4. Mr O complains about the care at the Trust’s ED. He says the Trust made him wait for admission for several hours after the out of hours GP sent him there. He says staff ignored his concerns and request for help.
5. Mr O says his experience was traumatic and distressing. He has flashbacks and insomnia. He is apprehensive about going back to the Trust and terrified about needing to visit the ED.
6. He would like a full apology, service improvements and a financial payment.
7. Mr O saw the out of hours GP at 2.45pm on 24 July 2022 because he had blood in his urine. The GP sent him to the Trust’s ED and advised him they had arranged a bed for him.
8. On arrival in ED, Mr O says staff told him to wait in the waiting room and that he needed to see an ED doctor before they could admit him. Mr O says he waited for several hours, while continuing to pass blood in his urine. Staff took blood samples but there was no further action taken. Mr O says he and his goddaughter repeatedly asked staff for updates but were not given any.
9. At 10.45pm Mr O collapsed and an ED doctor attended to him. He says they apologised and said he must have ‘slipped through the cracks’. The Trust admitted him to the ward at 3am and he had an eight day stay in hospital.
12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect that the organisation has not put right. We have found the Trust has already done enough to put right the impact of what happened.
13. The Trust’s first complaint response suggested that Mr O had misunderstood the GP and there was not a bed waiting for him. It said the observations done while he was in the waiting room suggested a low risk of being seriously unwell.
14. After getting this complaint response, Mr O returned to the Trust with more questions, and they met on 24 July 2023.
15. In this meeting, the Trust confirmed the urology team (who deal with the urinary tract system and reproductive organs) had accepted Mr O for examination, but staff in the ED had not correctly identified this. The Trust accepted that had it found this earlier, Mr O would have been seen and treated quicker. The Trust explained that at the time, there was a lack of standardised processes in place.
16. The Trust also reviewed Mr O’s records and confirmed there were no comfort checks or patient focussed rounds while he was waiting. The Trust apologised for the poor communication.
17. The Trust apologised for the delays in its complaint handling, that its correspondence was not of a high standard and that his questions were left unanswered for many months.
18. The Trust confirmed the standard of care fell short of what was expected.
19. At the meeting, the Trust apologised for Mr O’s experience. It confirmed changes had been made since his experience including: • a new same day emergency care facility designed to take patients who have been accepted by a specialty. This allows for more efficient assessment and treatment • a standardised process in the ED to identify patients who have been accepted by a speciality and to avoid the long unnecessary wait in the ED • patient focussed rounding where a care support worker does checks on patients in the waiting room at regular intervals. These improvements are being audited monthly • an ED quality initiative focussing on recognition and management of the deteriorating patient, fast initial assessment, improved communication, accountability and standardising operational processes • plans to do a piece of work around patient experience in the ED. It would like to use Mr O’s experience as an example to reflect and learn from.
20. The impact on Mr O was that his experience in the ED was traumatic and distressing. Mr O says he is apprehensive of going back to the Trust and has flashbacks.
21. It is difficult to separate out the impact the delays in ED had on him, from the bigger picture of his health condition and hospital admission. Mr O thinks his admission was longer than it may have been if there had not been a delay in ED. This would be difficult to prove.
22. Overall, there was an emotional impact on Mr O that fits with level two on our severity of injustice scale. This is a scale we use to work out how much someone has been affected by what happened and what the right amount of financial payment would be. Level two includes distress and worry from a period of one to two weeks, up to six months. We would reasonably expect any impact to diminish completely with time.
23. Our Principles for Remedy say, ‘Where maladministration [fault] or poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise.
An appropriate range of remedies will include: • an apology, explanation, and acknowledgement of responsibility • remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these • financial compensation for direct or indirect financial loss, loss of opportunity, inconvenience, distress, or any combination of these.’
24. We can see the Trust has offered an apology and taken responsibility. It has explained the service improvements it has made in response to Mr O’s complaint and the failings it found. These should prevent this from happening again.
25. We approached the Trust to ask if it would consider a small financial payment to fully resolve the complaint. It declined this as financial payments is not part of its complaint process.
26. We considered whether to progress so we could formally recommend for the Trust to make a payment to Mr O. As an organisation, we are prioritising our limited resources on cases where the claimed injustice sits at level three or above on our severity of injustice scale. Because we think Mr O meets the criteria for level two, we will not investigate further.
27. We can see the Trust has apologised, provided evidence of comprehensive service improvements and acted in line with our principles. We think this is an appropriate resolution.
28. We thank Mr O for bringing his complaint to us and appreciate the difficult circumstances he experienced. We hope he understands the reasons for our decision not to take any further action.
1. We have carefully considered Mr O’s complaint about Countess of Chester Hospital NHS Foundation Trust (the Trust). We are sorry to hear about the circumstances of his complaint. We understand he had a very distressing experience when he was waiting so long in the emergency department (ED).
2. We have decided the Trust has already done enough to put right the impact of what happened and we are not taking any further action.
3. We are grateful to Mr O for bringing his complaint to us and we hope our explanation below will show how we came to our decision.