Second infection
17. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any sign that something went wrong.
18. Mr Y says the second infection led to Mrs Y’s physical condition getting worse and affected the discharge and her physiotherapy assessment.
19. Mr Y complained to the Trust about this but the Trust did not investigate it or make any comment on it.
20. RCN guidance says a provider should make sure it ‘has in place a strategy that describes its vision and actions over time to diagnose, measure, prevent and manage all cases of pneumonia [and urinary tract infections and sepsis]’.
21. GMC guidance says if doctors assess, diagnose or treat patients, they must:
‘adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient promptly provide or arrange suitable advice, investigations or treatment where necessary’.
22. We considered if the Trust followed these guidelines.
23. Mrs Y was admitted to the Trust after being referred by her GP for a chest infection, as it was not responding to oral antibiotics. Medical records show Mrs Y’s WBC were elevated at 21.85 when the Trust admitted her. The normal range of WBC is between four and 11.
24. The Trust gave Mrs Y IV antibiotics. Blood tests taken on 4 and 6 December show her WBC settled into the normal range. The Trust took Mrs Y’s bloods again on 12 December and her WBC was 26.53.
25. Medical records show the Trust reviewed Mrs Y and her national early warning score (NEWS) during this time was zero. NEWS is a tool used by clinicians to quickly find out the degree of illness of a patient. The higher the score, the more acute the illness. Mrs Y’s score of zero suggests she was not acutely unwell.
26. The medical entries also show the Trust noted Mrs Y’s raised WBC and did a chest X-ray. Records show the Trust reviewed the X-ray and noted it showed nothing new. These actions indicate the Trust made efforts to diagnose a potential healthcare associated infection. This is in line with RCN and GMC guidelines.
27. Our adviser said based on the records it was not possible to know where the source of infection was, if there was an infection present on 12 December. They said it seemed to be an isolated increase in WBC without any effect on her pulse, blood pressure, temperature or breathing rate. They told us there did not seem to be any significant deterioration in Mrs Y’s clinical condition at this time.
28. Medical records show Mrs Y’s WBC started to reduce by 14 December, when the WBC was 12.2. On 17 December, her WBC was within a normal range at 5.18.
29. Considering the above, we have seen no evidence to show Mrs Y’s raised WBC was because of an infection. It could have been due to the infection she had been admitted with, or due to another cause.
30. Without evidence to show she got an infection in hospital, we cannot say the Trust did anything wrong and we are not taking any further action.
31. We hope Mr Y can take some comfort from what we have explained and how the raised WBC is not linked to Mrs Y’s deterioration.
Trust did not tell Mr Y about the raised WBC level
32. Mr Y complained to the Trust about this part of the complaint on 23 May 2022 but the Trust did not investigate or comment on it.
33. GMC guidance paragraph 32 and 33 says:
‘You must give patients the information they want or need to know in a way they can understand.
You must be considerate to those close to the patient and be sensitive and responsive in giving them information and support.’
34. Medical records do not show Mr Y was told about Mrs Y’s raised WBC.
35. Our adviser said the incident did not have a big effect on Mrs Y’s overall health and wellbeing. Medical records show there was not any significant negative change to her pulse, breathing rate or temperature over this period. She did not appear to be acutely unwell.
36. Our adviser said there did not seem to have been a pressing need for this information to be shared with Mr Y. They explained communication with family members should mainly be about significant events. There is no requirement for every test result to be shared with the patient or their family.
37. Considering the GMC guidance, it would be wrong to say the Trust should have told Mr Y about the raised WBC level. This is because we cannot see it had any big effect on Mrs Y’s health.
38. We appreciate Mr Y would have liked to know and we are sorry to hear of his distress when he found out later. Because we have not seen the Trust failed to follow GMC guidance, we are not investigating this further.
Trust’s complaint handling
39. Mr Y has told us the Trust did not answer his May 2022 complaint about the secondary infection and communication failing as set out in paragraphs 18 and 33. The Trust instead sent him a letter dated 2 November saying it considered the local complaint process complete. It advised Mr Y to contact us.
40. Our ‘Principles of Good Complaint Handling’ say ‘We understand there is often a balance between responding appropriately to complaints and acting proportionately within available resources.’ They also say organisations should give complainants a real opportunity to be heard and allowed to be involved in the complaints process before decisions are made.
41. Our ‘Principles of Good Administration’ say organisations should always act fairly, appropriately and keeping the complainant and what they want in mind. They also say organisations ‘should be open and truthful when accounting for their decisions and actions’.
42. We can see the Trust sent Mr Y complaint response letters on 10 June, 12 November and 13 December 2019. It has also sent Mr Y a fourth complaint response on 25 June 2021.
43. The 10 June 2019 response includes a detailed timeline of the treatment the Trust gave to Mrs Y. Mr Y says he asked a series of questions after getting this response.
44. In our view, the Trust provided four detailed response letters. These include thorough answers to his earlier questions. The answers appear to be based on Mrs Y’s medical records.
45. In the 13 December response, the Trust told Mr Y it felt the local complaint process was now complete. It advised Mr Y any further correspondence it received would be acknowledged and filed.
46. The Trust did provide answers to Mr Y’s questions in its June 2021 response. It provided him with details about the date when Mrs Y was first tested for sepsis, when she was first given blood and the date bruising on her thigh was first identified. The Trust repeated its position that the local complaint process was complete. It referred Mr Y to us again.
47. The Trust sent a fifth response in November 2022 after getting Mr Y’s complaint about elevated WBCs. It stated it felt the local complaint process was complete. It also referred him on to us.
48. Considering the above, we feel the Trust has taken appropriate steps to investigate Mr Y’s complaint. The Trust has limited resources and must use these effectively. It had provided four opportunities for Mr Y to voice his concerns, and it gave four detailed responses to these concerns. This appears to be in line with our ‘Principles of Good Complaint Handling’.
49. Using medical records to support the Trust’s responses also suggests its responses are in line with our ‘Principles of Good Administration’, which say organisations must be truthful when accounting for decisions.
50. We are sorry the Trust did not investigate Mr Y’s latest complaint and we can understand why he is frustrated about this. We feel the Trust’s decision to not investigate the latest concerns does not mean it failed to follow our Principles.
51. While we appreciate how important this is to Mr Y and that he may be disappointed by our decision, we will not consider this part of the complaint further.