13. The Health Service Commissioner’s Act 1993 section 9 (4) says we will not consider a complaint if it is made more than a year after the day on which the person complaining became aware of matters in the complaint unless we consider it reasonable to do so.
14. We consider the complainant’s reasons for any delays and the time take for local resolution with the organisation complained about in every case brought to us outside of our 12-month time limit.
15. We can only set aside the time limit if there are good reasons to do so. Attempting to investigate matters that have happened a long time ago presents practical challenges as staff may have moved on or have little recollection of events that happened at the time.
16. Mrs I was aware there was an issue to complain about on 25 January 2022, which we have taken as her date of knowledge. This was four months after surgery and gave enough time for her to recognise the symptoms she was suffering were out of the ordinary. For Mrs I’ complaint to be within our time limit, it needed to reach us by 25 January 2023. Mrs I’ complaint came to us 25 months after her date of knowledge, on 26 February 2024, making the complaint 13 months out of time.
17. If a complaint is brought to us after our 12-month time limit, we must consider the complainant’s reasons for any delay and the time taken for local resolution to be completed. We can only set aside the time limit if there are good reasons to do so.
18. Mrs I says that she is not computer literate or technically, medically, and scientifically qualified, so she has had to rely on her son to function as an advocate to pursue the complaint. Mrs I says that she is still feeling the effects on her health after her experience at the Trust. Mrs I says her son has a demanding job which has impacted the time spent trying to pursue the complaint.
19. Mrs I says to start the complaints process, she wanted to obtain her medical notes. She says the Trust took a long time to provide her with her medical notes and she says the Trust lost her initial request for this. It took two months for the medical notes to reach her. Mrs I says the medical notes are in excess of 2000 pages and are mostly handwritten and illegible. She says this was a challenging task to extract the relevant information which took several months to complete.
20. On 18 July 2022, Mrs I says she made a Freedom of Information Request (FOI) to the Trust which she says the Trust lost. She followed this up with another FOI request but had to chase the Trust in October and November 2022 as she had not received it. The response to the FOI request arrived on 16 November 2022. Mrs I says the response was vague and did not help with pursuing her claim which further delayed the complaint.
21. When Mrs I reviewed the clinical hospital notes, she noticed there were notes relating to two other unrelated patients. She reported this to the Trust on 16 November 2022. Mrs I says due to this incident, she questioned the accuracy of the records and decided to wait until the Trust responded to her which arrived on 24 January 2023. This further delayed her complaint.
22. Mrs I says her son finally completed the review of the clinical notes and drafted a letter of complaint to the Trust on 4 April 2023. This was 15 months after Mrs I’ date of knowledge. We appreciate Mrs I took time to await receipt of her medical notes, but given the delay for this, it is unclear why Mrs I did not make an initial complaint to the Trust sooner or contact PHSO after the mistakes with the Trust losing her requests and the time take to respond to her.
23. Mrs I says the Trust advised it needed 45 days to respond to the complaint and set a deadline of 15 June 2023 to respond. The Trust did not meet this deadline and advised it needed additional time until 13 July 2023.
24. Mrs I says she received several phone calls from Patient Advice and Liaison Service (PALS) on 12 June 2023, 13 July 2023, and 10 August 2023 advising her complaint would be escalated to an executive level. She says the Trust claim it left voice messages on Mrs I’ telephone, but she says there is no evidence of this.
25. On 5 October 2023, Mrs I wrote to her Member of Parliament (MP) as she was fed up with the constant delays from the Trust. She provided a copy of this letter to the Trust’s Chief Executive Officer (CEO) on 12 October 2023. The CEO replied to her the same day and an operational manager contacted her that afternoon.
26. The Trust say that one of the key medical team members had been on long term sick and that a final response would be with Mrs I within a week. Mrs I says she sent several emails to the Trust but did not achieve anything.
27. Mrs I says it took the Trust until 6 December 2023 to provide its initial response at which point she contacted her MP as she was unhappy with the response. She met with her MP on 5 January 2024 who advised her to contact PHSO.
28. Mrs I and her son then wrote a point-by-point response to the Trust with outstanding concerns on 23 January 2024 and asked for them to reply within a month. Mrs I did not hear anything from the Trust and contacted her MP again. On 22 February 2024, Mrs I’ MP advised that PALS had contacted him to say the Trust reopened the complaint, which was a month after she had given the Trust a month to provide a response to her further letter of concerns.
29. Mrs I sent her complaint form to PHSO on 26 February 2024.
30. The Trust contacted Mrs I on 28 February 2024 advising it would respond to the complaint on 17 April 2024. Mrs I then received a letter from the Trust advising it had closed the complaint as Mrs I had contacted the General Medical Council (GMC) and PHSO.
31. We can see that the Trust were responsible for large periods where it delayed its responses to Mrs I. It took eight months for the Trust to provide its initial response to Mrs I' complaint which is dated 6 December 2023. In its response, the Trust signposted Mrs I to PHSO.
32. Mrs I did not contact us at this point and instead raised further concerns and replied to the Trust’s first response.
33. In total it took 11 months during local resolution to complete, and Mrs I was first signposted to us by the Trust on 6 December 2023. Even if Mrs I had come to us when the Trust first signposted her to us, she would still be out of time by one month.
34. Mrs I did not come to us when she was signposted and decided to continue communicating with the Trust despite being aware that we were a potential aid to progress her complaint at that stage. It was not until 11 months later that Mrs I made first contact with us.
35. We appreciate Mrs I was proactive in contacting the Trust once the complaint was in full swing and chased the Trust for progress on its responses. We can therefore make allowances for some of this time as the delays were outside of Mrs I’ control. We appreciate how frustrating it must have been for Mrs I to chase the Trust for its responses and having to wait for answers to her complaint.
Conclusion
36. We are sorry to hear about the issues Mrs I has experienced and we appreciate this had a substantial impact on her health. We appreciate the time and effort both Mrs I and her son have taken throughout the complaints process.
37. There are significant prolonged periods for which we cannot fully account, particularly the initial 15 months, when Mrs I and her son were reviewing her medical records. This means we cannot justify setting the time limit to one side due to the complaint being 13 months outside of our time limit. This is a lengthy period and falls quite a way outside of the usual span we would consider to be able to set aside the time limit for.
38. We must apply discretionary powers to set aside the time limit consistently to be fair to other complainants. We can only do this where there is good reason for all delays. On this basis, we will not consider Mrs I’ complaint due to the time it has taken for the complaint to reach us.
39. We understand and appreciate the time and effort Mrs I and her son have taken to address the concerns with the Trust, and we appreciate the importance of Mrs I’ complaint. We appreciate how distressing and difficult this situation has been for Mrs I and her family.