A practice in the Hounslow area

5. Mrs B complains about the care and treatment provided to her father, Mr T when being referred for the Covid vaccination by the Practice to the roving team at the Trust.

6. Mrs B specifically complains that the Practice:

7. did not consider Mr T’s full medical history when looking at his eligibility and provide correct information in its referral to the roving team

8. Mrs B specifically complains that the Trust:

9. co-administered a COVID-19 and influenza (flu) vaccination, despite Mr T’s complex medical needs and history of frozen shoulder 10. did not adequately consider Mr T's capacity to make his own decisions before administering the vaccinations

11. As a result, Mrs B says:

12. Mr T showed signs of paralysis in his left arm, significantly impairing his ability to perform daily activities and diminished his quality of life. She told us he suffered avoidable significant pain and went on to completely lose the use of his arm prior to his death 13. Mr T was unable to give informed consent to the vaccinations. The team did not give Mrs B the opportunity to discuss the risks as lasting power of attorney of Mr T’s health, and she believes he was incorrectly administered the vaccination without her input.

14. Mrs B also says she has been significantly impacted emotionally and financially. She says she reduced her working hours to care for her father and had to purchase expensive medical equipment to assist with his needs. She says his avoidable death had a significant emotional impact on her and she now requires medication for depression.

15. Mrs B is seeking a financial remedy, an apology and service improvements.

16. Mr T had dementia, heart problems, and chronic pain.

17. The Practice made a referral to the roving team at the Trust for it to administer the flu and covid 19 vaccination.

18. In November 2023 Mr T gave verbal consent to the Roving team when they attended his home to be administered both vaccinations.

19. Consent was recorded by the roving Team and staff determined at the time of the visit that Mr T had capacity to make his own decision.

20. Staff at the roving team administered the flu and covid 19 vaccinations in separate arms.

21. The next day, an ambulance took Mr T to the Trust after a fall at home and staff admitted him.

22. Mr T was discharged from hospital a few days later.

23. Mr T’s health continued to deteriorate, and he died in January 2025.

35. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.

36. We have done this and have not found any indications that something has gone wrong.

Medical history /referral to the roving team

37. Mrs B told us that the Practice did not consider Mr T’s full medical history when making a referral to the Trust for him to receive the Covid 19 vaccination.

38. She says that the Practice did not consider Mr T’s history of frozen shoulder or his complex medical needs.

39. Mrs B says, that as a result Mr T was co administered both the Covid 19 and flu vaccination by the roving team at his home in November 2023.

40. She told us that this caused Mr T to experience paralysis in his left arm, which she says put him at greater risk of a fall.

41. She says that as a result of receiving both vaccines, Mr T’s health deteriorated which led to his death.

42. In its complaints process the Practice says that it acted in line with the relevant standards and guidance.

43. The Green Book 2023 provides clinicians with information on conditions which would exclude a patient from receiving the vaccinations.

44. The Greenbook says ‘It is generally better for vaccination to proceed to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment’. It also says ‘There is no evidence of any safety concerns for the co administration of both vaccines’.

45. We can see from Mr T’s medical records that he had numerous medical conditions. The records do not show evidence that Mr T was suffering from a frozen shoulder or similar medical conditions leading up to and at the time of the vaccinations.

46. We can also see that there are no contraindications listed in the Green Book, that would have made Mr T exempt from receiving the vaccinations due to his medical history.

47. The Green Book also says that patients who have a history of allergies following previous vaccinations should not receive the vaccinations. There is no evidence in Mr T’s records to suggest he has had a reaction to previous vaccinations; therefore, we think it was appropriate for the Practice to refer him for the vaccinations.

48. Our RGN adviser agreed there was no evidence in Mr T’s medical records to show that he had been diagnosed with a frozen shoulder or evidence of any medical conditions which would have excluded him from receiving the vaccinations.

49. Based on this, we cannot see any indication the Practice failed to follow the Green Book guidance when considering Mr T’s eligibility.

50. We know that Mrs B had concerns that the Practice failed to send Mr T’s full medical history to the roving team.

51. The Practice said that house bound patients are identified by using its clinical system. The system identifies patients who are vulnerable and at greater risk. A clinician then screens the list and sends the names of the eligible patients to the roving team at the Trust.

52. Our GP adviser did not have any concerns about the information provided by the Practice in its referral.

53. They told us that it is normal practice to clinically assess a patient and send the list of names of those eligible to the vaccination team. That is what happened in this case.

54. As above we can see, in line with relevant guidance, Mr T was eligible to receive the vaccinations.

55. We recognise that Mrs B says the Practice should have sent the roving team Mr T's full medical records and evidence of his frozen shoulder.

56. Given that our adviser had no concerns about the amount of information that the Practice sent to the roving team, we cannot say that if further information had been sent, it would have made a difference to the overall decision to administer the vaccines.

57. GMC good medical practice for clinicians says, ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:

a adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient b promptly provides or arrange suitable advice, investigations or treatment where necessary

c refer a patient to another practitioner when this serves the patient’s needs’

58. We can see the Practice assessed Mr T’s clinical history, identified he was eligible and referred him for necessary treatment to the roving team.

59. From the information available to us, we see no indication that the Practice failed to act in line with the GMC guidance when referring Mr T to the roving team.

60. Therefore, we will take no further action.

Simultaneous vaccines

61. Mrs B told us that the roving team wrongly co administered the Covid 19 and flu vaccination during a home visit in November 2023.

62. She says that the roving team co administering the vaccinations caused Mr T to experience paralysis in his left arm, which she says contributed to the deterioration of his health, which she says led to his death.

63. The Trust explained that it used relevant guidance, which says it is safe to give both vaccinations together.

64. Records show that the roving team administered both vaccinations during a home visit and both were given in separate arms.

65. NHS Northwest London roving team guidance 15 august 2023 for Care home and housebound autumn delivery says, ‘Covid & Flu will be co-administered on the same visit’.

66. The NHS England Flu and COVID-19 Seasonal Campaign 2023, also sets out what is expected of clinicians when administering the vaccinations.

67. This guidance says, ‘By supporting greater levels of co-administration of vaccines we also collectively have an opportunity to achieve greater efficiency in delivery for providers at what we know is already a busy time of year.’

68. Our RGN adviser also explained that vaccinations can be administered together.

69. From the information available to us, we consider that the Trust acted in line with its own guidance, and NHS England guidance for co administering both vaccinations.

70. For that reason, we will take no further action

71. It is not underestimated that the loss of a loved one will be devastating for their family. We are very sorry to hear how Mrs B and her family has been affected since the loss of her father It is clear it has been a very difficult period, and we understand how much this complaint means to her.

Capacity

72. Mrs B told us that she did not consent for Mr T to be co administered both vaccines by the roving team. She says that Mr T did not have capacity to make this decision.

73. The Trust says that if a patient cannot understand the questions asked, to allow them to consent to the vaccination, it would then ask a family member to be present to support the vaccinations.

74. We can see from the records available to us, that Mr T consented to both vaccinations which was noted on the provision of information and the flu screening consent form.

75. There is no information contained in Mr T’s medical records to suggest that staff had any concerns about his ability to understand and make decisions.

76. The NICE guidance for decision making and mental capacity says:

77. A person's capacity must be assessed specifically in terms of their capacity to make a particular decision at the time it needs to be made. Capacity must not be determined on the basis of age, appearance, condition, or an aspect of the person's behaviour. The starting assumption must always be that the person has the capacity, until there is proof that they lack capacity. Anyone who concludes that a person lacks capacity should be able to provide evidence.

78. We can see from Mr T’s medical records that he had a diagnosis of dementia, we cannot presume that this diagnosis automatically equates to Mr T having a loss of capacity.

79. Our RGN adviser told us that Mr T’s medical records show no evidence to support that he did not have capacity to consent to the vaccinations.

80. They also told us that they believe the records show that Mr T was able to consent to all health assessments on the run up to November 2023.

81. We recognise that Mrs B says she should have been contacted to give her consent, however, that was not necessary. Only the person with capacity can consent to a procedure, no-one can provide consent on their behalf. If a person lacks capacity, then people involved in their care should be contacted to make a best interest’s decision.

82. We can see from the information provided to us that Mr T had capacity to make his own decisions, and we can see no evidence a best interest decision was needed; therefore, staff did not need to involve Mrs B in their decision making.

83. We have seen no indication that the Trust did not adequately consider Mr T’s capacity when requesting consent to co administer the vaccines.

84. We understand this has been a stressful and difficult time for Mrs B and her family, and we appreciate her efforts in bringing her concerns to our attention.

85. We hope we have clearly explained why we have decided to take no further action.

1. We have carefully considered Mrs B’s complaint about her father, Mr T’s care and treatment by a GP practice in the Hounslow area (the Practice) and Chelsea and Westminster Hospital NHS Foundation Trust (the Trust), when being referred for and co administered the influenza (flu) and Covid 19 vaccinations.

2. We are sorry to hear of the sad loss of Mr T and the distress Mrs B and her family experienced following the referral

3. From the information provided to us, we have seen no indication anything went wrong with the way the Practice assessed Mr T’s suitability for the vaccinations or sent the referral.

4. We think the Trust followed guidelines when it administered the vaccinations together. We can also see no indication the Trust should have contacted Mrs B before it gave the vaccinations to Mr T.