MORE than 900 attempts were made to help a 45-year-old woman who died in a filthy wheelchair at her South Yorkshire home, it was revealed, in a serious case review into her death that was published yesterday.
Sheffield's Adult Safeguarding Partnership has published an executive summary of the review into the death of a woman identified in the report only as "Ann", but who is understood to be Angela Wright, who died at her Sheffield home in October 2008.
Mrs Wright, of Totley Brook Road, died as a result of an infection called pyelonephritis – a consequence of living with a catheter that had been unchanged for a "substantial" period.
The serious case review into the involvement public agencies had with Mrs Wright prior to her "premature" death has recommended seven areas of action for the agencies involved, and two national recommendations.
A spokesman for Sheffield Council said: "Local recommendations have either been implemented or are on target for implementation.
"The circumstances surrounding 'Ann's' death spanned seven years and involved support from several agencies in the city. All agencies made considerable and determined efforts to agree and deliver a care plan.
"More than 900 interventions by these agencies were made during this period."
The executive summary outlines a chronology of the support offered to and accepted or refused by the mother-of-three, who "regularly resisted professional help that she felt was not warranted."
"The inflexible demands that Ann placed on services were so stringent and so exceptional that her disappointment was inevitable", the report says.
"In 'Ann's' final months she identified more than 20 professionals in an e-mail as responsible for her death."
Her behaviour, which included refusing to let staff into her home and, if they did get in, refusing to let them carry out tasks such as changing her catheter, led to "extraordinary tensions for professionals and their organisations", the report says.
It reads: "Ann's criticism of individual staff engendered friction and her discourtesies ultimately exhausted their willingness to engage with her, making it difficult for them to provide consistent professional care."
One manager told the review team that Mrs Wright would ring health professionals outside of work and "spend hours on the phone ranting".
She also threatened legal action against various organisations. By law, public agencies cannot impose services on adults who have the mental capacity to make decisions about their care.
Sue Fiennes, independent chairman of Sheffield Adult Safeguarding Partnership, said the case was "exceptional" and added: "This is a tragic case in that someone who, through their unwillingness to be cared for and engage fully with professional services, has died prematurely. It raises questions about an individual's right to refuse care to their detriment when agencies believe services should be provided.
"This serious case review makes clear that, regrettably, public agencies were hampered in giving her the support they wanted to for a variety of reasons, despite the considerable efforts made to help her.
"We accept the recommendations in this report fully as they will further professionals' understanding, support and wider knowledge sharing in this complex and unique area of adult social care."
Those recommendations include asking staff to "scrutinise" the decision-making abilities of individuals who regularly refuse services and reviewing the way different agencies share information.
The inquest into Mrs Wright's death took place at Sheffield Coroner's Court last month. Recording a narrative verdict, coroner Christopher Dorries said the agencies were put in an "impossible position" and described Mrs Wright's death as a "tragic case".