Walsall Healthcare NHS Trust

4. Mrs B complains about aspects of care and treatment provided to her mother, Mrs C, by the Trust between May 2022 and January 2023. Specifically, she says Dr F: • was ‘irrational and bullying’ towards Mrs C and this affected her mental state • failed to provide fluconazole, an anti-fungal treatment, in Mrs C’s aftercare pack after chemotherapy treatment • stopped providing treatment for Mrs C after she failed to attend an Accident and Emergency department as advised by Dr F • after this, reinstated immunotherapy treatment but did not reinstate chemotherapy • gave false information about why the chemotherapy was stopped, meaning another doctor, Dr G, who took over Mrs C’s care did not reinstate this treatment.

5. Mrs B says Dr F gave false information about why the chemotherapy was stopped, meaning another doctor, Dr G, who took over Mrs C’s care did not reinstate this treatment. Mrs B says Dr G should have considered the family’s concerns and restarted chemotherapy treatment.

6. Mrs B also says the Trust’s investigation was biased as it was carried out by a senior nurse in Dr F’s team, who had advised them on making their complaint. She says the information in the Trust’s response is different to the information this nurse gave to them at the time.

7. Mrs B says her mother’s mental health suffered due to the bullying she received from Dr F. She says without chemotherapy her mother’s treatment did not work, leading to her cancer spreading. Mrs B says her mother would not have died if chemotherapy had been reinstated.

8. Mrs B wants Dr F and the Trust held accountable for their actions. She seeks justice for her mother and does not want this to happen to other patients and their families.

9. Mrs C had lung cancer and was being treated at the Trust. She first saw Dr F, a consultant oncologist, on 16 May 2022. Mrs C had been diagnosed with a non-curable, but treatable, carcinoma of the left lung.

10. Mrs C was prescribed chemotherapy and immunotherapy treatment. After the first round of treatment she went to stay at her daughter’s home in another part of the UK to recover. During this time, Mrs C was admitted to another hospital near her daughter’s home for treatment for an infection.

11. After the second round of treatment, Mrs C showed signs of a fungal infection, which she was prone to. Her daughter gave her some fluconazole tablets (an anti-fungal treatment) as this had not been provided in her aftercare pack by Dr F. Mrs B spoke to Dr F by telephone and was advised Mrs C should go to the local Accident and Emergency department. Mrs B says her mother did not feel unwell enough to go so they did not follow this advice.

12. Mrs B says her mother’s tumour had shrunk by 50% following these two courses of treatment. However, she says Dr F stopped her mother’s chemotherapy and immunotherapy treatment in July 2022 after they found out Mrs C had not attended Accident and Emergency as advised.

13. One month later Dr F prescribed immunotherapy treatment for Mrs C but did not restart the chemotherapy treatment.

14. Mrs B sought a second opinion from another consultant oncologist, Dr G, who took over her mother’s care from Dr F. However, Dr G did not reinstate the chemotherapy treatment, continuing with immunotherapy only. When this did not work Dr G prescribed other treatment for Mrs C to try but sadly, her health deteriorated and she died on 13 January 2023.

15. Mrs B complained to the Trust in April 2023. The Trust responded to the complaint on 30 June 2023. The Trust said the chemotherapy and immunotherapy treatment was put on hold in June and July 2022 due to safety concerns. It said fluconazole was not prescribed routinely for the specific chemotherapy and immunotherapy regime provided to Mrs C, but can be added if patients develop thrush and this was prescribed for Mrs C later on.

16. The Trust said combination chemotherapy and immunotherapy is only offered at a maximum of 4 cycles and was seen as not suitable for Mrs C after 2 cycles. It said this was because of Mrs C having infections including one requiring hospital admission, one at home and not attending Accident and Emergency when advised to, and family managing symptoms with over-the-counter medication (fluconazole). It said treatment with immunotherapy was continued after Mrs C spoke with Dr F and confirmed she would follow medical advice if she became unwell with side effects from the treatment in future. It said combined chemotherapy and immunotherapy is a toxic combination which can cause life-threatening complications. It said in patients who live alone with no safety net and who do not seek medical advice, the safety of treatment has to be considered. The Trust added Dr G said they would have made the same decision to stop chemotherapy at the time Dr F made that decision.

17. The Trust says Dr F did not intend their advice to be received insensitively or aggressively, and they were concerned for the patient due to their knowledge of serious side-effects from cancer treatments. Dr F apologised if Mrs B felt the care they provided to Mrs C was less than adequate. The Trust said it would reinforce advanced communication skills training for its staff to engage with families and cancer patients.

Care and treatment provided by Dr F and Dr G

20. Mrs B complains Dr F stopped her mother’s chemotherapy and immunotherapy treatment after Mrs C failed to attend Accident and Emergency as Dr F had advised. She says one month later Dr F restarted immunotherapy treatment but did not restart chemotherapy. She says immunotherapy alone did not work, causing Mrs C’s cancer to grow and sadly leading to her death.

21. Mrs B also says Dr F failed to include fluconazole, an anti-fungal treatment, in her mother’s aftercare pack, meaning she had to source this treatment privately for her mother when she developed symptoms of Candida infection (thrush). She also complains about Dr F’s manner in speaking to her and her mother, saying their tone was bullying and caused mental distress.

22. Mrs B says Dr G took Dr F’s word for the reason chemotherapy had been stopped, and did not restart chemotherapy when they took over Mrs C’s care. When the immunotherapy treatment failed to work, Dr G prescribed alternative medication but this too did not work. Mrs B says by that time it was too late for chemotherapy and if Dr G had restarted chemotherapy treatment this may have given her mother a chance to survive.

23. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there is an organisation that is better placed to deal with the concerns. Some complaints can be looked at by us, and also by other organisations. We have considered whether another organisation is better suited to giving an answer to the complaint and whether it can provide the outcome Mrs B seeks.

24. Mrs B’s specific concerns about her mother’s care and treatment are related to actions taken by Dr F and Dr G. She wants the doctors to be held accountable for their actions so that what happened to her mother does not happen to other patients and their families.

25. The General Medical Council manages the UK medical register which allows doctors to practice in the UK. It sets the standards of patient care and professional behaviour which doctors need to meet. It can investigate serious concerns about a doctor’s behaviour or clinical decisions. As a result of its investigations, it can refer doctors to a fitness to practice tribunal. Those tribunals decide whether a doctor’s fitness to practice is impaired, and if so, it can decide to restrict a doctor’s registration through conditions on their license to practice, suspension from practice, or removal from the UK medical register.

26. The General Medical Council sought advice from an independent expert in Clinical Oncology (cancer related healthcare). The expert reviewed Mrs C’s clinical records and listened to the audio-recordings taken by Mrs C during conversations she and her mother had with Dr F. It also obtained comments from Dr F about Mrs B’s allegations.

27. The General Medical Council decided the care and treatment given to Mrs C by Dr F and Dr G was appropriate and agreed with the clinical decisions they made. It agreed with Mrs B that Dr F should have included fluconazole in Mrs C’s after-care pack but said this did not raise concerns about Dr F’s fitness to practice. It said Dr F’s tone in the audiorecordings lacked empathy, and while this was not best practice, it did not show evidence of bullying behaviour. The General Medical Council decided to take no further action.

28. The Ombudsman would not just repeat an investigation which has already been done by an alternative organisation. The General Medical Council’s investigation, which involved reviewing the patient’s clinical records, considering Mrs C’s audio-recordings, getting Dr F’s comments on events, and seeking expert advice (what we would refer to as independent clinical advice) covered what we would have done in considering Mrs C’s complaint.

29. As the General Medical Council has considered the same issues Mrs C brought to us, and has looked at the same evidence we would have obtained, there is nothing further we would do. We will not be taking further action on this part of Mrs C’s complaint.

30. We do not dismiss Mrs B’s concerns about the clinical care and treatment provided by Dr F and Dr G, and Dr F’s attitude, and we understand she feels they have not been resolved. We hope Mrs B can find closure from this in future.

The Trust’s investigation of Mrs B’s complaint

31. Mrs B also asked us to look into her concerns about the way the Trust handled her complaint. She says the Trust’s investigation was biased as it was carried out by a senior nurse who works with Dr F and who advised them on their concerns relating to Mrs C’s care. She says as a result, the Trust’s response to the complaint is inaccurate.

32. Before we decide whether we will conduct a detailed investigation there are a number of checks we must carry out. We consider where the claimed impact arising from the issues raised by a complainant fall on our ‘Severity of Injustice Scale’. This is because as an Ombudsman, we are provided for and funded by the public. We therefore need to maintain a balance between supporting people in their complaints while ensuring we use our resources to focus on those complaints where we can achieve the most impact, and support those who need our help the most.

33. This means in some circumstances, we will not consider a complaint where the injustice someone claims they have experienced, has not had a significant or lasting impact upon them. This is because we have decided it would be more proportionate and a better use of resources to focus on issues where the impact arising from them is more significant.

34. Having considered Mrs B’s concerns on this issue, we consider the impact arising from this is on Mrs B is likely to have caused frustration, but we cannot see this would have been so significant or everlasting. Therefore, we have decided we will be taking no further action on this issue.

35. We thank Mrs B for bringing her concerns to our attention.

1. We have carefully considered Mrs B’s complaint about Dr F, Dr G and Walsall Healthcare NHS Trust (the Trust).

2. We have decided another organisation is better suited to consider Mrs B’s complaint about the care and treatment provided by Dr F and Dr G, and Dr F’s attitude, and it has already done so. We have decided not to take Mrs B’s complaint about the way the Trust investigated her complaint further, as the claimed impact of this does not meet our criteria for investigation as a publicly funded service.

3. We recognise Mrs B continues to have concerns about the care and treatment provided to her mother and Dr F’s attitude. We do not dismiss her concerns, but as this has been investigated by another appropriate organisation, we do not have anything to add to their investigation. We appreciate Mrs B may find our decision disappointing and hope she understands our explanations in this statement.