Nottinghamshire Healthcare NHS Foundation Trust

4. Ms H complains on behalf of Ms A about the care and treatment Ms A got from Nottinghamshire Healthcare NHS Foundation Trust (the Trust) during her admission between September 2021 and January 2022. Specifically, she complains that:

· on the second day of Ms A’s admission, the Trust’s healthcare assistant (HCA) left her in soiled sheets after her catheter burst and an HCA did not replace the sheets in a timely manner or change her catheter · the Trust’s HCA did not properly help Ms A to wash and dress in the mornings · the Trust’s HCA was rude to Ms H when talking with her about visiting arrangements during the COVID-19 pandemic · the Trust’s physiotherapist put off giving Ms A treatment and failed to go to scheduled sessions without explanation · the Trust’s physiotherapist made insulting comments about Ms A and shouted at her after she complained about not being seen for physiotherapy · a second HCA at the Trust did not help Ms A to change her incontinence pads and did not act in line with hygiene measures on the ward · a third HCA at the Trust ignored Ms A and did not give her personal care · the Trust’s deputy ward manager did not respond to Ms A’s request for pain relief or arrange for this to be given · a second deputy ward manager at the Trust made a hurtful comment about Ms A’s looks · and the Trust did not explain or help Ms A with the discharge procedure.

5. Ms H says her mother has post-traumatic stress disorder (PTSD) after what happened and has flashbacks and nightmares.

6. Ms H wants the Trust to give her mother a compensation payment of between £10,000 and £15,000 for the distress and neglect she experienced. She wants the Trust staff involved to accept responsibility and for the Trust to put proper training and suspensions in place.

7. Ms H says sometime before the events of the complaint took place Ms A had been diagnosed with depression, anxiety and multiple sclerosis.

8. Ms A was admitted to the Trust from September 2021 until January 2022, when she was discharged to a care home. Ms A gave a statement of her account of events when Ms H made the complaint on her behalf. As most of the events are without date, we will outline them in the order in which they appear on her statement.

9. As there are several complaints about Ms A’s care, we have given each its own title (for instance, ‘Complaint A’). We will use these titles throughout the rest of this statement.

10. Complaint A: On the second day of Ms A’s admission, Ms H says Ms A’s catheter burst, leaving her bed sheets covered in urine. She says Ms A asked an HCA at the Trust to change the sheets. She says the HCA at first refused to do this, and, even when she changed the sheets, she did not replace the catheter. Ms A says the catheter was only replaced after a different HCA saw her. The Trust says in its response that the HCA Ms A complained about was about to go off-shift when Ms A approached her and she saw that the catheter had come out. The Trust says the HCA changed Ms A’s sheets, so she was not in wet sheets for any length of time, and arranged for another member of staff to replace the catheter.

11. Complaint B: Ms A says the same HCA delayed giving her personal care before breakfast so she could go to the hospital dayroom by 10am. She says the HCA left her sitting in her faeces as she had breakfast. It is not clear from Ms H’s complaint to the Trust whether Ms A is saying this happened repeatedly or only once. The Trust’s response accepts one occasion (around 24 November 2021) when the HCA was caring for another patient who was distressed and so could not look after Ms A. The Trust says there were two new members of staff on the ward, but the HCA had forgotten to tell them Ms A should have a bowl to begin washing herself. The Trust accepts Ms A’s care was delayed and apologised for this.

12. Complaint C: Ms A says when Ms H asked about visiting her over Christmas 2021, the same HCA rudely told Ms H that the Trust did not know if there would be visiting as there had been a COVID-19 outbreak and it needed to think about the safety of its patients. The Trust says the HCA wanted to be sure Ms H knew about possible visiting restrictions. The HCA accepted that she ‘can be loud’ but says she did not mean to be rude and apologised if this was how she came across.

13. Complaint D: Ms A says at some point after the first two weeks of her admission, her mobility worsened and she was no longer able to stand. She says the Trust’s physiotherapist did not come to speak to her for a week, despite seeing other patients on the ward. Ms A says when she first spoke to the physiotherapist about the delay in being seen, the physiotherapist became defensive and argued with her before telling her to do bed exercises. The Trust says the physiotherapist did not remember the interaction Ms A described when asked. It accepts there were times when, due to staffing shortages, the physiotherapy team may not have been able to see her, which had been explained to Ms A. The Trust says there was evidence the physiotherapy team saw Ms A many times, and that it had given her advice on what she could do for herself when it could not see her.

14. Complaint E: Ms A says the same physiotherapist made hurtful comments about her looks because of her age and about her legs not working. She also told us the physiotherapist shouted at her after she complained about the assistant physiotherapists. The Trust’s response says the physiotherapist does not remember commenting on Ms A’s age. The physiotherapist accepts that she commented about Ms A’s legs not working, but that this was meant to be caring, and she apologised if it did not come across that way. The Trust says there was an incident recorded on 25 November, where Ms A was particularly upset with members of the physiotherapy team, but the physiotherapist says she did not raise her voice or shout at Ms A and discussed this with her after she had calmed down.

15. Complaint F: Ms A says on one occasion she soiled herself and buzzed for help. She says an HCA (the second HCA) came over, but, after Ms A explained she needed her pad changing, the HCA told her she was busy and walked off. Ms A says the second HCA did not come back despite Ms A buzzing for help again, and a different HCA changed her pad around 25 minutes after she had first asked for help. The Trust’s response says the second HCA remembers Ms A calling her over rather than buzzing for help. She says that as a dementia patient had pressed the buzzer for help to go to the toilet, she explained to Ms A that she had to look after that patient first. She says after she had come back from helping the other patient, Ms A was already getting help. The Trust says the second HCA apologised to Ms A at the time. Ms A also complains that the second HCA was not hygienic, and says she saw her several times not sanitising her hands between tasks. The Trust’s response says the second HCA denies this and says she was compliant with the relevant training.

16. Complaint G: Ms A says another time, a different HCA (the third HCA) did not give her personal care after she had buzzed for help and went into another patient’s cubicle. She says the third HCA stayed there for 45 minutes, when she had seen care for this patient usually only took 15 minutes. She says she saw that the third HCA’s feet were not moving and so thought she was not giving care. The Trust’s response says the third HCA remembered this incident, and that it took longer than usual due to the specific care the patient needed at that time. The Trust says the third HCA did not feel it was right to discuss this care with Ms A, but apologised for how the incident made her feel.

17. Complaint H: Ms A says one morning at around 8.15am, she had pain in both legs and needed Shortec (an opioid painkiller) for this. Ms A says the bank nurse told a deputy ward manager Ms A was in pain during the morning medication round, but the ward manager dismissed this. Ms A says she did not get any pain relief until lunchtime, when she complained. The Trust’s response says it would look into this further if it got specific dates. The deputy ward manager says she does not remember the incident, but she would have looked into this during the medication round if she was able to. The Trust says the Shortec prescription was ‘as needed’, so it was possible that the Trust could not have given it at the time Ms A asked for it, depending on how recently she had had it.

18. Complaint I: Ms A says she cannot shower often due to her disability, but accepted a shower with the help of two HCAs. She says as they were drying her on her bed, a different deputy ward manager (the second deputy ward manager) walked into her cubicle and said, ‘Good god’ loudly and started laughing. The Trust’s response says the second deputy ward manager could not remember the incident well. It says she believed that she went into the cubicle as part of the medication rounds to bring Ms A her medication. She says any comments she made were meant in a lighthearted way and not meant to be hurtful, and apologised for any offence they caused.

19. Complaint J: Ms A says when the Trust discharged her, it told her she would be moving and a staff member would give her a letter with the details. She says no one asked for her agreement or offered to talk about what was happening with her, as she could not read it without her reading glasses. She says she thinks the Trust did this to get rid of her. The Trust says that, according to the local Clinical Commissioning Group’s direction, where a patient is waiting for a care package and no longer needs hospital treatment, the patient should be moved to an interim bed. The Trust says it explained this to Ms A over the phone on 23 December. The Trust apologises if Ms A felt she was not being given a choice, but says it was following the advice and direction of the Clinical Commissioning Group.

Complaints C, E, F, G and I

22. Before we decide whether we should investigate a complaint in detail, we look at whether there is enough evidence for us to reach a decision on it. We have done this and do not think we would be able to reach a view, even on what is likely to have happened, on Ms H’s complaints about how the Trust’s staff treated her and her mother.

23. The complaints about the HCA’s talk with Ms H about visiting during the COVID-19 pandemic, about the Trust’s physiotherapist making an insulting comment about Ms A and about the second ward manager making a hurtful comment about Ms A’s looks all relate to spoken interactions. We have looked at both Ms A’s account of what happened and the Trust’s response. We can see that both parties have different accounts of what happened and of how the comments Ms A complains about were meant.

24. We cannot know exactly what was said between the Trust’s staff and Ms A, and we would not expect any of these interactions to be written down in Ms A medical records. We asked Ms A if she had any further evidence she wanted us to look at, but she did not say there was. There are differing accounts of events, and there seems to be no independent evidence we could use to take a view on what happened here. We therefore do not think we can say whether the staff members’ behaviour was (or even might have been) in line with the relevant professional standards or not.

25. With the complaints about the second Trust HCA not changing Ms A’s incontinence pad and the third HCA not giving her personal care, the Trust’s response also gives a different account of what happened, saying that both delays happened because the HCA was giving care to another patient. We do not think there would be evidence in Ms A’s medical records that we could use to reach a view on these parts of her complaint. We do not think that it would be right to look at the medical records of the other patients, even if it would be possible to find out now which patients were getting care at that time. We therefore do not think we could reach a view on these parts of Ms H’s complaint.

26. We want to make clear this does not mean we do not believe Ms A’s account of events. As an impartial organisation, however, we do not think we would be able to find independent evidence that would allow us to reach a decision on this complaint. It would therefore not be appropriate for us to look into these parts of the complaint further.

Complaints A, B, D, H and J

27. Before we decide whether we should investigate a complaint in detail, we look at the outcome the complainant is looking for, and whether this is something we could recommend, or would be likely to recommend, even if we fully upheld the complaint after an investigation. Having done this, we think an investigation would not get the outcomes Ms H has said she wants, and so it would not be right for us to investigate.

28. Ms H told us she wants her mother to get between £10,000 and £15,000 as compensation for the distress, pain and neglect she experienced. When recommending compensation payments, we look at our guidance on financial compensation, which includes our severity of injustice scale. A compensation payment of £10,000 or over would be at level six, the highest level of our scale.

29. We have not seen any signs in Ms H’s complaint that Ms A experienced a worse medical outcome as a result of the events she complains about. As such, the injustice she claims would mainly be described as ‘emotional’, in line with our guidance on financial compensation. Our guidance says that for levels four and above (that is, over £1,000), the injustice will be greater than ordinary distress or inconvenience. Our scale describes a level six emotional injustice as cases where we see evidence of ‘very severe trauma (which may be accompanied by mental ill health or mental/social disability) [or] severe distress over an extended period (generally several years)’.

30. Ms H says in her complaint to us that her mother was suffering from PTSD. We asked Ms A about whether a doctor had diagnosed her with PTSD, and she told us that was not the case. Without a formal diagnosis, we do not think we could connect any failings in the Trust’s actions to Ms A experiencing PTSD or other severe trauma.

31. We understand Ms A was in hospital for a long time, around four months. However, we have seen no signs that the events Ms H has complained about on her mother’s behalf happened over the whole of her admission. From what Ms A says in the complaint, many of these were separate incidents that happened over the course of a day (or one week, in the case of the claimed delay in being seen by the physiotherapist).

32. We could get records from the Trust to look into the care staff gave to Ms A in terms of pain relief, personal care, physiotherapy and her discharge. However, we think that in line with our Severity of Injustice Scale, even if we were to investigate and fully uphold Ms A’s complaint, we would probably not recommend financial compensation above level three of our Severity of Injustice Scale (£500 to £950).

33. We are not trying to minimise the impact these experiences had on Ms A and understand that, in light of her existing depression and anxiety, this could have caused her distress, as Ms H has said. But as Ms H has said she wants a much greater compensation payment than we would likely recommend as a result of an investigation, we do not think it would be right to investigate further.

34. Ms H also told us she wants the Trust’s staff members Ms A mentions in her account of events to ‘accept responsibility’ and get training, and that ‘adequate suspensions are put in place’. We can only make recommendations to the NHS organisation involved, in this case the Trust, and cannot make recommendations to individual clinicians or staff members. We cannot make recommendations about personnel issues such as disciplinary matters, suspensions or removal of staff.

35. In short, we do not think it would be right for us to look into this complaint further. Several of the outcomes the complainants want are not possible for us to get, and we do not think we could recommend the amount of financial compensation they would like, even if we investigated and upheld the complaint. We are grateful for Ms H taking the time to tell us about her mother’s difficult experience. We are sorry to hear about the difficult time Ms A went through and the obvious distress it caused her.

1. The Parliamentary and Health Service Ombudsman has carefully looked into Ms H’s complaint about the care and treatment the Trust gave her mother, Ms A.

2. For some parts of Ms H’s complaint, we do not think there is enough evidence we can use to reach a decision. For the other parts, we do not think we would recommend the outcomes Ms H is looking for, and some of them are also about issues we are not able to investigate by law.

3. We understand Ms A’s experience during her admission to the Trust caused her great distress. We are not trying to minimise this, and we are sorry to hear that this still causes her flashbacks and nightmares.