13. Mrs H told us there were many inconsistencies in the way staff behaved during her husband’s admission. She feels there needs to be better checks in place to make sure ICU staff make correct decisions for patients and their loved ones. Mrs H says she was stopped from visiting by staff who made judgments about her, when other people were able to visit. She says they made a single, life-changing, decision that meant her husband died alone and she faced the trauma of this.
14. Our ‘Principles of Good Administration’ say organisations should ‘act fairly and proportionately.’ This includes making sure that decisions and actions are appropriate and fair. Organisations should also ‘put things right.’ This includes accepting mistakes and apologising when appropriate.
15. The evidence shows Mrs H was separated from her husband. When he arrived in the emergency department, he was able to discuss his wishes with healthcare professionals. The clinical records show he wanted his friend to be his next of kin. He did not want Mrs H to visit him but said he was happy for staff to give her updates if she called. On 10 September 2022 Mrs H called and a member of staff gave her an update.
16. Mrs H called the Trust several times over the next days for updates. Nurses did not share information with her because she was not listed as Mr H’s next of kin. They failed to recognise the agreement from the emergency department that gave permission for them to give Mrs H updates. For most of this period the records suggest Mr H was unconscious so staff could not check with him about whether his decision had changed. The nurses said Mr H did not want Mrs H to visit him, which was in line with the wishes he stated when he first arrived at the Trust.
17. On 15 September the records show Mr H was alert enough for healthcare professionals to talk with him. The clinicians used the Glasgow Coma Scale (GCS). This is a way to assess someone’s level of consciousness. In the previous days they considered his GCS score was nine or ten, meaning his consciousness was moderately impaired. On 15 September they said his score was fifteen, meaning he was fully conscious. The score dropped to three the next day.
18. The clinicians considered Mr H had capacity because of his responses to their questions. They noted he did not want Mrs H to visit him or to be given phone updates. By this point Mr H’s friend had said he no longer wanted to act as next of kin. Doctors decided Mr H’s brother should be next of kin. They could not get Mr H’s opinion because by that time he was unconscious again. But, he had not made any comments that we can see to suggest he did not want his brother to receive information. The clinical team had also by this point taken the view that, if Mr H was reaching the end of his life, they would support Mrs H to visit him. They said this was for compassionate reasons.
19. About a week after Mr H was admitted, Mrs H called the Trust several times and nurses did not give her updates or agree for her to visit. That evening Mrs H attended with her brother and his partner. They thought Mr H was nearing the end of his life and they wanted to visit him. A nurse told them that was not the case and they could not visit or be given any information. Mrs H called again during the night and got similar responses.
20. The next morning a doctor agreed Mr H was approaching the end of his life. A nurse advised Mrs H she would be able to visit that afternoon. Mrs H and Mr H’s brother visited in the afternoon and a doctor explained that Mr H was dying. The records suggest they were there towards the end of Mr H’s life.
21. The GMC guidelines relate specifically to decisions about care and treatment and to the actions of doctors rather than NHS staff in general. But, they do include a section about capacity. It says doctors start with an assumption that every adult has capacity to make decisions. The guidelines also explain how someone’s capacity to make decisions can change during a hospital admission.
22. There is no suggestion in any records that when Mr H was conscious he lacked capacity to make decisions. As there is no other evidence available about Mr H’s capacity during the days in question we are obliged to rely on those records. Our view is the clinicians seem to have been right to assume Mr H had capacity.
23. In its complaint response the Trust accepted that its staff did not act in line with Mr H’s wishes about giving updates to Mrs H on 11 and 12 September. At the complaints meeting it recognised that the miscommunication was actually for a longer period, from 11 to 14 September.
24. The Trust accepted that there was miscommunication in the ICU. It explained that doctors and nurses had reflected on the complaint. It said the events had been discussed at consultant meetings, interdepartmental meetings and safety briefings. We have no reason to dispute what the Trust has said.
25. At the complaint meeting Mrs H also referred to staff not offering her husband a visit from a chaplain. The Trust explained at the meeting that staff are reliant on family members telling them about these wishes and there is no record that they were told. It accepted that its team failed to recognise if Mr H had any wishes like this.
26. The evidence suggests staff kept to Mr H’s wishes on 10 September and from 15 September onwards. On those dates the evidence suggests Mr H had capacity. But staff did not keep to some of his wishes between 10 and 14 September. There is evidence they made decisions during that period that were unfair to Mrs H. They should have given her detailed information when she called. But, Mr H seems to have been consistent that he did not want Mrs H to visit him, so staff followed his instructions in this way. That said, from what we have seen staff did not follow our Principles during those five days.
27. It seems likely that the failure to give Mrs H information when she called between 10 and 14 September led to distress for her that could have been avoided. It would still not have been possible for her to visit Mr H because his decision about her visiting seems to have been consistent. Mrs H would still have been left feeling it was unfair she could not visit him.
28. The Trust has already recognised how distressing this experience was for Mrs H. It has accepted its errors and apologised to Mrs H face to face and in writing. It has also attempted to explain why staff took the action they did. It has explained how it has learned from Mrs H’s experience and shared details from her complaint to try and reduce similar errors being made in future. The Trust seems to have taken appropriate steps to put things right.
29. Our decision is the Trust has taken appropriate action on Mrs H’s complaint. We cannot see that we could anything more. We can see how distressing this whole experience has been for her. We have read her impact statement which clearly explains how devastating she found the experience. We hope she can appreciate that we have carefully considered her evidence before making our decision.