Continuing treatment in hospital
19. Mrs A complains the Trust continued treatment rather than allowing her mother to come home and live pleasantly without suffering. She accepts difficulties around COVID-19 but feels the pandemic would have been more reason to allow her mother to come home.
20. The Trust says Mrs L suffered from a lack of oxygen caused by an excess of fluid in the lungs. This was triggered by congestive cardiac failure, that she was known to suffer with.
21. It says it continued oxygen therapy, hoping to be able to allow Mrs L to return home, but it could not maintain her oxygen levels. The Trust says her mobility reduced and she developed knee pain, later diagnosed as gout, so she needed to stay in hospital for treatment.
22. We discussed Mrs L’s condition with our physician adviser to better understand what care staff should have provided, in line with relevant guidance. The medical records show the hospital stay was long and complicated by several problems. These came to light after the initial reasons for admission had been addressed. Initially, the plan was to stabilise her heart failure and once oxygen treatment could be stopped, to arrange for discharge. Unfortunately, Mrs L developed gout in her knees and this led to her being unable to walk. She started to show signs of bowel obstruction, which turned out to be related to constipation, and persistent diarrhoea followed. This sadly affected her overall health and mobility.
23. The GMC Good Medical Practice says a doctor must, ‘take all possible steps to alleviate pain and distress whether or not a cure may be possible’.
24. We understand Mrs A feels it would have been better for the Trust to send her mother home rather than keep her in hospital during the pandemic. With Mrs L’s condition, and the GMC guidance in mind, we decided the Trust should have kept her in hospital and continued treatment. It would have been a failing for the Trust to discharge Mrs L, when treatment could be and should be provided in hospital. The evidence shows the Trust did what it could to try and relieve her pain and distress.
25. We understand Mrs A feels the Trust caused more pain and distress by continuing treatment. We will look at this in more detail when looking at the specific concerns she raises.
New medication
26. Mrs A says her mother’s medication was replaced with new medication that did not work.
27. The Trust explains it reviewed and changed Mrs L’s medication as the old medication, was insufficient to meet her current needs.
28. The NICE guideline for treating heart failure says, ‘Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated according to need’. Diuretics are drugs used to help with passing urine and to titrate means to alter the dose according to need.
29. We saw the Trust changed the medication and we looked at whether it should have. The records give evidence of doctors reviewing the previously prescribed medication. They made changes in response to the developing medical problems Mrs L had. Mrs L was admitted with a suspected stroke. We found the Trust followed the NICE guideline on heart failure and gave her diuretic treatment. The amounts were adjusted dependent on her need and when the Trust thought Mrs L was dehydrated. Staff gave this treatment in line with the NICE guidance.
30. NICE says treatment for an acute attack of gout should be started as soon as possible. Medicines to treat gout, such as colchicine and non-steroidal anti-inflammatory drugs (NSAID) should be used. Steroids given by injection into the joint or muscle, or orally, are also effective if NSAIDs cannot be tolerated.
31. The Trust treated Mrs L’s gout in line with the NICE guideline. It injected her knees with steroids and when this treatment had an incomplete response, it followed this up with a course of oral steroids. NICE says combination treatment like this can be used when there is an inadequate response to a single drug or treatment.
32. We appreciate Mrs A feeling that medication was changed and it did not work. We did not find that the Trust did anything wrong. Mrs L had new problems that needed to be treated. The Trust had a duty to review her medication to make sure it was effectively treating her changing needs. Staff adjusted the medication accordingly. If they found it was not effective, they used an alternative or combination, in line with the recommendations within national guidance. To have not, would have been a failing. We have not seen any evidence to suggest staff changed medication unnecessarily, that it did not work, or that it caused unnecessary harm or distress.
Treatment for the bowel blockage
33. Mrs A also says the Trust cleared a bowel blockage that had been there since 2016 and was managed well at home with laxatives. She explains the Trust gave her mother laxatives and enemas in an open ward, and not allowing her dignity. She told us her mother was unrecognisable under the Trust’s care.
34. The Trust says a CT scan showed a blockage in Mrs L’s bowel that was causing her distress and needed treatment. It says her abdomen was swollen and she was having multiple watery stools. It used a nasogastric (NG) tube to relieve the discomfort and drain the bile from her stomach. The Trust explains Mrs L could not eat or drink at this time, but it hydrated her intravenously. The Trust says its treatment plan was for multiple daily enemas and laxatives to relieve the pain and discomfort of the blockage. It says it understands this treatment can be upsetting for patients.
35. The BMJ best practice says a large bowel obstruction should be treated initially, ‘with intravenous fluid resuscitation, nasogastric intubation, and urethral catheterisation. Further management depends on the underlying cause of the obstruction. Maintain the patient as nil by mouth’.
36. NICE recommends treating constipation in adults with a combination of laxatives and enemas.
37. The medical records show Mrs L had symptoms of a swollen abdomen, nausea, abdominal pain, and constipation. The Trust suspected this was caused by a bowel obstruction. We discussed this with our physician adviser who said the decision was in line with BMJ best practice that identifies these symptoms as being indicative of a large bowel obstruction.
38. We looked at whether the Trust should have treated this or whether it should have allowed Mrs L to continue managing it herself. Our decision is the Trust’s treatment plan was in line with the BMJ guidance. It gave her fluids intravenously and used the NG tube to relieve discomfort. The NG tube helps decompress the stomach of any gastric contents/fluids that accumulate due to bowel obstruction. This means Mrs L was nil by mouth, but according to the BMJ guidance, this was the right thing to do.
39. The Trust did a CT scan and found that constipation was causing the blockage. NICE recommend treating this with laxatives and enemas, and the Trust changed its treatment plan to do this. NICE also say enemas may need to be repeated several times to clear hard, impacted faeces. We understand this treatment can be uncomfortable. We are sorry to hear what Mrs A says about how this affected her mother.
40. The Trust had a duty to give Mrs L this treatment and to send her home without doing this, would have been against BMJ best practice. Not treating the blockage would likely have made her symptoms worse and this would have led to increased pain and distress. The Trust had to balance the short-term impact of an uncomfortable and undignified procedure, with the longer-term benefits of clearing the blockage and preventing the symptoms from escalating. We found the Trust acted in line with GMC guidance, to ‘take all possible steps to alleviate pain and distress whether or not a cure may be possible’. Mrs L’s symptoms are likely to have become more prolonged if the constipation was not treated.
41. We considered if other treatment options were available. The NICE guidelines are clear, and we have seen the Trust used a laxative (Movicol) as recommended by NICE. The CT scan from 20 January 2021 shows this treatment worked. We have not seen anything to suggest the Trust failed to consider other treatment options, as the recommended laxative had the desired effect.
42. We have taken Mrs A’s concerns about her mother’s dignity and discomfort seriously. The notes for 26 December 2020 in the medical records say, ‘Pt is keen to have an operation, although very frail’. We did not see specific reference to the bowel treatment plan being discussed with Mrs L, but this entry suggests Mrs L wanted treatment. It also shows an understanding of her physical condition. There is no indication in the records of Mrs L lacking mental capacity or being unable to make decisions about her treatment. We have seen evidence from daily medical entries of discussions about Mrs L’s health and doctors making enquiries about her bowel treatment.
43. A doctor will routinely explain how they plan to address a problem when having a consultation with a patient. Nurses will routinely explain the treatment when giving enemas. We have not seen anything to suggest the Trust gave inappropriate treatment or that it did not consider how Mrs L was feeling.
Discharge summary
44. Mrs A says in the medical records there is a discharge summary, but her mother was not allowed home.
45. From what we have considered above, the clinicians intended to discharge Mrs L as soon as she was well enough. Unfortunately, her health declined. Having discussed this with our physician adviser, we have not identified a time during the admission where discharge would have been advisable. This is because Mrs L had quite distressing symptoms including pain from the gout, inability to walk or care for herself, and diarrhoea, that would have been difficult to manage at home.
46. We appreciate that being at home is often preferable to patients and their family. As Mrs L’s symptoms were ongoing and her health declined, it was correct for the Trust to continue treatment in hospital.
47. Mrs A also says her mother was cared for by a diabetes specialist although she did not have diabetes. We did not find anything to suggest Mrs L’s care was not overseen by suitably qualified clinicians. And, as explained above, the Trust followed the recommended guidelines for treatment.
48. Mrs A told us her mother was of the generation where she would accept what the doctors said and not speak up. She also feels the Trust did not care as her mother was dying. She says a member of staff said her mother was suffering and she wants to know why this was allowed.
49. We appreciate how devastating this must feel for the family. We discussed this with our physician adviser. We cannot tell from the medical records how much suffering a person was experiencing at the time. The records do say there were prescriptions for pain relief and at times Mrs L refused these. It is possible she felt she did not need them at the time. The record of interactions between Mrs L and the medical staff suggest her symptoms were generally well controlled. At the end of her life, she was prescribed and given an alternative, stronger pain killer. The nursing records suggest Mrs L was comfortable in the last days of her life.
50. We realise we were not there at the time, and we do not dispute what Mrs A says. Mrs L was very unwell, and we are not attempting to say her symptoms did not cause her to suffer at all. But we have not found firm evidence to support that the Trust allowed her to suffer unnecessarily. The evidence suggests the staff tried to alleviate Mrs L’s distress by giving her medication and treatment.
51. We realise this may be disappointing as Mrs A feels the Trust dismissed her concerns. We know it is important for Mrs A to see this complaint through for her mother. We understand our conclusions on the above points may not be what she was hoping for, but we hope the information in this report gives her assurance that we have taken these issues seriously.
Nursing care
Hydration
52. Mrs A says the Trust did not allow her mother to drink.
53. We have already seen that when Mrs L had an NG tube, she was nil by mouth and fluids were given intravenously to keep her hydrated. This treatment is supported by BMJ guidance.
54. Our physician adviser said this was the right thing to do while the bowel obstruction was treated. They did not see evidence of any other times where the Trust did not allow Mrs L to drink. We also discussed this with our nursing adviser, who was of the same opinion, that oral intake must be restricted while an NG tube is in place. This is important as there will be no passage for any ingested fluid or food to flow beyond the stomach.
55. We found that the Trust monitored Mrs L’s hydration and adjusted her medication and treatment in response to this.
56. Mrs A is correct that there was a period when her mother was not allowed to drink, but this was not due to neglect. The Trust was following a recommended treatment path and gave fluids intravenously.
Call bells
57. Mrs A says the Trust took her mother’s call bell away.
58. The Trust says the nursing team did hourly rounds to make sure Mrs L had what she needed, including making sure calls bells were accessible, and cared for any incontinence. It says as this is checked hourly, if the call bell did fall out of reach, Mrs L would not have been without this for long. It also says staff are in and out of rooms regularly so patients can ask for help.
59. The NMC Code is a professional standard that registered nurses should uphold. At point 17.1 the code says nurses should, ‘take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse’.
60. We looked at the medical records. These include daily intentional rounding nursing documents, which record how often nursing checks are done and whether a call bell is in reach. These documents evidence that observation checks were carried out primarily every two hours and occasionally completed hourly. However, some documents show prolonged times of up to six hours with no indication that an observational check was carried out. This evidence differs from what the Trust says and suggests there were extended times when it did not check on Mrs L, or make sure her call bell was accessible. This is a failing.
61. The NMC code explains how vulnerable people should be protected. Due to Mrs L’s health, she was vulnerable and in need of care.
62. Where we find failings, we look at whether these caused any injustice to the individual. Mrs A told us how her mother cried on the telephone when the call bell was taken away. There is no available evidence to tell us that Mrs L’s call bell was taken away by staff. We cannot say staff did this purposely. We think it is likely the call bell fell out of reach. The evidence shows extended periods where staff did not check on Mrs L and this suggests the Trust failed to monitor her fully. This means we cannot be assured that staff made sure her call bell was always within reach. This would have been distressing for Mrs L as she was unwell and unable to have the support of her family at her bedside because of COVID-19.
63. We need to consider what, if any, actions the organisation has taken to put this right, and if this is enough. The Trust did not identify gaps in nursing checks in its investigation. We asked the Trust to consider this aspect again and provide us with comments. We also asked how the pandemic was affecting it at this time, as this could be a factor affecting its ability to give care.
64. It confirmed Mrs L was fully dependent on staff and needed 24-hour care, seven days a week. The Trust says that not all care interventions were recorded, and that Mrs L’s interventions were far higher than the minimum standard required. It adds that the call bell should always have been available but if it was not at any time, this was not intentional.
65. Our Principles of Good Complaint Handling say learning should be taken from complaints and used to improve service. It is concerning that the Trust has not recognised the failing we found.
66. The NMC code also highlights the importance of keeping clear and accurate records. It says records should be completed at the time or as soon as possible after an event. The Trust says more interventions took place, than those that it recorded. This is not in keeping with the NMC code and is a failing in record keeping. Documentation is evidence of care delivery or interventions of care given to a patient. Where the records do not document care being given, an organisation cannot evidence this care happened. Even if there were more interventions than those recorded, there is evidence of prolonged uncompleted entries in the records, of more than two hours. Our nurse adviser explained the minimum standard of care being given every two hours, has not been evidenced in the nursing records.
67. The Trust did not give us any information on how the pandemic was affecting it at this time. We realise it is likely to have had an impact on the care, as we know the pandemic caused significant strain on the NHS in general. However, our nurse adviser explained the importance of duty of care and how any human error in record keeping or delivery of care is not allowable. Nursing practice should reflect providing quality care at all times.
68. We have not seen evidence to tell us this failing led to more serious health issues not being identified as soon as possible. For this reason, we cannot say the failing caused Mrs L’s health to deteriorate. But, we understand from what Mrs A tells us that her mother was distressed and felt alone. It would also have been distressing for the family to feel that their mother was not being cared for and they could not visit.
69. Our Principles also say if an organisation has failed to get something right and this has led to injustice or hardship, it should take steps to put things right. The Trust has not acknowledged the failing or taken steps to put right the impact this had. Because we have found failings which led to an injustice, we have made recommendations and these are explained at the end of this report.
Personal belongings
70. Mrs A says on her mother’s second ward, Mrs L was allowed the biscuits and mints she sent in, but on the original ward, staff kept these in a locker that her mother could not get to.
71. The Trust says personal belongings are kept in a bedside locker in line with infection control recommendations and the team would have helped with access whenever needed. The Trust has a policy on storing patient’s belongings. It says staff are responsible for recording what items a patient has and storing them safely.
72. Our nurse adviser says a patient’s personal belongings should be kept safe and a standard ward setting should provide a patient with a bedside locker to allow this. The patient should be able to access their locker whenever needed with support from staff, if required. Our nurse adviser explained the Trust was correct to refer to infection control. It is also important to note that because of the pandemic, good housekeeping and keeping a clutter free environment was even more important.
73. We do not think the Trust did anything wrong in storing Mrs L’s things in a locker. But, we need to consider whether she was given access to this and assisted.
74. As we were not there at the time and there is no video footage, we must take a view as to what, on balance, happened and if Mrs L was given access to her things. We do not dispute what Mrs A says. We understand how Mrs L may have been hesitant to ask staff to help her. Added to this is the evidence of periods when staff were not available.
75. It is likely that staff did not support Mrs L in the way they should have. We do not think this was intentional. It seems Mrs L did not feel able to ask staff for help. This indicates staff had not adequately explained what they could help with. Staff should have explained the policy on personal belongings. This is a failing.
76. This caused Mrs L and her family distress. We are sorry to hear how this affected them. We know that having access to personal items makes an admission more comfortable, especially when visitors are not allowed.
77. We are pleased the Trust apologised in its complaint response if it did not make it clear to Mrs L that she could ask for assistance, and this caused her distress. In line with our principles, we think the Trust’s apology is sufficient and we do not propose making further recommendations.
Bed sores
78. Mrs A tells us the Trust allowed bed sores to develop.
79. The Trust says it completed pressure area risk assessments regularly and a pressure relieving mattress and barrier products were in place. It says the team worked hard but pressure injuries (bed sores) did develop.
80. NICE has a guideline on treating bed sores. It recommends risk and skin assessments, repositioning and using pressure relieving devices.
81. We discussed this with our nurse adviser who identified how the medical records give evidence of the Trust doing skin risk assessments and evaluations. The Trust’s care plan consisted of two to three hourly checks. The records document how over time Mrs L’s skin deteriorated, and a referral was made to the Tissue Viability Nurse for wound care advice and review. This shows the Trust had a clear plan in place and photographs were taken which was in line with best practice. There is evidence of wound care dressings and creams being applied.
82. The Tissue Viability Nurse recommended repositioning once every two hours, but there is no evidence of this being actioned consistently. We did not find evidence of a wound care plan following the outcome of the Trust’s assessments. The records show the Trust used a pressure relieving device on Mrs L’s bed, but no pressure relieving seat cushion for when she was sitting out of bed. This would have been needed as NICE says to ‘consider the seating needs of people at risk of developing a pressure ulcer who are sitting for prolonged periods’.
83. NICE recommends using risk assessment tools/scales to validate best clinical judgement, such as the Waterlow scoring tool, Braden scale, or Norton risk assessment scale. These scales record any changes in bed sores and give a clear picture of the sore’s size, depth, and an assessment of its grade and surrounding skin damage. We found the Trust used the SSKIN assessment tool which is not as effective in measuring the deterioration or improvement of a bed sore once it has developed.
84. Our decision is the Trust did assess and treat the bed sores, but there are things it could have done better to fully meet NICE recommendations. The records do not give evidence of the standard of care being consistent, so we cannot say the Trust fully met the required standard. This is a failing to provide full and consistent bed sore care.
85. Mrs A says her mother’s bed sores caused her suffering and she became bed bound. Mrs A says she felt the Trust did not care as her mother was dying. She says she is heartbroken that this happened. We are sorry to hear this. Inconsistent care will have caused discomfort and a breakdown in Mrs L’s skin integrity. It is likely to have contributed to late identification of bed sores developing or deteriorating. Because nursing care was expected 24 hours a day, and there is evidence that this was not consistent, we found a direct link between the injustice and failing.
86. The Trust did not identify this failing in its investigation. We asked the Trust to provide further comments based on what we had found so far. It says risk assessments were in place that confirmed a high risk of developing a pressure injury and prevention care such as a specialist mattress and seat cushion, was in place. It says due to her care needs, there would have been times when Mrs L was repositioned more frequently than every two hours.
87. We accept the care was challenging. But, we have not seen evidence of a seat cushion being used. We also have not seen evidence of recommended assessment tools being used, or of the repositioning being done at the required times. We do not think the Trust has done enough to put this right. Because we have found failings which led to an injustice, we have made recommendations at the end of this report.
Leaking catheter
88. Mrs A says the Trust waited before fixing a leaking catheter.
89. The Trust says the nursing team were aware of the leaking catheter as the care was ongoing and challenging. It says the catheter did fail to drain reliably for a time and the team discussed managing this care. It says shortly after this, Mrs L pressed the call bell and informed the nurse her catheter was leaking. It says it asked Mrs L to wait as the senior nurse was getting the equipment to address this.
90. The Trust accept the care was difficult and that staff were aware of a leak. Our nurse adviser explains how deterioration in Mrs L’s skin integrity and bed sores is related to incontinence and being immobile. As a result, moisture lesions developed in her buttocks. The medical records document this. Our nurse adviser further explains that this is best managed by inserting a catheter. The Trust did this on 18 December 2020.
91. The complaint we are considering is not that the catheter was not the right thing to do, but that there was a delay in fixing it when it leaked. There is no specific guidance to refer to here as the complaint is about a delay, and not a clinical decision. Having discussed this with our nurse adviser, we do not think the Trust waited to fix the catheter. The Trust says staff knew of the ongoing issue, discussed how to manage it, and were preparing to fix it with suitable staff and equipment. For these reasons, we cannot say the Trust delayed for no reason or that it was unaware of a problem.
Communication
92. Mrs A says the Trust did not keep the family updated and when they called, staff said they needed to do things and her mother could not speak to them. She says the Trust did not tell the family they could do Zoom calls until just before she died and did not tell the family about Mrs L’s pneumonia, until she moved wards.
93. The Trust’s complaint response says during its investigation it became apparent that some of Mrs L’s medical conditions were not communicated with the family at the time. It apologises for this. It says that due to COVID-19 visiting restrictions, Mrs A was not able to witness the challenges and decline in Mrs L’s health. The Trust says the nursing team’s failure to communicate regularly with the family is a learning point. It regrets not offering Zoom calls as this would have helped to support them at such a worrying time. It says it has shared an edited version of their experience (to maintain privacy) with the whole team to highlight the impact of poor communication and stop this happening again.
94. The Trust says its medical team did keep the family regularly updated by telephone and this is documented in the records. It says it tried to contact Mrs A when her mother moved wards and left a voicemail. The Trust says it discussed end of life care with Mrs L and Mrs A on 9 February 2021. It accepts it would have been a shock for Mrs A having not seen her mother since December 2020. It says it understands the limitations of telephone updates.
95. There is no specific guideline or standard that says how often a family should be consulted, and this will vary depending on circumstances. Our nurse adviser highlighted parts of the NMC code which says nurses should, ‘work in partnership with people to make sure [they] deliver care effectively… recognise when people are anxious or in distress and respond compassionately and politely…share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand’.
96. The code also says complaints should be responded to professionally and used ‘as a form of feedback and an opportunity for reflection and learning to improve practice’.
97. We found the levels of communication varied during the admission. The medical records gave evidence of proactive discussion from the medical team at times, but there is also no evidence of communication at other times. This supports both what Mrs A and the Trust says. It is not possible to make a specific finding on whether the Trust did prevent the family from speaking to Mrs L, as they were providing care at the time.
98. Mrs A told us the Trust did not communicate with her about her mother’s physiotherapy. She says physiotherapy staff said her mother would be moving wards for rehabilitation, but the day before she moved, the Trust said she was going to a nursing home for this.
99. We reviewed the medical records and an entry says to update the next of kin and that the Trust contacted Mrs L’s daughter. The notes suggest a staff member advised Mrs L was improving and she could go home the next week. We note a further discussion between medical staff and Mrs L’s daughter which says an update on Mrs L’s medical management and ongoing physiotherapy was given, as her mobility was reduced. The records document that an update was given to Mrs L’s daughter about her mother’s renal function results and if there was improvement, to restart discharge planning. The physiotherapist made a note of having Mrs L’s consent to contact her daughter regarding physiotherapy. The note says they advised Mrs L was not medically fit at the time but they planned to aim for rehabilitation and discharge.
100. The medical records further say the physiotherapist discussed with Mrs L’s daughter about a referral and that ‘she is happy’. This suggests there was discussion at this time. There is no evidence in the medical records of the Trust saying Mrs L was going to a nursing home for rehabilitation. Our nurse adviser says that as her condition was deteriorating, it would have been inappropriate for her to go to a nursing home for rehabilitation. We know that sadly Mrs L died before being discharged. We cannot confirm what was said as we have no further evidence to consider.
101. Based on this, there is evidence of communication. The Trust’s plan depended on Mrs L’s clinical condition and whether she was well enough to continue with physiotherapy and rehabilitation. We have listened to what the family say about the communication not being good. We have already seen that communication was inconsistent so it is likely, that although there was some communication, this could have been better and clearer. This would have given the family more understanding and confidence.
102. Overall, the medical records do not give evidence of sufficient, consistent communication with the family to keep them up to date on Mrs L’s treatment, deterioration, and to address any concerns. The Trust, like other health organisations, was dealing with increased pressures due to the pandemic and we recognise this. But, the NMC code says, priority should be given to listening to people’s concerns so effective care can be given, and any anxieties can be relieved. Information needs to be shared with a family in a way they can understand. The Trust did not do this regularly. Our decision is the Trust’s standard of communication fell short of the required standard.
103. Mrs A says she feels the Trust’s lack of communication was cruel and insensitive. She says the lack of communication meant the family were shocked to learn Mrs L was at the end of her life, and they did not have time to prepare. Although we doubt the poor communication was intentional, this injustice is significant.
104. We are pleased the Trust has apologised for its communication and recognises the limitation of telephone updates, and how video calls were not offered. It explains it realises how these issues affected the family. It says it has learned from this and shared the experience with staff to stop this happening again. We asked the Trust to tell us more about the learning it took from this issue, and to confirm what actions had been taken and when.
105. The Trust initially responded by repeating the information from its complaint response and saying its main learning has been around improving communication with family when face to face contact is restricted. It confirmed the complaint has been shared anonymously for discussion and reflection.
106. This does not reassure us of any specific steps that have been taken to improve communication. As Mrs L was admitted in December 2020, the Trust should have had better measures in place to tackle challenges in communication that had been ongoing since March 2020.
107. We asked the Trust again what specific actions it has taken. It told us that communication has been a big challenge for it during the pandemic. It says it got extra electronic devices to help patients communicate with family and friends. It explains there were internet and technical issues on the ward which meant it could not use these devices reliably. It says the only way it could arrange video calling was by staff using their own devices and network providers.
108. The Trust says it communicated with the family when the treatment plan changed. It says Mrs L kept in communication with her family herself, and it would have been happy to speak to the family at any time on request. It says it accepts shortfalls in communication and would have rather been in a situation where it led on communication. It explains it has trialled a communication tool to ensure regular communication with a point of contact for each patient. It then revised the Visiting Policy so each patient could have a nominated visitor and face to face communication.
109. We appreciate the difficulties the Trust faced. We are pleased to see it tried new ways of communicating and this resulted in it changing its policy. The NMC code and our principles say it is important for complaints to be used as a way to learn. We think the Trust could have done more as it should always lead on communication. It cannot be expected of patients, especially if they are elderly and frail, to arrange communication themselves.
110. As the poor communication caused a significant injustice to Mrs L’s family, we have made recommendations to the Trust to put this right.