Mersey and West Lancashire Teaching Hospitals NHS Trust

Mersey Care NHS Foundation Trust

6. Mrs T complains Mersey Care NHS Foundation Trust’s Early Intervention Team did not detain Mr T sooner under the Mental Health Act 2005 when he was in crisis in April 2022. She says he should have been given intravenous medication, vitamins and a nasogastric (NG) feeding tube to ensure he had adequate nutrition.

7. She also complains Mr T was given Electroconvulsive Therapy (ECT) on 9 June 2022 without appropriate consent due to him lacking capacity to have a conversation about it at the time.

8. She says staff also did not provide pressure relieving care, there are inaccuracies in his medical records, and he was not supported with personal care.

Mersey and West Lancashire Teaching Hospitals NHS Trust

9. Mrs T complains Mr T was not reviewed by a doctor for 11 hours in A&E on 10 June 2022. The doctor recommended a NG feeding tube, but no feeding tube was started. Mr T was still not given a feeding tube when the Trust transferred him to a ward and he was unconscious.

10. Mrs T says staff observation records say Mr T was ‘well and alert’, but she says this is incorrect. She says staff also did not provide good quality general nursing care in relation to:

• continence care • moving and handling • administration of medication whilst Mr T was not alert or not awake.

11. Mr T fell out of bed on different wards, and on one occasion the family found him naked when they arrived to visit him. She says a staff member was verbally abusive when she challenged them about his dignity not being maintained. Mrs T also complains about staff communication, as she says she was not notified about significant events, such as Mr T’s falls.

12. Mrs T says that because of the failings of both Trusts, Mr T developed Wernicke’s Encephalopathy, which doctors believe is due to vitamin deficiency when Mr T refused to eat and drink for five weeks.

13. Mr T also suffered cardiac and respiratory failure in hospital because of the lack of nutrition. Mr T also suffered brain damage because of this and now needs full-time care to meet his daily living needs. He was also distressed during his hospital stay due to staff not meeting all his basic care needs.

14. Mrs T now must care for the family on her own, and she has suffered financially because of reliance on her sole income. She has also struggled with her mental health which has impacted on work and family life. She says her children have also been distressed at seeing their father’s deterioration.

15. In April 2022, Mr T had a mental health crisis. He went missing, and when he was found, he had started an extreme food and drink fast.

16. His family became very concerned when he started to lose a lot of weight and was still not eating or drinking.

Mersey Care NHS Foundation Trust

17. On 5 May 2022, a dietician reviewed Mr T at home who advised he did not need artificial feeding. A plan to prevent refeeding syndrome was put in place. Refeeding syndrome is a life-threatening condition where malnourished patients receive food after a long period of starvation.

18. By 26 May 2022, Mr T had not eaten for five weeks and he was sectioned (compulsorily admitted to hospital) under the Mental Health Act 2007 so he could be treated. A dietician reviewed Mr T on 30 May and the refeeding plan was continued.

19. On 8 June, a dietician planned a transfer to an acute ward for nasogastric (NG) feeding tube (through the nose) if Mr T was still not taking food by mouth. The Trust noted Mr T had accepted toast the previous day and it was hoped a treatment called Electroconvulsive Therapy (ECT) would improve his mental health.

20. ECT is a treatment that involved sending an electric current through the brain. This causes a brief surge of electrical activity within the brain (also known as a seizure). It is used as a treatment for severe depression.

21. Mr T had the first session of ECT on 9 June and a dietician recommended NG tube feeding. After the procedure, he deteriorated and needed to be transferred to a different hospital for further care.

Mersey and West Lancashire Teaching Hospitals NHS Trust

22. On 10 June, Mr T was transferred to Mersey and West Lancashire Teaching Hospitals NHS Trust. On 13 June, the Trust transferred Mr T to the intensive care unit (ICU). Whilst there, Mrs T complained about the quality of the Trust’s general nursing care, as this caused distress to Mr T and his family. Although the Trust had planned to insert an NG feeding tube, this was not inserted.

23. Mr T continues to need a high level of care since these events, which Mrs T says is because the Trust’s treatment was not suitable for Mr T and was not fully consented to.

26. 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 T 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.

27. Mrs T raised several concerns about the clinical care and treatment provided by both Trusts. She believes these failings led to Mr T developing Wernicke’s Encephalopathy, which doctors believe is due to vitamin deficiency when Mr T refused to eat and drink for five weeks.

28. When considering Mrs T’s complaint, it appears there may be a legal remedy available to her through the courts. This is because she believes both Trusts failed to take sufficient action to intervene when Mr T refused to eat because of his beliefs at the time, which appeared to be due to mental illness.

29. Given Mrs T’s complaint, it appears she may have a claim for clinical negligence. This is because she believes the Trusts’ failure to carry out the treatment has resulted in injury to Mr T. We have gone on to consider whether it looks like legal action could achieve the outcomes Mrs T is seeking.

30. As an outcome to her complaint, Mrs T has told us she is seeking a financial remedy. When we explored this further, Mrs T told us she is seeking a financial remedy of over £12,500. She is seeking a financial remedy to support Mr T’s rehabilitation. She explained that she considered this to be a low amount for the significantly reduced quality of life Mr T has. Mrs T also told us she believes Mr T has experienced a loss of earnings because of these events.

31. Whilst Mrs T has not specified what amount she is hoping to achieve, we appreciate she is hoping to receive enough to offset the loss of Mr T’s potential earnings and provide him a greater quality of care. We understand this to likely be in excess of what we would normally recommend. On this basis, it appears the courts may be more likely to achieve this outcome.

32. Mrs T also wants service improvements in the form of better care for Mr T, including a move to supported accommodation closer to home and rehabilitation. Whilst we can ask the Trust to consider service improvements, we cannot tell it what care it should provide. It does not appear that either organisation are providing Mr T with ongoing care, so the courts would be unlikely to be able to order either organisation to provide this.

33. It appears that both we and the courts could potentially achieve the financial remedy Mrs T is seeking, but the courts may achieve an amount closer to what Mrs T is seeking. We recognise that neither we, nor the Trust, are likely to be able to achieve the changes in care for Mr T that Mrs T is seeking.

34. In our view, Mrs T appears to have a cause of action to take this case to court and that this is more likely to achieve the outcomes she is seeking.

35. Mrs T agreed with our view that she should explore legal action. She understands the law says we cannot investigate if there was this option available, unless it is not reasonable to do this.

36. Mrs T has been told by a legal representative that she appears to have a claim for clinical negligence, and they will represent her. We hope Mrs T can resolve her complaint through this action.

37. It is not clear at this stage whether legal action will be able to consider all the issues Mrs T is raising. This is particularly in relation to Mrs T’s concerns about Mersey and West Lancashire Teaching Hospitals NHS Trust’s standard of nursing care, as described in paragraph 3 above.

38. We do not think we could consider these parts of the complaint while any legal action is ongoing. Mrs T also agreed these issues are secondary to the more serious impact she has complained about, and her priority is seeking financial remedy for this. We recognise these events contributed to the overall negative experience Mr and Mrs T had at the Trust. We think that considering these issues now could potentially impact the court’s consideration of Mr and Mrs T’s complaint, as the events and impact appear interlinked.

39. After discussing this with Mrs T, she agreed. Our decision not to look further at these issues does not take away from the impact these events have contributed to Mr and Mrs T’s negative experience of the Trust’s care. We understand they have had a lasting impression on them.

40. Mrs T can return to us if she finds she is unable to pursue legal action. She can also return to us if following legal action if she has outstanding outcomes which the court was unable to order, or if the court was unable to consider parts of her complaint. We were sorry to hear of Mr and Mrs T’s experience and hope they can obtain the outcomes she is seeking through the courts.

41. We have made Mrs T aware of our time limits, as we are unable to investigate complaints brought to us 12 months after someone has become aware of the problem. We can put this time limit to one side if we think there is a good reason to do so.

1. We have carefully considered Mrs T’s complaint about Mersey Care NHS Foundation Trust, and Mersey and West Lancashire Teaching Hospitals NHS Foundation Trust’s treatment of her husband, Mr T. We were saddened to hear of the events Mrs T complains about and how this continues to impact on both their lives due to Mr T’s ongoing needs.

2. We believe there may be a legal remedy available to Mrs T in relation to the treatment aspects of her complaint. Having discussed this with Mrs T, we have seen nothing to suggest it would not be reasonable for her to pursue this. We are therefore unable to consider her complaint at this time. We understand Mrs T has been told by a legal representative that she appears to have a clinical negligence claim and will take her case.

3. We also discussed the remaining issues of her complaint. These relate to Mersey and West Lancashire Teaching Hospitals NHS Foundation Trust’s quality of nursing care provided on the ward, and staff communication and behaviour.

4. We discussed these issues with Mrs T and she agreed these are not the primary reason for her complaint, and her priority is seeking financial remedy for the more serious ongoing impact to Mr T. We appreciate these aspects of poor care contributed to the overall poor experience Mr and Mrs T had of the Trust

5. We agreed we should not investigate these issues at this time. While a legal remedy may not exist for these issues, the events and any potential impact appear linked to the events the courts may consider. Because of this, considering these issues now may potentially impact the court’s consideration. We therefore should wait for the courts to complete their consideration before we consider any remaining parts of the complaint.