3. Mr I complains that the Trust failed to provide the correct treatment plan for his swollen right knee and this caused an unnecessary and long admission between 10 and 24 August 2023.
4. Mr I says it was distressing because he assumed he was having a routine procedure and potentially staying overnight, but he was kept in for two weeks. He found this frustrating and it added to his distress.
5. Mr I wants a financial payment.
6. Mr I is in his sixties and lives with his wife. He has a medical history of arthritis (an autoimmune disorder where the immune system attacks the lining of the joints causing swelling and pain).
7. Since March 2023, he had been experiencing problems with his right knee and he developed septic arthritis (a serious type of joint infection). He attended the Trust several times for an aspiration of the knee (procedure to remove fluid from the space around the knee joint using a needle and syringe).
8. He had swelling in his right knee in July 2023. His GP referred him to the Trust for an aspiration.
9. He attended the Trust on 10 August. He was admitted and discharged himself on 24 August.
12. Mr I complains the Trust failed to carry out the correct treatment plan for his swollen knee joint meaning he spent two weeks in hospital. He says he was started on antibiotic treatment and he waited for days before he saw a doctor. He says at this point, the Trust apologised and admitted it should have started the aspiration before the antibiotic treatment. Mr I says his antibiotic treatment continued for a week and the Trust advised he would need an injection to treat his rheumatoid arthritis. Mr I explains as he did not get the injection on 24 August as planned, he discharged himself.
13. Mr I says he got a letter from his consultant physician while he was still at the Trust. The letter explained the aspiration should have been done before the antibiotic treatment and because of this his doctor was no longer confident that an infection existed. It says he would be treated with a longer course of antibiotics which will mean he will have to stay in hospital for longer. The consultant apologised and explained they had requested an investigation to consider if lessons can be learned to make sure this does not happen again.
14. The Trust says Mr I was admitted with a hot, swollen right knee joint on 10 August. His medical plan was to have blood tests, a knee X-ray, a diagnostic aspiration of his knee and intravenous (IV treatment given direct into a vein) antibiotics.
15. The Trust said a referral was made to its rheumatology team on 10 August after 5pm for a right knee aspiration, when it should have been made it to its out of hours onsite orthopaedic team. During this time, it started IV antibiotic treatment. The Trust admits the aspiration procedure should have taken place before the IV antibiotics were started, to allow the fluid to be tested for a sepsis diagnosis or infection. The aspiration took place on 13 August and while the Trust thought it was unlikely that Mr I had an infected knee, it was necessary to wait for the blood results and results from the aspirated fluid to confirm this. It says at this point, it was also necessary to continue with antibiotic treatment and withhold the rheumatoid arthritis knee injection until a diagnosis was confirmed.
16. The Trust apologises for not following the correct process and it has highlighted this to the team involved for learning. It says it has shared this complaint with its wider team to make sure the correct pathways and out of hours referral processes are followed. It says this case was also used at its rheumatology clinical governance meeting on 18 October 2023. It has also apologised saying its communication could have been better.
17. Mr I wants a financial payment. After considering our severity of injustice scale (a scale we use to look at how badly someone has been affected and how much payment should be made to them to put this right) he said he would expect a payment in line with level three on the scale.
18. We asked the Trust if it would consider a financial payment to resolve Mr I’s complaint.
19. The Trust responded with an offer of £600. Mr I accepted this offer.
20. Considering the Trust’s complaints response, we can see it admitted its failings, apologised and made service improvements to make sure it does not happen again. We can also see the treating doctor wrote directly to Mr I with an apology. As the Trust has offered an appropriate payment and Mr I has accepted this, we think it has done enough to resolve the complaint in line with our Complaint Standards Framework.
21. Our Complaints Standard Framework gives guidance on how organisations delivering NHS services in England should handle complaints. It states an effective complaint handling system should include the following four standards - promoting a learning and improvements culture, encouraging feedback, be thorough and fair and give a fair and accountable decision.
22. We will not consider Mr I’s complaint further because the Trust has agreed to resolve his complaint. We thank Mr I for bringing his complaint to us.
1. We have carefully considered Mr I’s complaint about London North West University Healthcare NHS Trust (the Trust).
2. We have decided not to consider Mr I’s complaint further because the Trust has agreed to resolve his complaint. We are sorry to hear about Mr I’s complaint and understand an unexpected hospital stay is worrying. We recognise this was a very difficult and distressing time for him.