East of England Ambulance Service NHS Trust

East of England Ambulance Service NHS Trust

7. Mrs L is complaining about the information she received when she contacted East of England Ambulance Service NHS Trust (the Ambulance Service) on 29 March 2022. She is unhappy as she was told if she took her husband, Mr L, to A&E he would be waiting for 20 hours before he would be seen.

8. Mrs L believes her husband should have been sent an ambulance within 15 minutes due to his medical history and presenting symptoms.

9. Mrs L says her husband had clear signs of a heart attack and was already diagnosed with heart disease but the Ambulance Service told her to keep him at home.

10. Mrs L says she made the decision to keep her husband at home but took him to A&E the following morning, on 30 March 2022. She believes if she had taken him sooner his outcome would have been better.

11. Mrs L is upset she was given the incorrect information which led to her husband waiting for care and treatment.

12. Mrs L says she blames herself for not listening to what the ambulance service said. She says she has suffered from nightmares, flashbacks, anxiety and mistrust in the ambulance service and all health professionals.

13. Mrs L is looking for a financial remedy and service improvements to ensure this does not happen again to resolve her complaint.

East Suffolk and North Essex NHS Foundation Trust

14. Mrs L complains about her experience of attending East Suffolk and North Essex NHS Foundation Trust (the Trust) with her husband, Mr L on 13 March 2019, 25 February 2022, 22 March 2022 and between 30 March 2022 and 14 April 2022. She specifically says:

• the Trust told her she could not accompany her husband into the A&E department. Mrs L says her husband was deaf, had very poor eyesight and was diabetic but was made to go into A&E by himself • prior to his death her husband attended A&E three times, 13 March 2019, 25 February 2022 and 22 March 2022, with back pain and was told it was a back spasm. However, when he was in ICU she was told he had four fractures to his spine • Mr L’s end of life care was poor • the communication from the Trust was very poor and she was left not knowing what was happening with her husband’s care • the Trust failed to diagnose Mr L with multiple myeloma until he was admitted on 30 March 2022.

15. Mrs L says her husband was alone in hospital for over a week until she was allowed to go to see him. She says her husband was left alone and she could only see him once he had been admitted to ICU. This caused Mrs L upset and distress knowing her husband was in this situation.

16. Mrs L adds when she was allowed into the hospital to see her husband, he was so poorly he could not communicate with her properly. She therefore feels an opportunity to see her husband and say goodbye was taken away from her.

17. Mrs L says if her husband’s cancer had been diagnosed much sooner he could have received treatment and had a chance at a better outcome.

18. Mrs L has said she suffers from nightmares about her husband being on his own and has had to receive counselling following his death. She has also had to cut down her hours at work as she cannot cope, which has had a huge impact on her way of life.

19. Mrs L adds her husband was left in pain for longer than he should have been due to the incorrect diagnosis of his fractured back. Mrs L adds this was very difficult to watch and caused her distress and worry.

20. Mrs L is looking for a financial remedy and service improvements to ensure this does not happen again as a resolution to her complaint.

21. On 13 March 2019, Mr L presented to A&E with chest pain. The Trust placed stents into Mr L’s heart, which help to widen his coronary arteries.

22. On 25 February 2022, Mr L presented to A&E with lower back pain, stiffness to his shoulder and chest pain. The Trust carried out a CT scan and chest X-ray which came back clear.

23. On 22 March 2022, Mr L again presented to A&E with back and chest pain. The Trust carried out blood tests all of which returned normal.

24. On 29 March 2022, Mrs L called 999 as Mr L was struggling to breath and was in pain. The call was categorised as a category two call, which means an ambulance should arrive in 40 minutes. However, due to delays on the night Mrs L was told there was a delay of 150 minutes. The clinician who took the call therefore agreed with Mrs L she would take her husband to A&E in the morning.

25. In the morning of 30 March 2022, Mr L presented to A&E with chest and back pain.

26. The same day, the Trust completed a myeloma screen (a series of blood, urine and bone morrow tests) which confirmed Mr L had stage two myeloma.

27. On 31 March 2022, Mr L underwent surgery for cardiac catheterisation, where a catheter is inserted into a chamber or vessel in the heart to help with diagnosis.

28. On 6 April 2022, the Trust performed a bone morrow biopsy. The results of which became available on 14 April 2022.

29. On 13 April 2022, the Trust conducted an MRI scan which confirmed Mr L did not have a stroke.

30. Mr L was receiving full active treatment until late on 13 April 2022. At 10.03pm, Mr L began to appear very poorly and the Trust suspected he only had a few days left to live. It was agreed he would be referred to the palliative care team first thing in the morning.

31. On 14 April 2022, Mr L sadly died.

33. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mrs L to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

East of England Ambulance Service NHS Trust

34. Mrs L’s complaint regarding the ambulance Trust has three parts, which include: • she was given the incorrect information and was told her husband would be waiting 20 hours at A&E • the ambulance Trust did not send an ambulance within 15 minutes • the ambulance Trust told her to keep her husband at home.

35. Mrs L has said the ambulance Trust has given her incorrect information, did not send an ambulance and told her to keep her husband at home. Mrs L says her husband was displaying signs of a heart attack and therefore the ambulance Trust should have helped Mr L following this 999 call. We consider, based on the information we have at this time, the ambulance Trust has potentially breached its duty of care. We are sorry to learn about her experience.

36. Mrs L has said the impact of the above breaches in care was that her husband did not attend A&E until the next day. Therefore, he was left without treatment for longer and suffered with pain and other symptoms for longer. Mrs L feels if an ambulance had been sent when she contacted 999 on 29 March 2022, her husband would have had a better outcome. We understand why this is concerning to Mrs L.

37. The Fatal Accidents Act allows spouses, partner, cohabitees or parents of an unmarried minor to make a claim with the current claim set at £15,120. Any dependants may claim for their loss of dependency in circumstances where the deceased would have been able to bring a claim for damages for personal injury if the deceased had not died. A claimant can also claim for funeral expenses under this act.

38. We would therefore consider as Mrs L is saying her husband would have had a better outcome if the ambulance had been sent to him on 29 March 2022, she could potentially have a legal claim here.

East Suffolk and North Essex NHS Foundation Trust

Missed back fractures

39. With regards to Mrs L’s concerns her husband attended A&E three times with back pain and it failed to pick up his fractures. Based on the information we have at the time, the Trust has potentially failed to investigate Mr L’s back pain appropriately and has therefore potentially missed a diagnosis. If so, this would be a breach in the Trust’s duty of care. We are sorry to learn of the impact this had on Mrs L.

40. This had a physical impact on Mr L as he was in pain for longer and without the appropriate treatment.

41. We consider Mrs L may have a potential clinical negligence legal claim.

End of life care

42. Mrs L has concerns her husband’s end of life care was poor. Mrs L has said the Trust has failed to administer the care her husband needed on his final days and weeks. She has said this led to her husband being in pain and not being as comfortable as he should have been as he was nearing the end of life. We would therefore consider the breach in care she describes may have had a physical impact on Mr L and Mrs L could potentially mean she has a clinical negligence claim available to her.

Multiple myeloma diagnosis

43. Mrs L has also said the Trust failed to diagnose her husband with multiple myeloma until 30 March 2022. We understand from Mrs L’s complaint her husband had been visiting the Trust and under its care from January 2019. From the information we have, we understand Mr L attended the Trust on multiple occasions but was not diagnosed with multiple myeloma for over three years. This could potentially be a breach in duty of care by the Trust. We consider this could potentially mean Mrs L could make a clinical negligence claim.

44. In terms of the impact of this on Mr L, Mrs L has said if her husband’s cancer had been diagnosed sooner, his treatment could have been different and he could have had a better outcome. We therefore consider the breach has likely had an impact on Mr L.

45. Mrs L is looking for a financial remedy and service improvements as a resolution to her complaint about both the Ambulance Trust and the Trust.

46. Mrs L would like a figure of around £5000. She says this will enable her to get back to where she was before all of this happened, help pay for her husband’s funeral, help pay for her therapy sessions and help their children and her survive with more dignity.

47. Whilst, £5000 is not an exceptionally large amount of money, we consider the amount she actually wants may increase. This is because based on the reasons why Mrs L would like this money, we think to cover everything she says she needs to pay for and needs to help her live a better life, the costs would likely exceed £5000.

48. Mr L was in his late fifties at the time of his death, and whilst we do not know if he was working or not, as he was of working age, Mrs L may even begin to seek costs to cover his lost salary.

49. There is no upper limit to what we can achieve through our recommendations or the amount of financial remedy we can recommend. The law says if legal options are available and it is reasonable for someone to pursue this then it they should do so.

50. We would therefore consider as a successful Fatal Accidents Act claim pays £15,120 this is more than what Mrs L is looking for and could potentially cover funeral expenses and loss of income. We hope this will provide Mrs L with the outcome she is seeking.

51. We understand Mr L’s death has had a profound effect on his wife, Mrs L’s emotionally and financially. Therefore, we hope our decision does not increase any stress or anxiety for Mrs L.

52. We can clearly see from Mrs L’s complaint about the Ambulance Trust and the Trust that her income and lifestyle is not the same as when her husband was alive. She said she had to take time away from work and is gradually beginning to work more and more hours.

53. While Mrs L has not said she would not be able to afford a legal claim, we are aware that potentially her income may be limited. However, we know there are various arrangement available to Mrs L, including ‘no win no fee’ solicitors which she is able to explore. There are also many other funding options for a claim which she will be able to discuss with a solicitor. We have also provided Mrs L with details of organisation who may be able to help her find appropriate legal representation.

54. When we have asked Mrs L whether she has considered legal action, she has simply stated she believed the next stage of the process was to approach us.

55. We understand Mrs L is also looking for service improvements, this can be achieved through the court system as a by product of a legal claim. If not, Mrs L can bring her complaint back to us to look into. Mrs L would need to be aware of our time limit when doing this.

56. Mrs L has not provided any reason why she would not be able to or is not suitable to pursue a legal claim. She has said she has not done this previously as she thought the next stage in the complaints process is to approach us. We therefore consider there is no reason for Mrs L not to pursue a legal claim at this stage for both Trusts.

57. We are sorry to learn of Mrs L’s experience. Her life has changed dramatically since her husband’s tragic death. We hope our consideration provides her some assurance on next steps.

Attending A&E and communication

58. Mrs L has raised concerns, she was not allowed to attend A&E with her husband or visit him for some time following his admittance to the Trust. She has also said the communication between the Trust and herself was poor.

59. We are sorry to hear Mrs L was unable to attend her husband when he first attended the Trust in March 2022 and also that the Trust did not appropriately communicate with her regarding her husband’s condition. This must have been incredibly upsetting, worrying and frustrating for her.

60. We do not consider there is a legal claim for Mrs L to pursue with these parts of her complaint. However, we consider it would be very difficult for us to consider these aspects further and make findings on them without making findings on the other aspects of Mrs L’s case.

61. As we are saying the other aspects of Mrs L’s complaint about the Trust should be considered through a legal claim, it would not be right for us to then make findings on these aspects of her complaint at this time.

62. We therefore consider it is best for Mrs L to seek legal advice on all aspects of her complaint. We hope this is not something Mrs L worries about and hope she understands if she is unsuccessful or the legal case does not cover all aspects of her complaint or achieve all of her outcomes, she is able to come back to us for a consideration without delay.

63. Mrs L’s experience is incredibly sad. We thank her for bringing this complaint to us.

1. We have carefully considered Mrs L’s complaint about East of England Ambulance Service NHS Trust (the Ambulance Trust) and East Suffolk and North Essex NHS Foundation Trust (the Trust). We consider Mrs L could take legal action on the matter she has brought to us.

2. Mrs L has raised concerns when she contacted the Ambulance Trust on 29 March 2022, she was given the wrong advice, told to keep her husband at home, and it did not send an ambulance. Mrs L has a potential fatal accidents legal claim available to her. We would consider Mrs L would need to pursue this before we are able to continue to consider her complaint.

3. Mrs L has raised concerns the Trust missed her husband’s back fractures, did not provide appropriate end of life care and missed diagnosing him with multiple myeloma. We consider as Mrs L is saying the Trust breached in its duty of care she potentially could pursue a clinical negligence claim. We again have not seen any reason Mrs L cannot pursue this claim at this point, therefore we will not consider her complaint any further.

4. With regards to Mrs L’s complaint about the Trust’s communication with her and not allowing her to visit her husband, we consider we are unable to conclude and continue to consider this element of her complaint at this time. This is because as the other elements of her complaint have a potential legal claim available, any consideration of the communication issues would be difficult for us to undertake separately from the main body of her complaint. We therefore consider Mrs L should seek legal advice on her entire complaint at this point.

5. We recognise this decision will not be what Mrs L expected. We hope our consideration reassures her about how she can make a legal claim and if this is not successful she is able to come back to us.

6. We understand how difficult it has been for Mrs L to raise this complaint with us and would like to thank her for allowing us this time to consider her complaint.