Kent Community Health NHS Foundation Trust

4. Mr R complains about the decision the Trust made when it decided he does not meet the criteria for housebound status.

5. Mr R said because of this decision, he cannot receive home visits for his appointments. He said this denies him safe access to essential nursing care and forces him to attend appointments at his GP.

6. He said attending appointments every three months for his Nebido injections is extremely difficult. He said it is physically painful and unsustainable.

7. Mr R wants the Trust to register him as housebound as he reports being exhausted for several hours after going to the GP. This adds to his pain and stress.

8. Mr R has autism, registered blind and a wheelchair user. He needs nebido injections every three months. Nebido injections are testosterone replacement therapy (TRT) used to treat men with low testosterone levels.

9. In January 2025 Mr R moved home and registered at the local GP as a new patient.

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

14. Early February 2025, after recently moving into the area, Mr R attended the local GP practice to register as a patient so he could receive his three monthly TRT injections.

15. Mr R told us he spoke with the GP to explain his situation, highlighting he should be registered as housebound due to his health. He is living with disability, blindness, autism and other medical conditions. He said the GP declined to support his request, stating he does not meet the eligibility criteria.

16. In mid February, Mr R attended the GP practice for his TRT injection. On the same day he made a self-referral to the community nurses for the removal of his stiches on his elbow.

17. The Trust said it received his self-referral for community nursing. It said during the triage conversation, Mr R said he had attended his GP practice that day for a routine injection. The Trust said it informed Mr R the community nurses have a strict housebound criteria. As Mr R had visited the GP practice, this would mean he did not meet this criteria.

18. The Trust agreed that on this occasion the nursing team would visit Mr R towards the end of February, at home to remove his stitches and then discharge him back to his GP.

19. As agreed, the community nursing team removed Mr R’s stiches at home as per the one-off agreement. They received a further referral the same day from his GP practice requesting the home nursing team do his three monthly TRT injections at home.

20. The Trust contacted Mr R and told him he did not meet the criteria and he would need to attend his GP Practice for these injections, to which it said he agreed. It discharged him back to his GP.

21. In May when his next injection was due, Mr R said the Trust asked him to try attending his GP Practice to receive care. He told us he did this in good faith, but the visit was physically painful, mentally overwhelming, and logistically exhausting. Since then, he said the Trust told him, “one time isn’t enough” and he needs to try again before his needs can be taken seriously.

22. Mr R said this is both unfair and inappropriate. He said he should not have to keep proving his limitations, especially as they are well documented and clearly meet the national criteria for being housebound.

23. He said due to him having autism, living with a disability, having a prolapsed disc, and being registered blind, he needs assistance to leave the house.

24. Mr R contacted the community nurses on a few occasions regarding the home visit criteria. At the end of March, it documented Mr R had telephoned the Community Nursing Team disputing he was housebound. It records he was quite ‘sweary’ on the phone and escalated the issue to the clinical lead.

25. As a result of the escalation, the assistant director had a telephone conversation with Mr R with regards to his house bound status and criteria.

26. At the beginning of July, the Trust arranged for the deputy operational manager to visit Mr R and do a home assessment.

27. Mr R’s home assessment records note he said he was unable to walk more than 10 metres. If he was to go out in the car he would have to use his wheelchair to get to it. Mr R explained he was registered blind and could not self- propel the wheelchair due to his poor eyesight. He said he had a stigmatism and no lenses in his eyes making him sensitive to light. He also said he was diagnosed with autism two years ago.

28. The records also note, Mr R also stood, this caused him minimal effort. They further say Mr R was told ‘not to see the manager out but he stated that he needed a drink and walked into the kitchen unaided’.

29. The Trust said Mr R did not meet the local criteria for home visits because he was not housebound by their definition.

30. The Trust has its own local guidelines for housebound criteria. This criteria is set by Kent Community Health NHS Foundation Trust (KCHFT). It said it cannot override it.

31. It said defining which patients are housebound can be quite subjective.

The Trust local guidance says;

‘A housebound patient is temporarily or consistently unable to leave home without exceptional effort and support. They would normally be someone a GP would visit as the only practical means of them being able to see them face-to-face. A patient is not housebound if they are able to leave their home without help or with the help of family, friends or other helpers, go to the doctors, dentists, clinics, hairdresser, supermarket, bingo, luncheon or similar club or leisure venue.’

32. Our adviser said assessing if a patient meets the criteria for community nursing care within their own homes, is done on an individual basis following local guidelines. They said they can see Mr R does face challenges mobilising. They agree the Trust made the correct decision following their own local guidelines in concluding Mr R did not meet the housebound criteria. This is because he could leave the house for other appointments with the help of others.

33. Mr R’s said the Trust did not follow the NHS or Care Quality Commission (CQC) definitions of housebound status and have denied him essential home nursing care.

34. We could not find the source of the NHS and CQC definitions of housebound that Mr R provided.

35. Our adviser confirmed there is no NHS or CQC guidance that advises when patients are eligible for community nursing visits, this is provided locally.

36. Our adviser referred us to the nursing standards used in making decisions. NMC (2018) Future nurse: standards of proficiency for registered nurses states:

3.5 demonstrate the ability to accurately process all information gathered during the assessment process to identify needs for individualised nursing care and develop person-centred evidence-based plans for nursing interventions with agreed goals

37. The Trust has assured Mr R it has not denied him care. He just does not currently meet the housebound criteria, as he is able to leave his home with assistance. It said all individual circumstances will be considered if there are any changes to their needs or situation.

38. We have seen evidence to show the Trust asked the Practice to speak to staff and explain Mr Rs needs when he enters the building. The Trust would also ask if he could not be kept waiting too long to see the clinician, so to limit the amount of time he is in his wheelchair. It is documented Mr R agreed to this.

39. This is in line with nursing standards. Although Mr R did not meet the housebound criteria, the Trust assessed his needs and an individual nursing plan was put in place to support him with agreed goals, as documented.

40. We understand this decision is difficult for Mr R. He feels the Trust lacked flexibility or empathy to his situation. The evidence shows the decision followed the Trust’s guidelines, not a lack of empathy. The Trust did try to reassess him at home, but the outcome did not change.

41. Based on evidence we have seen, we are satisfied the Trust acted in line with guidelines when It assessed Mr R for housebound status.

1. We want to thank Mr R for bringing this complaint to us. We recognise all the challenges he has faced relating to the Trusts decision. We are sorry to hear about the frustration and distress this decision has caused him. We recognise how difficult this has been on him physically and have taken his concerns seriously.

2. We have carefully considered Mr R’s complaint regarding the Trust’s decision about his housebound status. After reviewing all evidence, we found the decision to be reasonable and found no indication the Trust got anything wrong with its decision-making process.

3. We hope our explanation reassures Mr R about the Trust’s actions. We recognise the importance of his complaint and the time he has invested in pursuing it.