University Hospitals Birmingham NHS Foundation Trust

3. Mrs A complains about the care and treatment she received from the Trust. She says:

• from 2017 to 2019 staff refused to treat an abscess • in June 2019 and September 2019, staff incorrectly told her the abscess was deep vein thrombosis (DVT) and chronic septic arthritis • in July 2019 she developed gangrene, and staff would not treat this and told her it was DVT • in March 2020 staff did not provide appropriate pain relief.

4. Mrs A says she had to have her leg amputated because the Trust’s staff did not treat the abscess and gangrene. Mrs A says this experience has caused her immense pain and stress and distress to her family. She said she must now take lots of medications.

5. By bringing this complaint to us, Mrs A would like to receive a payment in recognition of the pain suffered, an apology from the Trust and service improvements to make sure this does not happen to anyone else.

6. In 2017 Mrs A developed an abscess in her leg.

7. Between 2017 and 2019 Mrs A attended the Trust multiple times with infections.

8. In July 2019 Mrs A attended the Trust with an abscess in her lower leg and says staff told her it was DVT. Mrs A says this is when the gangrene began to develop.

9. On 27 September Mrs A attended A&E at the Trust as her leg was swollen and the pain was unbearable.

10. Mrs A was admitted on 28 September. She says staff told her the swelling and pain were due to chronic septic arthritis (previously diagnosed in 2017). The abscess subsequently burst, and Mrs A spent eight weeks in hospital, including three days in intensive care.

11. In March 2020 Mrs A attended the Trust with pain in her foot. Mrs A said staff initially wanted to discharge her with no further action. Mrs A had her foot amputated, and she believes this is due to the abscess and gangrene being left untreated.

12. She says staff did not give her appropriate pain relief during this admission.

13. Mrs A says she initially complained to the Trust in March 2020. The Trust did not respond, and Mrs A chased it in March 2022. The Trust responded in September 2022. Mrs A complained to us the following month.

15. The law says a person needs to make a complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year unless we consider there is a good reason to do so. We have discussed this with Mrs A to understand the reasons why she could not complain sooner. We have also considered the time the Trust took to respond to Mrs A.

Events in 2019

16. Mrs A told us she was admitted to the Trust on multiple occasions due to infections from late 2017. Mrs A would have reasonably known about these events as they happened from 2017 to 2019. As Mrs A may not have known what was wrong, we can say that the latest she would have become aware is September 2019, when the abscess burst and she received treatment. Mrs A submitted her complaint to us on 8 October 2022. This means this part of her complaint falls two years outside our time limit.

17. Mrs A has not provided reasons for not complaining about these issues sooner. Still, for the reasons we set out below, the complaint falls outside our time limit irrespective of this.

Events in 2020

18. In this case, Mrs A knew she had concerns about appropriate pain relief in March 2020. She would have known at that point that the untreated infection was gangrene, as this was when her foot was amputated. Mrs A complained to us on 8 October 2022. This means this part of her complaint falls outside our time limit by one year and six months.

19. Mrs A says she complained to the Trust in March 2020 after surgery to amputate her foot while still an inpatient. We appreciate that Mrs A raised this part of her complaint to the Trust quickly and without delay. It seems the Trust either did not receive the complaint or overlooked it.

20. Mrs A did not receive any contact from the Trust, and she did not contact it again regarding her complaint until March 2022. Mrs A says this was because she thought COVID-19 would cause backlogs. We understand that Mrs A was allowing the Trust more time to respond to her complaint. Still, we do not consider that two years was a reasonable time for her not to chase the Trust when it had not responded. It should have been clear that there was a problem with the complaint she says she submitted in March 2020 after not receiving an acknowledgement in two years.

21. Mrs A contacted the Trust in March 2022 and discovered she had not submitted her initial complaint from 2020. Mrs A submitted her complaint to the Trust again in March 2022.

22. The Trust responded on 15 September 2022. This was approximately six months after it had received the resubmitted complaint.

23. We appreciate six months is a long time to wait for a response and we have taken this into account while considering the time limit. Although the Trust took six months to respond, this does not account for all, or even most, of the delay in bringing the complaint to us.

24. We asked Mrs A to explain what happened between March 2020 and March 2022. She said she was waiting for the Trust’s response. She said the ward she had been on had been closed due to COVID-19, and she thought this had impacted the investigation into her complaint. She added that she contacted a no win no fee solicitor in this time, who told her they would not take her case on.

25. There was a two-year gap between March 2020 and March 2022 when Mrs A did not contact the Trust. We have considered the reasons Mrs A has provided. We understand Mrs A thought the delay was due to COVID-19 backlogs, which is understandable, but in our view, two years is too long to wait before contacting the Trust once it became clear no response was forthcoming. Mrs A also chose to seek legal advice from two solicitors during this time. This shows she could have contacted the Trust sooner.

26. We recognise that Mrs A had an incredibly unfortunate time of ill health with devastating consequences. Regrettably, we have seen no good reason to put aside our time limit to consider these issues. This decision is supported by legislation and is in no way a reflection of the seriousness of these events or how Mrs A was affected.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs A’s complaint about University Hospitals Birmingham NHS Foundation Trust (the Trust).

2. This complaint falls outside our one-year time limit. We have not seen a good reason to put our time limit aside, so we have decided not to consider the complaint further. In making this decision, we do not wish to diminish the deep distress Mrs A has felt because of her incredibly unfortunate experience.