Nurse’s behaviour on 31 October 2022 and failure to acknowledge communication needs
12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect that the organisation has not put right. Having considered this, we think the Trust has already done enough to put right what happened.
13. Miss I told us that at her appointment with the rheumatology nurse, she felt as though she had been verbally humiliated and bullied. She said this caused her to abandon the appointment due to the distress it caused her.
14. She told us she expected the appointment to be a discussion about a new medication that doctors were intending to prescribe her for her newly diagnosed rheumatoid arthritis. But, she said the nurse accused her of being confrontational because she was refusing to take the medication. She also says the nurse asked why she ‘bothered to attend the appointment’.
15. We understand this appointment has caused Miss I much distress and she tells us her mental health deteriorated because of what happened. Miss I does not feel as though she can continue getting treatment from this department. After a local resolution meeting, another appointment was booked for Miss I at another hospital within the Trust.
16. In its final response to Miss I, the Trust said the nurse apologised. The nurse advised it was never their intention to upset her, or to force Miss I into taking the medication. The Trust told Miss I the nurse would be reflecting on the feedback and taking learning from the complaint.
17. The Trust then held a local resolution meeting with Miss I on 2 March 2023. The matron and specialist rheumatology nurse led the meeting. They told Miss I the nurse did not dispute anything Miss I said happened and accepted her version of events.
18. They advised her the nurse accepted and understood that they were inappropriate in what they said to her. They told Miss I the nurse is having regular meetings with the rheumatology specialist nurse to make sure their behaviour is monitored and their performance is being managed.
19. Our Principles say to put things right, organisations should, ‘acknowledge mistakes and apologise where appropriate, provide prompt, appropriate and proportionate remedies considering all the relevant factors of the case when doing so’.
20. They also say organisations should seek continuous improvement and, ‘ensure that all feedback and lessons learnt from complaints contribute to service improvement.’ They should, ‘ensure they: tell the complainant when lessons have been learnt as a result of their complaint. And state any changes they have made to prevent the problem recurring.’
21. Having reviewed all the evidence, we think the Trust has acknowledged and apologised for the nurse’s behaviour during the appointment. We also think it has made appropriate service improvements to make sure that this does not happen again and the nurse’s performance improves.
22. Our guidance on financial remedy explains when we think a financial payment is appropriate to put things right. It says we would not think a payment is appropriate for cases at level one on our severity of injustice scale. Level one is when the person has experienced a low impact injustice and the effect is of short duration and there are no other negative effects or ongoing wider impact.
23. We do not think a financial payment is appropriate in this case. We are sorry to hear how Miss I was affected and having thought about this carefully, we think the impact fits with level one on our scale.
24. We have decided the Trust has acted in line with our Principles and guidance on financial remedy to put things right and improve.
Complaint handling not following communication needs
25. Miss I complains that after she sent her first complaint to the Trust, she got an email back asking for a phone number. She says this was despite writing at the top of her complaint that she is deaf and cannot use phones.
26. We looked at the emails and can see Miss I got an email from the Trust on 1 November 2022. This confirmed the complaint had been passed to management for review. It asked for Miss I to confirm her preferred title and preferred contact number.
27. Miss I replied on the same date saying she is unable to use a phone due to being deaf and her hearing aids not being compatible with phones. The Trust acknowledged its mistake and offered its apologies for this. Communication then continued over email, which Miss I tells us is her preferred method of communication.
28. We understand the communication caused Miss I distress and as though the fact she is deaf was being ignored. We have carefully considered what the Trust has done to put right the impact this had on Miss I.
29. We can see it acknowledged and apologised for its communication and its response is in line with our Principles. The Trust then handled communication in line with Miss I’s needs and preference.
30. We think the original mistake was a one-off error. We thought about continuous improvement and we do not think it needs to do more because its mistake does not seem to be part of a wider problem.
31. The impact of this issue also does not seem to be one that would fall above level one on our scale, so we do not think a financial payment is necessary. Based on this we have decided the Trust has done enough to put things right and we will not consider this part of the complaint further.
32. On 3 November 2022, the complaints team sent Miss I an acknowledgement letter saying, ‘I am sorry that I have been unable to discuss your complaint with you by telephone. The information you have provided by email is very clear. However, if you would like to discuss your concerns or the complaints process, please do not hesitate to contact me on 01733 678028.’
33. We recognise this hinted towards phone being the Trust’s preferred method of communication. But, a contact email address was provided at the top of the letter, although it did not refer to this email address.
34. We understand this letter caused Miss I more distress as she felt she was not being listened to or understood. She said it was embarrassing for her to keep sending long emails to the Trust because she is afraid that it affects the impression people have of her.
35. The Trust replied on 7 November apologising for the contents of the acknowledgement letter. The Trust described it as a general template. It raised it with the rest of the complaints team to highlight and remind them of the importance of making sure letters are relevant and helpful to each complainant.
36. Section 24 of the NHS Accessible Information Standard states organisations must make sure that a standard print letter is not sent to an individual for who this is not an appropriate or accessible format.
37. We do not think the Trust acted in line with this guidance because it did not take Miss I’s individual circumstances into account when sending out a general letter.
38. We can see the Trust apologised for the communication it used and raised it with the rest of the team to stop it happening again. The Trust provided Miss I with an email address to use for communication with the complaints team. Miss I also had a point of contact in the complaints team who she was emailing before and after getting this letter.
39. Overall we think the Trust’s response to this issue is in line with our Principles and it has explained appropriate service improvements. Based on this, we think the Trust has done enough and we will not consider this part of the complaint further.
No reasonable adjustments for deaf people in correspondence
40. Miss I complains that in March and May 2023, the Trust sent general appointment letters from the rheumatology department. She tells us these letters only gave her a contact telephone number if she needed to make any changes to her appointment. She says the letters did not give any information about whether a lip reader would be at the appointment.
41. When Miss I got the March letter, she contacted the complaints department because that appointment was arranged after a local resolution meeting on 2 March 2023. During this meeting, the Trust agreed that the phone advice line for the rheumatology department was not acceptable for all patients. It agreed to put other types of communication into practice.
42. After her email to the complaints department, Miss I was advised she could email the matron of the department direct. The complaints department also confirmed that a lip reader had been booked for the appointment.
43. On 21 April 2023, the complaints department contacted Miss I by email to advise her of the service improvements it had put into practice within the rheumatology department. They told Miss I the senior secretary had added an alert to advise the team to only contact her by letter or email and they also planned to make sure an email address was always added to any correspondence sent to Miss I.
44. The complaints team also told Miss I they had contacted another trust who provides patient transport. The Trust explained that if she needed any transport, subject to her eligibility, she could email a specific email address to book this service.
45. Miss I complains that she got another letter on 18 May 2023 from the rheumatology department that was a general template without a specific contact email address on. Miss I tells us this final letter has caused her so much distress that she no longer wants to have treatment for her rheumatoid arthritis from this Trust. We understand she has asked to be discharged. We are sorry for how this has made her feel and recognise the impact this has had on her.
46. Miss I again raised this letter with the complaints team who passed it to the matron. The complaints team offered their sincere apologies and apologised for the impact this had on Miss I. The matron wrote to Miss I on 24 May 2023 and advised that a new email would be added to the rheumatology headed letter and this would be completed by 1 June.
47. The matron also advised that they were continuing with the change of communication methods to patients and were working with the patient experience team and quality improvement groups to make changes for individuals.
48. We made enquiries to the complaints team about this. Staff advised us that they contacted the Patient Advice and Liaison Service (PALS) team and organised for them to be a direct advocate for liaising with appropriate staff members on her behalf.
49. Miss I was given the contact details for PALS at both hospitals where she has had appointments at with the Trust. This was to make sure that she has direct access to the Trust when needed.
50. Section 30 of the NHS Accessible Information Standard states, ‘Organisations must take steps to ensure that communication support, professional communication support and information in alternative formats can be provided promptly and without unreasonable delay. This includes making use of remote, virtual, digital and telecommunications solutions’.
51. Having considered the evidence, we do not think the Trust acted in line with this guidance because it did not make sure that the correct communication and support was given to Miss I when sending out the general letters.
52. But, we have considered what the Trust has done to put this right. It apologised for the general letters without an email address. It has put service improvements in place to make sure that all letters sent by the rheumatology department include an email address. The Trust also organised for Miss I to have PALS as her direct advocate for speaking with staff and for changing appointments.
53. Overall, we think the Trust’s response to this issue is line with our Principles and we do not think it needs to do more to put things right.
54. We do not think the impact of what happened is above level one of our severity of injustice scale so we will not be considering a financial payment.
55. We recognise how important Miss I’s complaint is to her and do not wish to minimise how difficult an experience she had. We hope this statement explains why we think the Trust has done enough and assures her that improvements have come about as a result of her raising the issues.