Barts Health NHS Trust

4. Mr E complains about the care and treatment his mother had on 10 August 2021.

5. Mr E says the Trust: • failed to properly assess and treat Mrs E by not doing an X-ray of her back or prescribing antibiotics • discharged Mrs E when she was not fit to be discharged • arranged a care package that could not meet her needs and failed to give enough information on the referral.

6. Mr E says the Trust’s failure to properly assess and treat his mother and then discharging her, left her infection and broken back undiagnosed and untreated. Mr E says this caused his mother to suffer severe pain and an uncomfortable decline. Mr E says the untreated infection caused confusion and Mrs E could not look after herself or take her medication. Mr E says these failings caused his mother’s death.

7. Mr E says the fact Mrs E was not X-rayed when she first attended A&E means the family will never know if her back was already broken, or if she broke it when she fell at home because the Trust discharged her too soon.

8. Mr E says the poor care package meant his mother’s needs were not met. He says she missed taking medication and this contributed to her decline and death.

9. Mr E says these events had a big impact on the entire family physically, mentally, emotionally, financially and academically for those who were studying.

10. Mr E wants a financial payment for what his mother and family have been through. Mr E also wants service improvements to make sure the same things do not happen to others and for the Trust to apologise for its mistakes.

11. Mrs E was in her nineties and lived independently. Mr E says she always kept herself and her home immaculate and she enjoyed going out for meals every week. Mr E says his mother visited the family regularly, cooked all her meals herself and did not need any help.

12. In the early hours of 10 August 2021, Mrs E went to A&E by ambulance after a fall at home. COVID-19 restrictions were still in place. Because of this, the family could not go with her to hospital. Mr E says this meant the family could not give enough background information to show how Mrs E was before her admission, so the Trust could appreciate how much she had declined.

13. Later that day Mr E’s wife got a call to say Mrs E needed to be picked up and taken home. Mr E says it was clear from this conversation that his mother had not been properly assessed and treated. Mr E says his wife told the Trust Mrs E was extremely unwell with severe back pain and breathing difficulties and should not be discharged.

14. Mr E’s wife says she was told by staff that if they did not come to collect Mrs E, she would be sent home in a taxi. Mrs E’s grandson picked her up and brought her home.

15. Mr E’s wife says she knew the care package the Trust put in place would not meet her mother in law’s needs. She says Mrs E was too poorly to take her critical medications and was not in a fit state to be left to do this. She says carers are not allowed to give medication and this contributed to her decline.

16. Mr E and his family strongly believe the Trust should not have discharged Mrs E. He says she could not walk or look after herself properly and this resulted in her not taking her medications and her decline.

17. Mrs E returned to hospital on 22 August 2021 after another fall. The Trust reviewed radiology images and diagnosed her with a broken back and pseudomonas (a type of germ that can cause infections).

18. Mr E believes his mother’s back was already broken on 10 August and if it was not, she broke it because the Trust discharged her too soon. Mr E says the Trust should have taken an X-ray of his mother’s back when she first went to A&E and it should have given her antibiotics. He accepts he will never know for sure when his mother’s back was broken and he holds the Trust responsible for this.

19. The main cause of Mrs E’s death is noted as acute cardiac failure (a sudden, life-threatening condition that happens when your heart can no longer do its job) and hypertension (high blood pressure). The secondary causes are noted as lumbar spine fracture, clinical frailty, stroke, chronic kidney disease and hypertension.

21. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances.

22. We have discussed this with Mr E to understand his circumstances and the outcomes he wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

23. Mr E says the Trust has been negligent in the care and treatment it gave his mother. Mr E says the negligent actions of the Trust caused Mrs E harm. He explained how his family was affected by the care and also how the family have been affected by what happened.

24. It seems Mr E has grounds to make a legal claim.

25. There are reasons why legal proceedings may be a better option. These include: • the possibility Mr E might get what he wants to achieve • if failings are found, the legal process could recommend more compensation than we can • if unsuccessful, Mr E has the right to come back and ask us to consider the complaint again.

26. We discussed with Mr E whether there are any barriers stopping him from looking into legal action.

27. Mr E said he cannot pay legal fees. We discussed the option of ‘no win, no fee’ solicitors and he told us he has seen negative media about this. He also said using solicitors can result in large bills for the public purse, with relatively small sums reaching claimants.

28. We considered Mr E’s concerns and while there may be some negative news articles about ‘no win, no fee’ agreements, this is not enough to say it is unreasonable for Mr E to look into these.

29. We realise Mr E has said money is not his main motivation, but he has said he wants us to consider a financial payment and the impact his mother’s death has had on the family’s finances.

30. We showed Mr E our severity of injustice scale which is a tool we use to look at how someone has been affected by what happened and what amount we should recommend, if we find a failing. Mr E thought his complaint fitted with level five on the scale and would mean a payment of up to £9,500. He says this because he feels the poor service the Trust gave his mother was a big factor in her death. Mr E says her chances of survival were compromised and there was a loss of opportunity to give treatment that may have prevented or delayed her death.

31. This is a big impact that does not include how Mr E says the death affected the family. There is the possibility that Mr E could achieve more through a legal claim, and it is more appropriate for him to get legal advice on this.

32. Mr E feels the legal process will not answer all his concerns. He says he and the family have been through a difficult time and have had these issues and the complaint hanging over them for over two years. He said he does not want to prolong this by taking legal action.

33. Mr E and his wife strongly believe the Trust has been negligent and have come to us to investigate. A legal claim would look into whether the care and treatment the Trust gave Mrs E fell below standard. If so, it will look to see what impact can be linked to any potential negligence it has found. This would answer Mr E’s concerns about whether anything went wrong, and if his mother’s outcome could have been different if these mistakes did not happen.

34. We cannot say our investigation would be quicker than making a claim and if we were to look at the complaint now and not achieve Mr E’s outcomes, he may run out of time to take legal action.

35. We appreciate Mr E has been through an incredibly difficult time and he feels we should look at his complaint.

36. To progress his complaint with us, Mr E would need to engage with us and give us any extra information we need, as he has been doing. This is no different to what a solicitor would ask him to do. We have to stay impartial but a solicitor who represents their client, acts on their behalf. Mr E can speak to organisations for more support and guidance on making a legal claim and can also get help from an advocate.

37. We have considered in detail the reasons Mr E feels it is not appropriate for him go down the legal route and have decided it is reasonable for him to look into legal action.

38. Mr E could achieve more compensation by making a legal claim. The legal system can take into consideration special damages (specific financial losses and expenses) and Mr E could achieve service improvements and an apology as a by-product of his claim. The Trust may put in place a plan to stop the same things happening again and provide this to the court as evidence that it has taken learning from any negligence found.

39. We feel the legal process would answer his concerns and we cannot say our investigation would be quicker or less stressful. In line with the law, Mr E should first speak to solicitors to see if they will accept the case.

40. If Mr E approaches several solicitors and none are prepared to take the case on, or they proceed with it and it turns out to be unsuccessful, Mr E has the right to come back to us and ask us to consider the complaint again.

41. We appreciate our decision may not be what Mr E was hoping for and he may find it disappointing. We are sorry to hear about the death of his mother and the impact this had on him and his family. We hope we have clearly explained the reasons for our decision and he is reassured he can come back to us if needed.

1. We have carefully considered Mr E’s complaint about Barts Health NHS Trust (the Trust). We are sorry to hear about Mr E’s concerns with the Trust and recognise he and his family have been through a very challenging and upsetting time.

2. Mr E feels the Trust has been negligent in the care and treatment it gave to his mother, Mrs E. Mr E says this led to her decline and caused her death. Mrs E sadly died in September 2021, and we extend our sincere condolences to Mr E and his family.

3. We think Mr E could take legal action to resolve his complaint.