University Hospitals Sussex NHS Foundation Trust

3. Mrs A complains about the care the Trust gave to her husband from 28 June to early July 2022, but mostly what happened to Mr B between 4.10am and 10.45am on the day before he died. Mrs A is also concerned about delays in the Trust dealing with her complaint.

4. Mrs A says she got a phone call from her husband at 4.10am and he said he was extremely cold and soaking wet. Unfortunately, Mr B could not get anyone from the hospital to help him, so Mrs A called the hospital who reassured her that staff were now attending to her husband. During her journey to the hospital at 9.05am, Mrs A got a call from a doctor to say her husband’s condition had severely deteriorated. When Mrs A arrived at the hospital at 10.45am, she found her husband unresponsive, freezing cold and wet. She was told he was unlikely to survive the day and he sadly died the next day.

5. Mrs A says her husband’s death was unexpected because she had been told to expect him home in the next few days, after a recent procedure to insert a feeding tube. Mr B’s death has had a major impact on his wife and the wider family. Mrs A also says it took the Trust seven months to respond to her complaint and the response failed to address the matters she raised.

6. As an outcome, Mrs A wants further explanation about what happened to her husband after his procedure. She wants to know what went wrong and what could have been done differently so no other family must go through something similar in the future. Mrs A also wants service improvements so the Trust can respond to complaints quicker.

7. Mr B was in his seventies and had a complex medical history. He had been in hospital earlier in 2022 due to problems eating. It was decided he needed a feeding tube inserting so he was transferred to the Trust on 28 June 2022. On admission to hospital, Mr B was described by the Trust as extremely frail with a poor nutritional status. He also had respiratory (breathing) problems including chronic lung disease.

8. On 29 June 2022, a feeding device was inserted through a surgical incision (cut) into Mr B’s abdominal cavity. The operation was successful but unfortunately the Trust said Mr B then became very unwell and his condition deteriorated leaving him vulnerable to a chest infection and then pneumonia (inflammation of the lungs usually caused by an infection).

9. The Trust said that a few days later Mr B’s condition deteriorated between 2.25am and 5.13am. He was experiencing shortness of breath and was reviewed by the respiratory team at 5.30am. They confirmed he was in respiratory failure and he was prescribed nebulisers (a device to give medication like an inhaler) to try and loosen the secretions (fluid build-up).

10. More observations were taken at 9.04am and 9.22am, as well as a review by a chest physiotherapist at 9.15am. The Trust said respiratory secretions were affecting Mr B’s oxygen perfusion (the process of making sure there is enough oxygen in the blood) and the nurse made an emergency call to the medical team. The intensive care team assessed Mr B but decided that further medical intervention would not be in his best interests. It was agreed that he should be given palliative care and support on the ward to improve his comfort. Mr B sadly died the next day from pneumonia.

14. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong with Mr B’s care.

15. We note from the records that after Mr B was transferred to the Trust on 28 June 2022, he had a feeding tube inserted the next day. Our adviser has reviewed the operation notes and says it was a successful procedure, as the Trust has said in its complaint response.

16. Unfortunately, on the morning of 30 June 2022, Mr B’s oxygen level dropped. Our adviser says this was a serious issue and Mr B had to be given high flow oxygen which meant his oxygen input was increased from one litre to 15 litres, the highest amount that can be prescribed.

17. The Trust organised a chest X-ray later that day. Our adviser says the X-ray report shows changes in his right lung. Mr B had known problems with his right lung and this finding was in keeping with a previous X-ray. The X-ray showed that he had bronchiectasis, which is chronic damage to the bronchial tubes and can cause lung infection. It also showed a collection of fluid on his right lung which was secondary to his last surgery and evidence of pneumonia for which he had recently been treated.

18. The clinical team at the Trust thought that Mr B’s deterioration on 30 June 2022 was due to sputum plugging, which is where mucus collecting in the lungs can plug up or reduce airflow in the larger or smaller airways. This can lead to a partial collapse of the lung. Mr B also had likely pneumonia again. Given this, our adviser says Mr B was treated appropriately with intravenous or IV antibiotics (given into his veins) in line with the NICE guidance on treating hospital-acquired pneumonia. This guidance states, ‘First-choice intravenous antibiotics (should be prescribed) if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance.’ This was alongside chest physiotherapy which Mr B was also having for his symptoms.

19. We have considered what happened on the day when Mr B called Mrs A at 4.10am saying he was extremely cold and soaking wet, until about 10.45am when Mrs A arrived at hospital.

20. Having considered the relevant records, our adviser says Mr B was reviewed by a doctor at 5.46am after it was reported that his oxygen level had dropped again. He was given high flow oxygen again at 15 litres. As before, the clinical team thought this may be due to sputum plugging. Another chest X-ray showed signs of infection in Mr B’s left lung which was a new issue. Our adviser says Mr B being extremely cold and soaking wet (as reported by Mrs A) could also be signs of infection or a related fever at the time.

21. At 9.10am, Mr B was reviewed by a physiotherapist for his sputum and his oxygen input was reduced to four litres. At 9.25am, Mr B was seen by the medical emergency team. He was noted as ‘warm’ at this point, and his antibiotics were changed to stronger medication.

22. At 10.15am, our adviser says there is a documented discussion with Mr B, Mrs A and the clinical team. It is noted that resuscitation was discussed as was a plan to ask the intensive treatment unit (ITU) if any extra support could be given to Mr B for his breathing because he was having difficulty with this. An ITU review at 10.50am did not find that extra support for his breathing would be beneficial, but active treatment with IV fluids and antibiotics should be continued.

23. So, we have considered if Mr B’s condition deteriorated during this six-and-a-half-hour period to the point that more medical support for his breathing difficulties was not in his interests and palliative care was an appropriate next step.

24. The records show that Mr B was having increased difficulties breathing during this time due to the documented problems with his lungs, but the Trust continued to provide him with active treatment. At 2.29pm, it is noted in the records that he was not responding at all. Mr B was reviewed by the clinical team who thought he was now sadly coming to the end of his life. The appropriate next steps would be to put Mr B on a palliative care pathway. Our adviser says this course of action was appropriate for Mr B and was approved at 4pm after further discussions between the clinical team and Mrs A.

25. This is in line with the NICE guidance on the care of dying adults in the last days of life which says, ‘Assess for changes in signs and symptoms in the person and review any investigation results that have already been reported that may suggest a person is entering the last days of life.’ A lack of any response, as indicated by Mr B’s records, is a sign that he was entering the final stages of his life.

26. It is noted that Mr B sadly died the next day due to pneumonia. We are aware from our consideration of his records that Mr B had other underlying respiratory conditions but in summary, our adviser says that Mr B was already frail throughout this episode of care. He was underweight and had significant issues with his lungs which were damaged. Unfortunately, this led to Mr B developing pneumonia and respiratory failure which caused his death. Our adviser has added that although the feeding tube procedure Mr B had on 29 June 2022 went well, issues around this surgery like the anaesthetic (pain relief) could have weakened him and reduced his body’s ability to deal with infection.

27. Mrs A complained to the Trust on 14 July 2022 about Mr B’s care. Unfortunately, Mrs A did not get a response until 23 January 2023, over six months later. Mrs A did not feel that this first response fully addressed the matters she had raised. Mrs A sent an email to the Trust on 6 February with her outstanding concerns. The Trust provided a final response to Mrs A’s complaint on 23 June.

28. The NHS Complaints Regulations say the ‘relevant period’ for a complaint to be responded to is six months. They explain, ‘“relevant period” means the period of 6 months commencing on the day on which the complaint was received, or such longer period as may be agreed before the expiry of that period by the complainant and the responsible body’.

29. This means the Trust should have provided Mrs A with a response to her complaint within six months from when it was received. We note this target was not achieved, but the Trust did apologise for the delay when it replied to Mrs A. It provided assurances that it takes complaints very seriously and aims to investigate quickly and in detail. The Trust also explained that the delay in its response was due to unexpected and unplanned staff absences in the complaints team.

30. It is unfortunate that Mrs A did not feel the Trust’s first response to her complaint fully addressed all her concerns, but it is noted that the Trust provided another reply to her outstanding concerns after she followed this up. It also offered a meeting, but Mrs A did not arrange this because she now lives abroad.

31. In summary, we have not seen any signs of failings in the care given to Mr B. We have seen signs of a failing in the way Mrs A’s complaint was handled because the response was delayed. But, we are satisfied that the Trust has already taken appropriate action to address this by apologising for the delay, providing assurances of its commitment to deal with complaints quickly and explaining the reasons for the delay. We do not think there is any action for us to take.

1. We have carefully considered Mrs A’s complaint about University Hospitals Sussex NHS Foundation Trust (the Trust). We have seen no sign that anything went seriously wrong.

2. We are sorry to hear what happened when Mrs A’s husband, Mr B, was in hospital. We appreciate that Mr B’s death was unexpected and a shock for Mrs A and her family as they expected him to be discharged from hospital after a few days. We also appreciate that the Trust’s response to Mrs A’s complaint was delayed and at first it failed to fully address her concerns. This made Mrs A’s grief worse at a time when she was trying to come to terms with Mr B’s death.