Poor nutrition
15. Miss U tells the food provided on the ward was of poor quality. She explains Mr T often request food be brought from home as the food he was provided was inedible.
16. In its response, the Trust explained Mr T did not eat or drink well throughout his stay at JRH, as such he was referred to a dietician. The dietician recommended Mr T be given Fortisip compact three times a day and was encouraged to have extra snacks. Fortisip is a ready-to-drink nutrition supplement that is high in calories. The dietician also recommended the ward kept a strict food chart.
17. The Trust apologised the hospital food was not felt to be of a good standard and explained it would share feedback with the catering department.
18. We refer to NHS England’s key characteristics of ‘good nutrition and hydration care’ which states:
‘Screen all patients and service-users to identify malnourishment or risk of malnourishment and ensure actions are progressed and monitored.
Together with each patient or service user, create a personal care/support plan enabling them to have choice and control over their own nutritional care and fluid needs.’
19. We can see Mr T was seen by a dietician and their advice was followed through. We are sorry the hospital food did not meet Mis U and Mr T’s expectations and note preferences can vary. The Trust has acknowledged Miss U’s feedback and advised it will pass her concerns to the catering department.
20. We consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.
21. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.
22. The Trust has apologised the food was not up to Miss U and Mr T’s standards and has explained what actions it will take to address this, so that the service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.
Discharge
23. Miss U complains the Trust advised Mr T would be discharged on Monday 10 July 2023, however, this did not happen.
24. In its response the Trust explained Mr T was assessed by the ward occupational therapist on 8 July 2023 and the need for a walking rail at home was identified. The earliest this could be done was the following Monday (10 July 2023). However on 8 July 2023 at 8pm, Mr T’s Nurse reported he was drowsier and that his oxygen levels had dropped. The Nurse informed the medical staff who reviewed Mr T. It was noted Mr T was not fit for discharge as he was no longer medically stable.
25. While we acknowledge this may have been disappointing news for Miss U, we consider patient safety is a priority, and as such the Trust has a duty to ensure patients are stable and fit for discharge before being sent home.
26. NHS England statutory guidance on discharge states patients should only be discharged when they are medically optimised. The guidance highlights the following criteria for discharge:
‘Persons with low NEWS (0 to 4) scores - can they be discharged with suitable follow up?
• if not scoring 3 on any one parameter - for example, pulse rate greater than 130 • if their oxygen needs can be met at home • stable and not needing frequent observations every 4 hours or less • not needing any medical or nursing care after 8pm:
• people waiting for results - can they come back, or can they be phoned through?
• repeat bloods - can they be done after discharge in an alternative setting?
• people waiting for investigations - can they go home and come back as outpatients with the same waiting as inpatients?’
27. We refer to the following NHS Guidance which states:
‘Patients with oxygen saturations of 92% or lower or experiencing moderate/severe shortness of breath are generally unsuitable for early supported discharge’.
28. We also refer to NICE clinical guidelines which state:
‘you should not routinely discharge patients if they have had two or more of the following over the last 24 hours:
• Temperature higher than 37.5°C • Respiratory rate 24 breaths per minute or more • Heart rate more than 100 beats per minute • Systolic blood pressure 90 mm Hg or less • Oxygen saturation less than 90% on room air • Abnormal mental status • Inability to eat without assistance’
29. We have reviewed Mr T’s medical records and can see his oxygen levels had dropped and these could not be met at home. The records show on 8 July 2024, Mr T’s oxygen saturation levels dropped to 84%. We realise how difficult and upsetting this matter will be for Miss U. We hope she takes some reassurance from knowing the Trust acted in line with clinical guidance.
Call bells
30. Miss U complains call bells were not often responded to by staff on the ward especially when Mr T required assistance.
31. In its response the Trust explained it reviewed staffing levels for the period complained about and could see there were days where there was a minimum number of staff available. The Trust apologised for this and explained the complaint has been escalated through the local policy for staffing escalation including reminding all staff and ward managers to ensure this does not happen again.
32. We consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.
33. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.
19.The Trust has apologised Mr T’s calls for assistance were not responded to and has explained what actions it will take to address this, so that the service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.
Family room
34. Miss U complains the standard of the family day room was poor.
35. The Trust explained it would take on board Miss U’s concerns and apologised she felt it was not up to standard. It explained it provided feedback to the ward housekeeper and manager to ensure the room is kept clean and organised. The Trust apologised the room was of a poor standard and explained it will work hard to ensure the room is kept clean and tidy.
36. We consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.
37. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.
38. The Trust has apologised the room was not up to standard and explained what actions it will take to address this, so that the service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.
Failure to inform
39. Miss U explains the Trust failed to inform her of Mr T’s deteriorating health between 8 and 10 July 2024.
40. During a local resolution meeting, Miss U expressed her concerns and the Trust explained the on call registrar called Miss U on 9 July 2024 to discuss Mr T’s health. During the telephone call, the call notes state Miss U advised she would be calling a taxi so she could come to hospital. Shortly after, the Trust explains Mr T deteriorated further, before Miss U arrived.
41. We appreciate Miss U tells us she was not informed of Mr T’s deterioration. When considering this, we have paid particular attention to what she has told us and looked to see if there was any evidence in the medical records which we could use to support her account. We have been unable to identify any records or supporting information which would allow us to challenge or criticise the information provided by the Trust. We appreciate how disappointing this will be for Miss U.
42. For this reason, although we do not dispute what Miss U has said, we have not seen any indications of a service failure in relation to the communication with her about Mr T’s health between 8 and 10 July 2024. However, we can see the Trust has apologised if this was not communicated in an appropriate way, and we consider this is an appropriate response to the distress this caused in line with the Ombudsman’s Principles for Good Complaint Handling.
Personal belongings
43. Miss U complains Mr T’s phone charger went missing.
44. We refer to the CQC guidance which states:
‘The safe custody of patients’ property, valuables and cash is a service the Trust must provide to protect the interest of patients, staff and the Trust’.
45. We can see the Trust did not complete a checklist in line with the Trusts own policy on personal belongings nor did it act in accordance with the CQC guidance.
46. In its response to Miss U’s complaint, the Trust apologised Mr T’s charger was missing and has explained it has reminded all staff to ensure a property checklist is completed when patients are admitted to the ward. It also explained it reminded staff to make sure property is not moved from the patient’s personal bed space.
47. We consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.
48. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.
49. The Trust has apologised Mr T’s charger was displaced and explained what actions it will take to address this, so that the service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.
Professional standards
50. Mis U explains the professional standards of the nursing staff were below standards. She complains staff were often loud and giggly.
51. The NMC Code of Practice explains staff should be aware at all times of how their behaviour can affect and influence the behaviour of other people in their care.
52. In its response to Ms U, the Trust apologised for staff conduct. It explained it shared Miss U’s concerns with the Nursing team and sent out a reminder asking the ward is kept calm and quiet as possible.
53. When considering this point, we paid particular attention to what Miss U told us and looked to see if there was any evidence in the records which we could use to support her account. We have been unable to identify any records or any other supporting information which would allow us to challenge or criticise the information provided by the Trust. We appreciate how disappointing this will be for Miss U.
54. That being said, we consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.
55. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.
56. The Trust has apologised for the noise on the ward and explained what actions it will take to address this, so that the service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.
Conclusion
57. For the reasons outlined above, we do not propose to investigate Ms U’s complaint further. We know from the information Ms U sent us and from our discussions, how important this complaint is to her and how much this experience has had an impact. We were very sorry to hear about Ms U’s experience and we appreciate the details she has kindly shared with us. We offer our condolences for her sad loss.