London North West University Healthcare NHS Trust

4. Mrs H complains about London North West University Healthcare NHS Foundation Trust (the Trust). Specifically, she says it levied unfair overseas visitor charges for treatment carried out in the Emergency Department (ED) and by the GP. She says it provided no details of the treatment being charged for or evidence consent was taken to carry out treatment.

5. Mrs H says this matter has had a severe emotional impact on her. She says these discriminatory practices have added to the emotional distress of losing her mother. She says the charges have imposed a significant financial burden on the family.

6. Mrs H would like the charges to be waived and financial compensation for emotional distress. She would also like service improvements such as a review of policy relating to overseas visitor’s healthcare, greater transparency of charges, and education in relation to rights and responsibilities of overseas patients.

7. Mrs H’s mother was visiting Mrs H to spend quality time with her after suffering with health issues. Mrs H’s mother was a heart patient and was taking Furosemide regularly to reduce leg swelling and help with shortness of breath. During her stay in the UK, she ran out of Furosemide and Mrs H wanted to register her mother with a GP. This was going to take seven days, so they were advised to call NHS 111 service. NHS 111 advised them to go to the ED. She says it took three visits to the ED to eventually be prescribed Furosemide. Mrs H tells us she was fully aware of the policy regarding overseas charges and was asking staff about this before any tests were carried out.

10. The law says we can only investigate complaints which have been brought to us within one year of the person becoming aware of the issues complained about. We can put this time limit to one side, but only if we see a good reason to do so.

11. We can see Mrs H had cause to complain about overseas visitors charges on 7 October 2022 as this is the date she received the invoice. To be in time, Mrs H would have to have brought her complaint to PHSO on or before 7 October 2023. Mrs H brought her complaint to PHSO on 27 December 2023 therefore her complaint is two months and three weeks out of time.

12. Mrs H complained to the Trust on 26 October 2022, 19 days after receiving the invoice. We will put this gap in the timeline to one side as it is not excessive.

13. The Trust responded to Mrs H on 11 January 2023, two months and two weeks after receiving her complaint. We will put this gap in the timeline to one side as this is the time taken for the Trust to respond. Mrs H had no control over this delay.

14. Mrs H returned to the Trust on 24 January 2023, 13 days after receiving its response. We will put this gap in the timeline to one side as Mrs H had returned to the Trust to pursue her complaint. The Trust letter had signposted her to PHSO and had also advised she could return to the Trust if she had further concerns. We consider it was Mrs H’s choice to continue to pursue her complaint locally at this point.

15. The Trust responded to Mrs H’s further concerns on 2 February 2023. We will put this gap in the timeline to one side as this is the time taken for the Trust to respond and was outside Mrs H’s control.

16. Mrs H returned to the Trust with further concerns on 17 March 2023, one month and two weeks after receiving the second response from the Trust on 2 February 2023. Mrs H’s mother sadly died on 30 January 2023. Mrs H told us she was in shock and grieving for her mother. We will put this gap in the timeline to one side as it is not excessive in which to return to the Trust with further concerns, particularly as Mrs H was coping with the recent loss of her mother.

17. The Trust responded to Mrs H’s further concerns on 1 June 2023. We will put this gap in the timeline to one side as this is the time taken for the Trust to respond and was outside Mrs H’s control.

18. Mrs H brought her complaint to us on 27 December 2023. We asked Mrs H why she delayed in bringing her complaint to PHSO after receiving the Trusts final response on 1 June 2023. Mrs H tells us she delayed in bringing her complaint to PHSO because she misunderstood the time limit. She says based on her understanding from the Trust’s final response dated 1 June 2023 she thought she had 12 months from the date of this letter to bring her complaint to PHSO.

19. The letter from the Trust dated 1 June 2023 signposted Mrs H to PHSO. It stated ‘to take a complaint to the Ombudsman go to their website or call. It is important you make your complaint as soon as you receive our final response as there are time limits for the Ombudsman to look into complaints.’ We do not agree the letter suggest there is a 12 month window from the date of the letter. The letter advised Mrs H to make her complaint to PHSO as soon as possible.

20. Mrs H told us the Trust had previously agreed to waive part of the charges and this led her to believe the complaint would eventually be resolved through local resolution. On 11 January 2023, the Trust agreed to waive £652.50 as it recognised outpatient appointments included in the charge should not have been billed. We appreciate Mrs H returned to the Trust on two further occasions pursuing her complaint and may have been hopeful for a resolution however, the final response dated 1 June 2023 was clear in advising Mrs H local resolution was exhausted and signposted her with some urgency to PHSO. Mrs H had all the documentation she needed on 1 June 2023 to bring her complaint to PHSO.

21. Mrs H explained she was grieving for her mother. She told us her mother lost her son two years before she died, and she was the sole carer for her granddaughter. She says when her mother died, Mrs H’s niece, who lives in India, became deeply depressed and needed to be cared for. Mrs H says she has been in regular contact with her sister who lives in India helping her to find ways to support her niece. She says she has been regularly calling and talking to her niece to keep checking she is ok. Mrs H says she travelled to India in January 2024 for fifteen days to look after her niece.

22. We appreciate Mrs H was coping with the loss of her mother and focusing on caring for her niece. However, Mrs H had been able to pursue her complaint as recently as 17 March 2023 under the same circumstances. We can see no reason to suggest Mrs H could not have brought her complaint to PHSO on or soon after 1 June 2023 when she received the final response from the Trust.

23. The law says the complainant must refer the complaint to us within one year from the day they became aware they had reason to complain unless it was not reasonable to do so. We did not see good reason to put the six month and four week gap in the timeline to one side from 1 June 2023 to 27 December 2023.

24. For this reason, we will inform Mrs H we cannot consider her complaint further. We understand this decision will be disappointing for Mrs H.

1. We have carefully considered Mrs H’s complaint about London North West University Healthcare NHS Trust (the Trust). We were very sorry to hear about the sad loss of her mother. We recognise Mrs H has had a difficult time since losing her mother.

2. Unfortunately, Mrs H made her complaint outside of our 12-month time limit. We have carefully considered the circumstances of the complaint and the reasons for the delays in bringing the complaint to PHSO. We have not seen sufficient reason to put our time limit to one side. For this reason, we will not be taking any further action.

3. We will explain our decision in more detail below.