kidney treatment received by her sister. She also complained that her sister received inadequate bowel care when she was admitted to the Hospital in April and May 2020 with breathing problems. Ms B did not receive that care as no skilled staff was available to deliver it, and nursing staff did not update doctors that it had not been done.  Ms B developed new symptoms suggesting a bowel blockage, but was discharged without these symptoms being considered. Mrs A complained to the Health Board about these failings but was unhappy with its response.

What we found

We found that Ms B’s kidney treatment was reasonable. However, we were very concerned that Ms B did not receive the right bowel care and that she was discharged home without being seen by a doctor after she developed new symptoms. We also found that the Health Board’s own investigation into Mrs A’s complaint was not thorough or open enough. In addition, we found that the record keeping by the Health Board fell short of the requirements expected for both doctors and nurses.

Commenting on the report, Public Services Ombudsman for Wales, Michelle Morris, said:

I would firstly like to offer Mrs A and her family my sincere condolences. I recognise that they will find much of the detail in this report distressing.

It is clear from my report that there were shortcomings in medical and basic nursing care received by Ms B. I am concerned that although Ms B herself and Mrs A clearly informed the nursing staff of Ms B’s bowel care needs, that was not given the attention that it should have had – particularly given the possible serious medical consequences of not doing so.

We cannot say for sure that the fact that Ms B did not receive the bowel care she needed contributed to her death, as she was very unwell with other problems.  However, I have no doubt that the failings I have identified caused her avoidable and unnecessary pain and discomfort as well as compromised her dignity. 

Ms B was in hospital during the early days of the COVID-19 pandemic.  We understand and acknowledge that these were difficult and uncertain times with stretched NHS resources. However, Ms B’s care was simply not of an acceptable standard.

The NHS in Wales is now bound by statutory Duty of Candour, requiring them to be open and honest with patients and service users when things go wrong. In my view, the initial review of Ms B’s care undertaken by the Health Board lacked depth, rigour, openness and transparency required by that Duty.  

I am also very concerned that my office has identified similar problems of failings in basic nursing care, in record keeping, and in communication in previous cases we have investigated about this Hospital. 

What we recommended

We recommended that Betsi Cadwaladr University Health Board should provide an apology to Mrs A and pay her £4,500 for distress and having to pursue her complaint

In addition, we recommended that the Health Board should:

• share her report with staff involved in Ms B’s care for them to reflect on their actions.
• remind nursing staff at the Hospital about proper record-keeping.
• complete a Bowel Care Protocol, and take steps to ensure that nursing and medical staff at the Hospital are trained to carry out manual bowel evacuation procedure.
•  review its complaint handling and responses in light of the NHS Wales Duty of Candour which will be introduced in April 2023.

The Health Board accepted our recommendations.

Read this report here.

El síndic de Greuges de la Comunitat Valenciana, Ángel Luna, ha recomendado a la Conselleria de Educación, Cultura y Deporte que dote a la Escuela Infantil Niño Jesús de València de un docente de apoyo y de un educador de educación especial para cubrir las necesidades del alumnado con necesidades educativas específicas del centro.

La actuación del defensor del pueblo se inició tras la queja presentada por un representante del AMPA en la que manifestaba la falta de respuesta de la Conselleria a las peticiones realizadas solicitando los recursos de apoyo para el alumnado de la escuela. Precisamente, sobre esta falta de respuesta, el Síndic ha aludido a la «condición de interesado» que tendría el AMPA del cetro para instar a la administración educativa a dar una contestación directa, congruente y motivada a dicha asociación.

En su resolución, Luna recuerda la obligación legal de Educación de garantizar plenamente el derecho a la educación inclusiva, equitativa y de calidad. La Administración debe «favorecer que el alumnado con necesidades educativas especiales pueda continuar su escolarización de manera adecuada en todos los niveles educativos pre y post obligatorios». Además, deberá realizar los ajustes razonables en función de sus necesidades y facilitar medidas de apoyo personalizadas y efectivas con el fin de fomentar al máximo su desarrollo académico y social en condiciones de igualdad respecto a los demás alumnos.

El Síndic insiste en que las demoras en cubrir las plazas así como la tardanza en la creación de otras nuevas generan situaciones de mayor vulnerabilidad y desigualdad en el acceso a la educación para el alumnado con necesidades educativas específicas.

Consulta la resolución del Síndic sobre este asunto.