Bedfordshire Hospitals NHS Foundation Trust

4. Mrs S complains Trust staff did not refer her father, Mr T, to the safeguarding team during his admission between 23 November and 14 December 2020.

5. She explains her father had suffered a stroke so his cognition (thinking) was reduced, he had a history of anxiety and depression and he had experienced childhood trauma meaning he needed support. She says the SALT did not refer him when he said, ‘I am done with living everyone has deserted me’, when he cried and when he was visibly anxious.

6. She further complains the SALT was not qualified to comment on Mr T’s mental health but they:

• recorded on the single assessment form that he was not distressed when administering an enema (treatment to encourage bowel movement) on 1 December 2020 • commented on the decline of his mental health in a voicemail they left for the Disabilities Trust on 15 December 2020.

7. She explains the safeguarding referral would have made sure her father got support with deciding on the care and treatment he needed, especially as his family could not be there to help due to COVID-19 restrictions. She says if staff had referred him, they may have given him different treatment plans, which may have increased his chance of survival. He also may not have had to have the enema.

8. She also explains the SALT’s actions affected the way staff at the Disabilities Trust viewed her father, herself and her family. She says this affected the way her father was cared for and treated.

9. She would like the Trust to answer the questions she asked, acknowledge the failings that happened and make service improvements.

10. Mr T was admitted to the Trust on 23 November after having a stroke. This caused him to have difficulties communicating and mobilising independently.

11. On 24 November, the SALT assessed Mr T’s needs. At this stage, he had significant confusion and poor memory. He was also uneasy on his feet and needed help to dress, stand and walk. Mr T told SALT he was ‘done with living as everyone has deserted’ him.

12. Near the end of November, Mr T began experiencing constipation. On 1 December, staff decided to give him an enema to help relieve his symptoms. This is where liquid is delivered through a nozzle into the anus and rectum to help empty the bowel.

13. On 2 December, the medical team told Mr T’s family they had carried out an enema to help relieve Mr T’s constipation. Mr T’s family told the medical team that invasive procedures, like enemas, are likely to cause Mr T distress. This is because of the abuse he experienced as a child. They also told the medical team Mr T had a history of anxiety and depression.

14. On 3 December, the physiotherapist and SALT assessed Mr T’s needs. They detailed these on a single assessment form. The SALT noted that Mr T had not been distressed during the enema procedure.

15. As Mr T needed rehabilitative care, the Trust planned to discharge him into the care of the Disabilities Trust who provide this. They discharged Mr T on 14 December.

16. On 15 December, the SALT left a voicemail for the Disabilities Trust to handover Mr T’s care. In this voicemail they explained that Mr T's mental health had declined during his admission which had affected his ability to engage in impairment-based therapy. These are therapies aimed at improving language functions for the patient.

Staff and SALT did not refer Mr T to the safeguarding team

20. The Trust explained it was not aware that Mr T had suffered from childhood abuse and trauma until 2 December, when Mrs S told them. After this date, the team caring for him took into consideration his past childhood trauma and considered this before giving any further medical interventions that may have caused him upset.

21. It says because Mr T was not experiencing, or at risk of, abuse or neglect as a result of the care and support he needed during his admission, staff did not need to refer him to the safeguarding team.

22. The Care Act 2014 says organisations are responsible for raising safeguarding concerns if they suspect an adult who has care and support needs is being abused or neglected. They should do this when they feel the adult is unable to protect themselves against the abuse or neglect.

23. NHS England’s safeguarding policy and the Trust’s safeguarding guidance confirm that the Trust should raise safeguarding concerns when an adult:

• ‘has needs for care and support (whether or not the local authority is meeting any of those needs) and, • is experiencing, or at risk of, abuse or neglect and, • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.’

24. Our consultant in general medicine explained a patient’s medical history can indicate they are at an increased risk of abuse. For example, a patient with limited mobility caused from a neurological condition, such as a stroke, could suffer physical abuse or neglect more easily than an adult who does not have limited mobility. This is because they have to rely on others for their care. Although such conditions can make a patient more vulnerable to abuse, that does not mean they will experience abuse.

25. Our consultant in general medicine further explained that because of the symptoms Mr T had after his stroke, he needed care and support for his poor mobility and cognition. This means Mr T met the criteria set out in point one of NHS England’s safeguarding policy and the Trust’s safeguarding guidance.

26. But we have seen no evidence that Mr T was at risk of, or was experiencing, abuse or neglect, before and after his family told the medical team about his previous childhood abuse.

27. We do not underestimate the impact that Mr T’s childhood abuse would have had on him. But this did not mean he was at risk of abuse, or suffering from abuse, during his admission at the Trust.

28. This shows us that Mr T did not meet the criteria in point two and three of NHS England’s safeguarding policy and the Trust’s safeguarding guidance. Because of this, there was no need for staff to refer him to the safeguarding team during his admission.

29. In relation to SALT specifically, our SALT adviser explained that a patient reporting low mood or thoughts of suicide are not risks managed by a safeguarding team.

30. Although it is clear Mr T needed support with his care needs, at the time, SALT had no evidence that Mr T was subject to, or at risk of, abuse or neglect. In line with NHS England’s safeguarding policy and the Trust’s safeguarding guidance, SALT did not refer him to the safeguarding team.

31. We recognise that Mrs S wanted her father to have the best possible care and treatment. We have not seen any evidence that staff did not do what they should have done and we have not found any failings in the care and treatment they provided.

SALT commented on Mr T’s mental health

32. The HCPC’s standards of proficiency say SALT should only comment on clinical matters that are within their remit. Our SALT adviser explained that SALT support a person’s wellbeing and quality of life by assessing their needs, so it is important for them to comment on a patient’s presentation during assessment and treatment.

33. RCSLT guidance explains SALT must comment on a patient’s impairment, activity, participation, wellbeing and communication needs. It is particularly important for SALT to closely observe a patient’s overall presentation when they have difficulties communicating verbally.

34. This helps monitor whether the patient is showing any potential signs of distress and engagement during treatment. It also helps inform planning for future therapy sessions and intervention.

35. The SALT noted in the single assessment form that when the enema was given to Mr T, he did not appear to be distressed. It specifically says, ‘this was not evident when treatment was provided to patient as far as staff are concerned’.

36. It is unclear whether the SALT was there when the enema was administered and if this is their personal observation, or they are repeating information given by clinical staff who were there at the time.

37. In any case, SALT summarised Mr T’s presentation at the time of the enema procedure. Whether this was a colleague’s account or their own view if they were there during the treatment, it was in line with the RCSLT guidance to include this information.

38. As the SALT did what they were supposed to do, we have not identified this as a failing.

39. We also recognise that Mrs S was concerned the SALT commented on her father’s mental health declining during a voicemail they left for the Disabilities Trust.

40. HCPC standards of conduct say professionals must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services given to the patient to help facilitate their individual care package.

41. Our SALT adviser explained that clinically relevant information about a patient’s ongoing care must be shared with relevant services. This includes a patient’s mental health presentation. This helps staff decide what therapy or intervention is most appropriate or likely to be effective for the patient.

42. We can see the SALT left a voicemail for the Disabilities Trust when handing over Mr T’s care. They specifically commented on Mr T’s mental health affecting his ability to engage in impairment-based therapy.

43. Our SALT adviser explained this information linked to Mr T’s ongoing health, and it was important to share this with the new therapy team to help support his intervention and care planning. It was important for the SALT to share this information with the Disabilities Trust at the time.

44. As the SALT’s actions were in line with HCPC’s standards, we have not identified this as a failing.

45. We recognise the events Mrs S complains about have been very difficult for her. We hope our report assures her that staff did what they were supposed to do. We do not uphold this complaint.

1. The Parliamentary and Health Service Ombudsman has investigated the complaint about Bedfordshire Hospitals NHS Foundation Trust (the Trust). We found staff and the speech and language therapist (SALT) were right to not refer Mr T to the safeguarding team during his admission. This was in line with the Trust’s own guidance and national guidance on safeguarding.

2. We did not find any failings in the SALT making written comments about Mr T’s mental health or in the voicemail they left for the Disabilities Trust. We do not uphold the complaint.

3. We do not underestimate the difficult circumstances surrounding Mrs S’s complaint, and we are sorry to hear about these. We hope our report clearly outlines why we feel staff acted as they should have done when treating Mr T.