IMCA Client F

F is a hospital patient in Cwm Taf who is in a minimal conscious state. IMCA was appointed as his RPR. F has family who visit regularly, however they often disagree about his support needs, and how he should be supported when he leaves hospital.

Barriers faced in being heard:

F has a tracheotomy in place which has not been able to be removed due to persistent secretions in his throat. This has a big impact on long term care and potential rehabilitation.

F’s family wish him to be moved to a Cardiff hospital for intensive rehabilitation, however there is a long waiting list. The hospital MDT explained they would like F to be transferred to a Cwm Taf hospital instead. F’s family have initially disputed this as they feel that if he moves to the latter, there will be no active attempt to wean F from the tracheotomy.

IMCA established that F should be supported to be hoisted out of bed and into a chair for at least an hour a day. However due to staffing issues, this has not been possible. IMCA raised this as a concern as F requires as much stimulation as possible given his minimally conscious state. IMCA has also asked the physiotherapy team involved if F would have the opportunity to be hoisted out of bed if he was moved to the Cwm Taf hospital. IMCA was informed this would be decided by their team.

F currently has a qualified nurse observing him on a 1:1 basis 24 hours a day in order that he can receive the required assistance in relation to the secretions in his throat. IMCA asked that this be monitored and reviewed on a regular basis as this is a major restriction in relation to his Deprivation of Liberty.

F is in a side room on his own. IMCA has raised a question as to whether he would benefit from being in a bay with other patients so that he is able to potentially interact with other people. However, F’s family have said that F would not want this and would rather be in a private room.

F’s sister and partner disagree on what should happen when F is discharged from hospital. F is not medically stable for discharge yet, however if a decision cannot be agreed then an application to the Court of Protection will need to be made.

IMCA has had to outline service boundaries clearly to F’s sister who has been contacting the IMCA service on a regular basis and asking for the IMCA’s personal opinions on the situation.

Advocacy undertaken:

  • IMCA has ensured that the conditions within the DoLS authorisation have been met.
  • IMCA has also ensured that questions are being asked on behalf of F to ensure the support he is receiving is the least restrictive possible.
  • IMCA has ensured that F has had an independent representative to ensure the Best Interest process is being followed correctly and is not being dominated by the personal views and disagreements of the family.

Outcomes:

F has been placed on the waiting list for a bed at the Cardiff hospital. It has been agreed that F will be transferred to the Cwm Taf hospital as an interim measure.

Previous Case Study Next Case Study