Sherwood Forest Hospitals NHS Foundation Trust

3. Mrs E and Ms P complain about the care and treatment Mr W received from the Trust between 26 April 2023 and 29 April 2023. Specifically, they complain the Trust:

• wrongly stopped Mr W’s Edoxaban medication between 26 April and 28 April 2023 • only gave Mr W half a dose of thrombolysis medication instead of the full dose on 29 April 2023.

4. Mrs E said because of the actions of the Trust Mr W had a stroke on 28 April which left him disabled and caused further deteriorated after the stroke.

5. Mrs E said Mr W’s disability may not have been so severe if he was given the full dose thrombolysis medication.

6. From their complaint Mrs E and Ms P want service improvement and financial redress of £12,500 or more.

7. What follows is a summary of the complaint components. We have not included all the detail as both parties are aware of this.

8. Mr W attended the emergency department on 26 April 2023 due to a painful left hip and swelling and bruising to the left knee.

9. The Trust noted he has atrial fibrillation (AF) for which he was treated with Edoxaban medication, and previous stroke.

10. The Trust recommended Mr W to be admitted to hospital for the team to monitor his haemoglobin (HB) levels. The Trust also recommended Mr W to withhold taking his Edoxaban medication pending these discussions.

11. Edoxaban is medication that prevents blood clots and reduces the risk of stroke.

12. Mr W was subsequently transferred to the Emergency Assessment Unit (EAU) on 27 April 2023. He was reviewed by a member of the Trauma and Orthopaedic team, who conducted a full examination, and it was decided that he did not require any input from their team, and they recommended for him to be reviewed by the Haematology team for further management.

13. On 28 April 2023, Mr W was further reviewed by one of the clinicians who noted that his levels of HB had slightly increased.

14. The Trust recommend he could be discharged home and to recommence his Edoxaban medication the following day (29 April), and for his General Practitioner to check his HB level in one weeks' time.

15. Mr W had a stoke after he was discharge and was admitted to the hospital on 29 April.

18. For any complaint the Ombudsman receives, the Health Service Commissioners Act of 1993 (HSCA) states the Ombudsman must first consider if there is a legal route to achieving the remedy sought.

19. This is contained within section 4(1)b of the act which states the Ombudsman shall not investigate if there is a remedy by proceeding the complaint through any court of law.

20. Further to this, the HSCA states the Ombudsman must be satisfied that in considering the personal circumstances of a complaint it is not reasonable to expect the complainant to resort to legal proceedings.

21. This translates into our own policy referred to as a ‘two stage legal test’ that we must look at before any consideration of a complaint. The two stages are, is there a legal route and is it reasonable for the complainant to pursue?

Is there a legal route?

22. From talking to Mrs E and Ms P (the complainants) we know the claimed injustice in this complaint is their consideration of the Trust wrongly stopping Mr W’s Edoxaban medication and not giving him the full dose of thrombolysis medication.

23. Because of this the complainants say Mr W was permanently disabled and this has significantly now affected his quality of life.

24. We consider clinical negligence takes place when a patient who underwent a treatment becomes injured (through negligence) as a result of that treatment. That said, it appears Mrs E and Ms P could potentially pursue a clinical negligence claim as they say the Trust incorrectly stopped Mr W’s medication which led to him having a stroke.

25. We next note the complainants are looking for service improvement and financial redress of level six (£12,500 or more).

26. Where mixed outcomes are sought, we should still ‘consider if an alternative legal remedy is appropriate, even when some of the outcomes requested by the complainant cannot be achieved through legal action. This includes consideration of whether any financial remedy sought is an amount we are likely to recommend.’

27. In reaching our view, we consider if a complainant has an alternative legal remedy in relation to their complaint, based on the remedy they are seeking, one that a court could reach determination on.

28. We consider Mrs E and Ms P do have a legal route (though we are not reaching a view on the success of a claim). This is because the financial redress they are seeking is significant and wide-ranging amounts can be made as a binding determination through court if negligence is found and upheld. We also recognise that as a biproduct of court, service improvement can sometimes be achieved.

Is it reasonable to pursue a legal claim?

29. Next, after establishing there is a legal route, we have gone onto explore with Mrs E and Ms P if it is reasonable for them to pursue.

30. When considering reasonableness, the factors we take into account are based on the individual circumstances of a complaint such as (though not exhaustive a list of considerations): if the costs are proportionate to the legal claim; if financial means to pursue a claim are in place; how long legal proceedings may take; if there are any other circumstances which may impact on this.

31. We talked with the complainants to understand the complaint, the injustices they say Mr W has faced, to better understand the financial remedy and other improvements sought and whether legal action would be reasonable for them to pursue.

32. We asked Mrs E and Ms P if they have any barriers that prevent them from seeking alternative legal remedy. They explained following their complaint with the Trust, they were referred to Ombudsman and they were under the impression they had to exhaust all ‘channels’ before taking legal advice by coming to the Ombudsman first.

33. We also note, Mrs E informed us she is Mr W’s full-time career and had to ‘adapt’ her entire life to the needs of Mr W. We understand and appreciate how being a full-time career can make enquiring about legal action challenging. We note Ms P (Mr W’s daughter) is raising this complaint together with Mrs E and have not seen any barriers preventing her from pursuing this matter further.

34. During our discussions no other barriers to exploring a legal route were identified or discussed that would make it unreasonable to pursue this.

35. As such, we have seen Mrs E and Ms P have alternative legal remedy and have not been made aware of any other present factors that may cause us to doubt this reasonableness, we consider that it is reasonable for them to explore this in full.

36. This marks the end of our primary consideration of Mrs E’s and Ms P’s complaint.

1. Mrs E (wife) and Ms P (daughter) are making this complaint on behalf of Mr W (aggrieved).

2. We have carefully considered Mrs E’s and Ms P’s complaint about the Trust. We are sorry to learn of their concerns regarding the treatment Mr W’s received and how his Edoxaban medication was stopped. In speaking with Mrs E, we consider they could take legal action on the matter they have brought to us, and it is reasonable for them to do so.