Yorkshire Ambulance Service NHS Trust

2. Mrs A complains about the care and treatment provided to her late mother by the Trust, on 19 December 2018. She says the Clinical Advisor who was involved in the 999 telephone calls failed to prioritise the response from the Trust, which meant that an ambulance was not sent out to her mother when it should have been. Mrs A says the ambulance was only sent after her mother had stopped breathing, and by this time it was too late

3. Mrs A’s mother fell ill in the early hours of 19 December 2018 and Mrs A called 111, and then 999, to request assistance. After several telephone discussions and 1 hour and 22 minutes after the first 999 call, an ambulance arrived to find Mrs A’s mother unresponsive and not breathing. Resuscitation was attempted but Mrs A’s mother had sadly died.

4. Mrs A complained to the Trust about the delays and the conduct of the 999 call handler on 28 December 2018 and the Trust investigated her complaint. Mrs A attended a local resolution meeting with representatives of the Trust in May 2019 and received the Trust’s final response later in May 2019. The Trust upheld the complaint, and its final response included a lengthy investigation and learning report, which set out the failings and the actions to be taken. The Trust’s final response letter included an apology to Mrs A for the impact of the failings and referred her to the Ombudsman if she wanted to take the matter further.

5. Mrs A first contacted us by telephone in October 2020. We received her complaint form in January 2021.

7. The law says a complaint should be brought to us within a year of the person becoming aware of the problem. This is referred to as the ‘date of knowledge’. We cannot consider complaints brought to us more than one year after the date of knowledge unless we can see there were exceptional circumstances which prevented the person from bringing the complaint sooner.

8. On her complaint form, Mrs A confirmed that she became aware of the need to complain at the time of the incident on 19 December 2018. This is the date of knowledge. To meet our time limit regulation, Mrs A needed to bring her complaint to us by 19 December 2019. We have seen from the information Mrs A provided that she was very proactive and made her complaint to the Trust promptly and without delay. The complaint was made to the Trust on 28 December 2018.

9. The Trust concluded its investigation and issued its final response to Mrs A within 5 months of receiving the complaint. The Trust’s final response was sent to Mrs A on 16 May 2019, and it advised Mrs A to bring her complaint to the Ombudsman if she remained unhappy with the Trust’s attempts to resolve her complaint. Mrs A did not approach the Ombudsman until her telephone call in October 2020. This was 22 months after the date of knowledge and 17 months after the Trust sent her its final response.

10. We considered the explanation Mrs A provided for not contacting us sooner. On her complaint form Mrs A said she could not complain to us sooner as her mother's death had made her extremely ill. She said there were a number of unfinished jobs she had to deal with in her daily life, and that dealing with this complaint was not easy for her. She said the complaint process was exhausting and caused her health issues.

11. When we discussed this during our telephone call, I asked Mrs A to provide some more information to explain why she did not complain to us sooner, after the Trust’s final response. Mrs A said she had other affairs to deal with such as sorting her mother's belongings and selling her mother’s house, which she said she managed to sell just over a year ago. Mrs A said she has suffered sleepless nights and was heartbroken at the loss of her mother. This incident and the circumstances of her mother’s death have clearly caused Mrs A a great deal of grief. She said she deliberated on her complaint for a while before deciding that she should complain to the Ombudsman.

12. We acknowledge and accept Mrs A’s account of this period. It was clear during the discussion that this was an extremely upsetting incident for her, and it was also clear the death of her mother has had a profound impact on her, which she still has difficulty dealing with several years later. We acknowledge her account of the difficulties and frustration she said she had experienced during the Trust’s investigation of her complaint, and we acknowledge that complaining about such an upsetting, sensitive incident is very difficult.

13. We have seen that through her original complaint she has achieved an agreement with the Trust. It acknowledged that improvements were required, and the Trust said in its report how improvements will be implemented to benefit the people who require its services in future. We agree that this is a valuable commitment to improve from the Trust, which has only been achieved by Mrs A pursuing her complaint with the Trust promptly and with a great deal of dignity and conviction.

14. It is our view that when Mrs A contacted us in October 2020, her complaint was already significantly outside our time limit. Having considered all of the additional information Mrs A has now provided to explain the delay in approaching us, we still think it would have been possible for her to have contacted us sooner after the Trust issued its final response in May 2019. We have not seen any evidence to indicate that there was a significant barrier which prevented Mrs A bringing her complaint to us within our time limit. For this reason, we have decided not to consider this complaint further.

15. Once again, we acknowledge the severity of the complaint and the impact this has had on Mrs A. We hope our discussion with her has helped her to find closure with her complaint and we would like to offer our condolences on her loss.

1. We have carefully considered Mrs A’s complaint about the Yorkshire Ambulance Service NHS Trust (the Trust) and have decided the complaint falls outside of our time limit