HEALTH agencies in Cambridgeshire that discharged a woman from their care contributed to her death, a coroner said yesterday (Tuesday).

On resuming the inquest into the death of Huntingdon woman Christine Arnold, 63, deputy coroner Belinda Cheney said the mother-of-two died of natural causes in July 2011 following a fall from her bed. She also had a hole in the wall of her abdomen, which resulted in sepsis.

However, the inquest was looking into the lack of care Mrs Arnold received that allowed her to live in poor conditions and to die a year after various health agencies had withdrawn their support.

Mrs Arnold had been confined to her home in Nene Road for seven years due to her obesity and immobility. In addition to suffering from asthma, diabetes and depression, she was bed-bound, and lived in squalid conditions.

Mrs Cheney said Mrs Arnold had been assessed by the mental health team in 2006 but discharged on the grounds that her needs were physical and that she had refused to engage with them. But the physical disability services refused to accept a referral in 2010, stating Mrs Arnold's needs were related to mental health.

Eventually, the district nurses who attended her were so worried about her welfare they instigated safeguarding of vulnerable adults (SOVA) proceedings.

Mrs Cheney said: "Everyone assessed: the physical disability people by telephone to ask if she would accept a visit, and when she declined they didn't call again. A physiotherapist sent to assess at the same time wouldn't return due to concerns for her safety and that of her client due to the filthy conditions of the house.

"Yet these conditions were not filthy enough for the housing provider to evict her and force her into new accommodation."

The closure of the SOVA programme in 2010 appeared to absolve everyone from trying to work with Mrs Arnold, Mrs Cheney continued.

Because of her unwillingness to engage with health agencies, Mrs Arnold underwent a Cambridgeshire County Council-led vulnerable adult process in 2010, performed by the district nurse. During the process, Mrs Arnold's capacity to make decisions about her care and treatment was assessed and deemed to be normal.

The agencies then withdrew their support.

"All services - bar the GP practice - that had the power to do so, discharged her from their service," Mrs Cheney said. "Capacity does not mean someone does not have needs. Someone should have engaged with her. Disengagement by all services played into Christine Arnold's feeling of abandonment."

The inquest also heard about the "missed opportunities" by those in primary care to examine Mrs Arnold when she called for medical attention and was given repeat prescriptions over the phone instead.

"Her GP never saw her after April 2010, despite knowing her medical history was precarious," Mrs Cheney said. "There was no physical examination which may have led to a diagnosis, which could've provided an opportunity to diagnose the condition, which could have saved her life."

Recording a narrative verdict at Lawrence Court, Mrs Cheney said: "Christine Arnold died of natural causes contributed to by her own refusal to accept much of the support and treatment offered, but also by the decision of a variety of services involved in her care to discharge her when she was assessed as having capacity to refuse support and treatment - even when this was not the purpose of the assessment - and also because opportunities were missed thereafter by those in primary care to examine her when she called for medical attention and was given repeat prescriptions over the phone."

The court was told that CCC had reviewed the needs of excluded adults: the physical disability team would now take responsibility for vulnerable adults and Cambridgeshire Community Services NHS Trust had improved district nurse record-keeping, appointed an additional 13 district nurses and introduced community matrons as care co-ordinators in GP practices.

In conclusion, Mrs Cheney said that Mrs Arnold was known to every possible service but was not seen by one in the months leading up to her death.