Incorrect number on system, and no alternative contact
30. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so, we cannot link the events complained about with the negative impact Mr T has claimed.
31. Mr T complains the dental hospital (part of the Trust) held an incorrect mobile number for him on the system, and it did not contact him using any other means about an appointment.
32. Mr T tells us he had an appointment in 2019, and he was waiting to receive an appointment letter with details of his next treatment. He says this is how he became aware of previous appointments he had at the dental hospital.
33. Mr T says he contacted PALS in 2021 or 2022 as he had not heard anything. He says when he did this, PALS passed the complaint to the dentist he was waiting to have an appointment with.
34. He says this dentist contacted him and said she and other staff had tried to contact Mr T in 2020 during the COVID-19 pandemic, but they held the incorrect phone number which meant they were ringing him and speaking to someone else who was abusive. Mr T says the dentist explained they had been trying to contact him as they were still holding appointments. He explained the dentist was happy to continue Mr T’s treatment as his job involved steps to prevent the spread of COVID-19.
35. Mr T says the dentist said they had installed a new computer system, which is what caused the issue. He says the dentist told him she would arrange an appointment for him, which the dental hospital scheduled for August 2022.
36. Mr T also says he moved house in July 2020, but he had post redirection in place for 12 months so he would have received an appointment letter if the dental hospital had sent him one.
37. Mr T says he gave the correct number to PALS, which the dentist called him on and said she would get his records changed.
38. Manchester University NHS Foundation Trust’s ‘Access Policy’ (2018) is relevant here. This says:
39. ‘Communication with patients will be informative, clear, and concise and meet patient’s accessible information and communication needs in line with the Accessible Information Standard. A summary will be recorded in the Trust’s information systems. Appointments will be confirmed in writing, including alternative languages and formats e.g. braille, text and email. Some patients may have agreed an appointment before leaving clinic. Prior to all appointments a text-reminder system is in place, therefore it is essential that patient’s contact numbers are kept up to date.’
40. In the complaint response, the Trust said it introduced a new electronic patient record system (HIVE) across the whole Trust in September 2022, and it explained, on migration from the existing system, there was some data quality issues with telephone numbers transferring. It apologised Mr T was affected by this before his details could be updated.
41. It also apologised no one wrote to Mr T in 2020/2021 to ask him to contact the dental hospital to arrange next steps for treatment. It said this was an oversight, and it said its usual protocol is to send a letter and/or text messages to patients it is unable to contact via phone.
42. When we asked the Trust to confirm the mobile numbers it has holds for Mr T on its new system, it confirmed Mr T’s mobile number ending 862. We are satisfied this is his current number as we have used this to contact Mr T. Mr T tells us he has had the same mobile number since his referral to the dental hospital in 2016.
43. The Trust confirmed this mobile number has not changed since its new system went live on 8 September 2022. The Trust confirmed this by running an audit report on Mr T’s record on the new system to see if it had made any changes/updates to his registration details since the merge. It provided a screenshot to evidence no changes were made. It said this would have been the number in use since September 2022.
44. As part of our investigation of the complaint, we asked the Trust to clarify whether Mr T was impacted by the data quality issues the Trust experienced with migration, because the evidence it provided contradicts what it told Mr T in the complaint response.
45. The Trust told us it had investigated this further, and it realised Mr T's number was the same when it migrated from the existing system to the new electronic patient record system. It apologised it did not make this clear to Mr T in its initial complaint communication with him.
46. The Trust told us it has no evidence of what contact details it held for Mr T on the old system as it has switched off this system, and there is no way of obtaining this information.
47. We also asked the Trust if it could tell us when it had tried to contact Mr T about treatment. It said it had no details of this, and the teams were contacting a large volume of patients each day and do not keep such details.
48. It also told us the dental hospital started to plan clinics to gradually recover services in July 2020, after COVID-19. It said it clinically prioritised patients, and it significantly reduced clinic numbers. It also told us only certain surgeries could happen due to new guidelines.
49. We have not received any evidence from either Mr T or the Trust to show it called him about an appointment between February 2020 and him contacting PALS to complain in June 2022. Having weighed up what is likely to have happened, we consider on the balance of probabilities there were issues with Mr T’s mobile number on the old system and Trust had tried to contact Mr T some time between February 2020 and June 2022 to offer him an appointment, but this was unsuccessful due to this issue. We also consider there was an opportunity for the Trust to write to Mr T to offer him an appointment in line with its usual process, and it told Mr T it did not do this. At this stage, we are not assured it acted in line with its own policy in relation to contacting Mr T about an appointment.
50. We consider it is likely Mr T would have had an appointment sooner than February 2023 if the Trust had acted in line with its own policy. We therefore sought clinical advice to help us understand what impact this had on Mr T.
51. Mr T has explained because of the above failing and the Trust not contacting to arrange an appointment. He says he was unaware the Trust was trying to arrange an appointment for him. He tells us this caused delays to him getting treatment, and this resulted in him losing teeth rather than being able to save them. He says he now needs four implants to cover the gaps and potentially needs more treatment because of what happened.
52. Mr T also says because of what happened this has affected his mouth as he now eats on one side due to missing teeth, and it has affected his mental state due to his appearance.
53. We asked our adviser about the treatment Mr T required and whether his condition changed, during the period he did not have an appointment with the Trust between 2020 and 2023.
54. Our adviser has explained Mr T required gum treatment prior to May 2023 and would continue to need this. They have explained gum disease does not improve, if there is no improvement in oral hygiene by the patient. They advised once it becomes a periodontal disease it is a chronic illness which requires regular care.
55. In relation to one of the teeth (Upper Right 7), there was more decaying between 2020 and 2023. Our adviser explained the need for this tooth to be extracted was identified in 2020 and would have happened if Mr T had an earlier appointment.
56. In relation to other teeth (UL6/7) our adviser has explained there appear to be changes.
57. It is difficult to say to what extent the impact of the delays on Mr T’s condition has been. The records show Mr T’s oral hygiene was poor. Our adviser said this would be the main factor and had a significant impact on his teeth, but also the lack of appointments during the period would not have helped.
58. The records show Mr T presented initially with multiple teeth requiring dental work such as fillings, gingivitis (gum inflammation), plaque and tartar build up. Also, edentulous spaces, (spaces without teeth).
59. Based on the available records, Mr T’s needs and treatment would have been the same in 2020, as it was in 2023.
60. Even if there had not been delays with the Trust arranging an appointment, Mr T would have needed to have the teeth extracted. Our adviser said the teeth had a dubious long-term prognosis. They explained he would most likely have lost them, because of his initial oral condition, not because of any delays.
61. Our adviser explained when he was having his treatment at the Trust in 2020 and before, he had several teeth which required work and stabilisation. This is what the Trust did initially. This is why he was still stable when he went to Preston, as they were able to carry out the work by addressing his remaining dental needs.
62. Furthermore, any implants Mr T needed/wanted, he would have had to pay for privately, as this is not something the NHS would offer unless under certain circumstances, which Mr T would not likely fall in.
63. We are sorry to hear of the problems and treatment Mr T has required with his teeth. We appreciate this would have been a difficult time and frustrating with the Trust not arranging an appointment.
64. The evidence indicates the Trust did not act in line with its own policy in relation to contacting Mr T about an appointment. We consider if it had, he would have had an appointment sooner than February 2023.
65. The evidence also shows even if Mr T had an earlier appointment with the Trust, this would not have led to a different outcome of the impact on his teeth and mouth. He would have experienced the same outcome if he had an earlier appointment. Also, his treatment would have been the same.
66. Having thought about this issue carefully, taking into consideration available evidence, we are unable to say the outcome would have been different if the Trust had contacted Mr T to arrange an earlier appointment. We cannot say if he had an earlier appointment, he would not have lost the teeth he did.
67. As we are unable to say Mr T’s claimed injustice flows from the potential failings we have identified, we will not take any further action regarding this complaint.
No contact regarding appointment cancellation on 18 November 2022
68. Mr T complains the dental hospital did not successfully contact him to let him know it had cancelled his appointment for 18 November 2022 when his dentist was on long-term sick.
69. Mr T says he travelled to the dental hospital for the appointment, and he found out the dentist was on long term sick leave so it had cancelled the appointment. He says he confirmed his mobile number with reception, and it did not have the right number. He says no one wrote to him, and this was a wasted trip.
70. In the Trust’s complaint response, it said it cancelled the appointment verbally with Mr T so it did not send a letter. It apologised if Mr T wanted a letter to confirm this.
71. Our ‘Principles of Good Administration’ say: ‘Public bodies should do what they say they are going to do. If they make a commitment to do something, they should keep to it, or explain why they cannot.’ Based on this, we consider it would have been reasonable for the dental hospital to let Mr T know in advance if it knew it was unable to go ahead with his appointment due to staff illness.
72. The records show the Trust booked Mr T a consultation for 18 November 2022. His records also show he had a telephone appointment on 16 August 2022 where the dentist arranged this review.
73. We are unable to say from the records whether the telephone appointment on 16 August 2022 was an incoming or outgoing call, so this does not help us understand what mobile number the dental hospital held for Mr T at this time.
74. The appointment history records show the Trust cancelled the 18 November 2022 appointment on 4 November 2022, and it noted the cancel reason was due to the clinician being off sick. The notes also say they phoned the patient, and he did not want any more appointments.
75. The Trust confirmed this mobile number has not changed since it went live on 8 September 2022. It confirmed this by running an audit report on Mr T’s record on the new system to see if any changes/updates had been made to his registration details since the move. It provided a screenshot to show no changes were made.
76. We have not received any further evidence from Mr T or the dental hospital to support his account. We have also not seen any reference in the records to show Mr T attended the hospital on 18 November 2022. We asked the dental hospital for records of any contact with reception staff, and it said it does not have the facility to collect this information.
77. We have considered whether we are able to reach a decision about this part of the complaint. We recognise the version of events Mr T and the dental hospital have provided differ, and we have not received any independent evidence to support Mr T’s account.
78. Having weighed up the evidence we do have available, we consider it more likely than not the dental hospital made efforts to contact Mr T on 4 November 2022 to cancel the appointment. This is because, at the time, it had the correct number on its new system matching the number we have contacted him on. Whilst the evidence suggests the Trust held the correct mobile number on the system for Mr T at this time, it was unable to provide a record showing the number it dialled. It would therefore not be possible for us to say what telephone number the dental hospital used when it contacted Mr T.
79. Based on the evidence we do have, we feel we are unable to reach a conclusive decision about what happened for this part of the complaint. Therefore, we will be taking no further action with this issue.
Delays referring to another organisation
80. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
81. Mr T complains the dental hospital took too long to refer him to Preston, as it did not refer him when it said it would in November 2022. He also says it sent referrals to the wrong place when it eventually referred him in February 2023.
82. Mr T tells us he asked the receptionists on 18 November 2022 if they could refer him to Preston, which they said they would. He requested this as he had moved house. He says he then received a phone call in January 2023 about the referral, and the person he spoke to asked him to send a copy of a report from his cardiologist about his suspected heart attack. He says he had to have a review appointment at the dental hospital in February 2023, and the dentist he saw said she would refer him to Preston. He says following this, the dental hospital sent his referral to the wrong location, and he had to take steps to sort this out.
83. In its complaint responses, the Trust said Mr T attended a review appointment with a dentist on 17 February 2023, then it sent a referral letter directly to Royal Preston Hospital requesting it transfer his care.
84. In its second complaint response, the Trust said it did not have any detail of any requests for any referrals to Preston in Mr T’s clinical records prior to the appointment he had in February 2023, and it confirmed it sent a referral letter to Preston Hospital on this date.
85. Our adviser has explained there is no specific guidance about the process for a referral when requested or how a Trust should make a referral. Also, that there is no guidance about how long it should take for a Trust to make a referral, when a request is made.
86. We have considered the General Dental Council, Standards for the dental team.
87. This states at standard 1.7.6 ‘When you (a dentist) are referring patients to another member of the dental team, you must make sure that the referral is made in the patients’ best interests rather than for your own, or another team member’s, financial gain or benefit.’
88. Standard 2.3.11 states ‘You should provide patients with clear information about any referral arrangements related to their treatment’.
89. We have reviewed the complaint file, and we can see Mr T requested PALS transfer his care to Preston on 23 November 2022. Following this, the PALS team requested one of the dentists transfer Mr T’s care that same day, and they emailed Mr T on 1 December 2022 to tell him they were finding out if they could accommodate his request for a transfer.
90. On 12 December 2022, the Trust wrote to Mr T to tell him it had scheduled an appointment for him at the dental hospital on 17 February 2023.
91. Call notes from 17 January 2023 show a dentist called Mr T as the reception team had advised he called to ask if he could be seen at the dental hospital in Manchester, despite a previous phone call when he requested to be seen close to his home in Preston. We have no evidence of the earlier phone call. The notes say Mr T requested a transfer to Preston, and the dentist confirmed they would be happy to write a letter about this.
92. Notes from Mr T’s review appointment on 17 February 2023 show he requested treatment locally as he had moved house, and the dentist noted they would refer Mr T to Preston and discharge him from Manchester dental hospital.
93. The referral letter says it was created by the dentist on 17 February 2023 and edited by another member of staff on 19 April 2023. The letter is dated 14 April 2023.
94. The copy of the letter in Preston’s records show it received Mr T’s referral on 18 April 2023 and he had his first appointment on 9 May 2023.
95. As part of our primary investigation, we asked the Trust to explain why the letter shows it was created in February, but not sent until April. We also asked for a copy of the original letter created on 17 February 2023 before this was updated.
96. The Trust explained the dentist Mr T had his appointment with on 17 February 2023 created the letter that same day. It explained the secretary then goes into the dictated letter and edits and finalises this ready for sending to a patient. It said this is always done at a later date, and it apologised there was a longer delay than it would usually expect.
97. We also asked the Trust to explain its process for referring a patient to another organisation. It told us all onward referrals are clinically decided and actioned by the respective clinicians. It also said, ‘The expectation is that the patient would advise the referrer and the onward care provider of any change to circumstances, including relocation, to ensure the required service can still be provided by the receiving service.’
98. We have considered evidence from our adviser. They explained when the Trust sent the referral, it was important the information provided was accurate. Mr T had not received dental treatment with the Trust since 2020. Our adviser confirmed, the review appointment in February 2023, was necessary, to ensure the Trust had accurate up to date information.
99. In Mr T’s case there does not appear to be a formal form completed or signed to make the transfer request. Records show Mr T requested the transfer, the Trust processed this and carried out the transfer.
100. From our advisor’s experience of working at Trust hospitals, they have explained usually a dentist will dictate the letters on the same day as having seen a patient. The medical secretaries will type them, proofread them and send them out at a later date.
101. They said it is not uncommon to wait for three months for a Trust to process a letter after a dentist/medical professional had dictated it. They stated this will depend on the capacity of the Trust and its current work/patient load.
102. We appreciate the frustration experienced by Mr T, with waiting for the Trust to process the referral. We acknowledge the inconvenience caused to Mr T.
103. Mr T asked the Trust to transfer to another hospital. Following this the Trust arrange a review appointment for him in its clinic, which it would need to do before it made the referral. During the appointment the Trust has confirmed it would make the referral to the other hospital. Following the appointment the Trust has created the referral and then later sent it off. This is in line with the GDC guidance of ensuring the referral is made in the patients bests interests and proving information about the referral arrangements.
104. We acknowledge Mr T’s frustration that he had made earlier requests for the referral in November 2022 and January 2023. Considering available evidence, the Trust could not have processed the referral at this time as he needed the review appointment.
105. It is unfortunate the Trust did not send the referral for a further two months after it had created the letter. Considering the evidence from our adviser this can be common practice within Trusts, with how letters are typed up. We understand how frustrating this may feel to Mr T.
106. We consider the Trust acted in line with the guidance in relation to the referral it has made to Preston hospital at Mr T’s request. As such there does not appear to be any indications of failings by the Trust with this issue.
Unnecessary letters about appointments and cancellations
107. Mr T said the dental hospital sent him lots of unnecessary letters about appointments and cancellations.
108. Mr T told us he did not keep the letters, but he said the dental hospital sent him these letters when it was referring him to Preston. He says this was unnecessary as the dental hospital was making appointments and then cancelling them.
109. In the Trust’s complaint response, it said it is standard Trust process to send reminders for all appointments. It said its process is to send text reminders prior to booked appointments. It said there is a crossover period after an appointment is cancelled within a certain timeframe, and that as the reminder is scheduled to be sent it cannot be stopped. It apologised Mr T felt he did not need these reminders, and it said it was not possible to turn off the reminders.
110. Our ‘Principles of Good Administration’ say ‘public bodies should communicate effectively.’
111. The records show the dental hospital sent Mr T a letter on 12 December 2022 about his appointment booked on 17 February 2023 at 1.30pm. We cannot say this letter was unnecessary, as we can see Mr T attended this appointment.
112. The dental hospital also sent Mr T a letter on 4 April 2023 to let him know it was cancelling his appointment on 11 April 2023. We can see it scheduled this appointment on 16 March, and it cancelled this on 29 March 2023. The notes show it arranged and cancelled this appointment after discharging Mr T on 17 February 2023 when it agreed to refer him to Preston for future treatment.
113. As the notes show the dental hospital had discharged Mr T when it scheduled and cancelled this appointment, we consider it more likely than not it should not have made this appointment.
114. The records also show the Trust sent Mr T a letter on 29 December 2023 about an appointment it had booked for 28 April 2023 at 10.30am. The date of the letter is many months after the date of the appointment on the letter. As the notes show the Trust had discharged Mr T before both dates, and the appointment it wrote to him about was in the past, we consider it more likely than not it should not have made or written to Mr T about this appointment.
115. Based on the evidence we have, we cannot be assured the dental hospital communicated effectively with Mr T about these appointments in line with our principles.
116. We recognise receiving these letters would have been confusing and frustrating for Mr T, as he was waiting for an appointment with a different organisation at this time. Mr T also tells us he had to phone the dental hospital for more information about these appointments.
117. Our Principles of Good Complaint Handling say that to put things right organisations should provide an apology, explanation, and an acknowledgement of responsibility, as well as remedial action.
118. Our principles for remedy say, ‘Public bodies should promptly identify and acknowledge maladministration and poor service, and apologise for them.’
119. We have spoken with the Trust, and it has confirmed it would send Mr T an apology for the unnecessary letters sent, acknowledging the impact of these letters.
120. We considered our severity of injustice scale. Our scale contains six different levels of injustice that a complaint could fall into, which increase in severity. Each level is then linked to a range of the financial amounts we would usually recommend in those circumstances.
121. Level one says ‘A case will generally be level one if we consider the person affected has experienced a low impact injustice such as annoyance, frustration, worry or inconvenience, typically arising from a single (one-off) incidence of maladministration or service failure, where the effect on the person complaining is of short duration, and where there are no other adverse effects or ongoing wider impact. We will usually consider an apology to be an appropriate remedy for these cases.’
122. We acknowledge the frustration and inconvenience caused with the Trust sending the unnecessary letters to Mr T. We consider this aspect of Mr T’s complaint would fall within level one of our severity of injustice scale. Taking into consideration the error, the impact this has caused, we consider an apology from the Trust is sufficient to remedy this error. We find the Trust sending Mr T an apology letter to acknowledge this error is in line with our principles for remedy.
Complaint Handling
123. Mr T is also unhappy with the handling of his complaint. Specifically, he says the Trust did not progress it quickly enough, as it sent his complaint from March 2023 to a member of staff who no longer worked for the organisation.
124. In the Trust’s response, it said the PALS manager spoke to Mr T on 28 April 2023, and they apologised for his previous experience and assured him of the actions it was taking to improve the service.
125. It also said the PALS team leaders had delivered refresher training to all PALS staff to reinforce the high standards of communication and service expected within the department.
126. The response apologises for Mr T’s experience, and said it hoped the telephone call assured him the Trust had taken his complaint seriously and taken appropriate action to address the shortcomings in the handling of his complaint.
127. Our ‘Principles of Good Administration’ say: ‘Public bodies should behave helpfully, dealing with people promptly, within reasonable timescales and within any published time limits. They should tell people if things take longer than the public body has stated, or than people can reasonably expect them to take.’
128. Our ‘NHS Complaint Standards’ also say: ‘Staff respond to complaints at the earliest opportunity and consistently meet expected timescales for acknowledging a complaint.’
129. We have reviewed the complaint file that shows Mr T contacted PALS on 13 March 2023, and he left a voicemail for the complaint handler who had dealt with his concerns previously. Another member of the team picked up the voicemail, and returned the call that same day. The team member then sent an email to the original case handler to let them know about the call, and they requested the case handler call Mr T back as they thought he wanted to re-open the complaint.
130. Mr T called PALS again on 6 April 2023 to let the team know he was unhappy no one had returned his call. Mr T told PALS he had called in March to ask for it to reopen the complaint but did not hear back. The team noted Mr T had not received a call back as the case handler was on a secondment and no one was aware of this. PALS then reopened the complaint on 6 April 2023, and took steps to start considering Mr T’s concerns.
131. Based on the evidence, we cannot be assured the Trust acted in line with our Principles of Good Administration here, or the NHS Complaint Standards. This is because staff within the team did not effectively communicate about a staff members secondment, which resulted in a member of the team requesting a call back from someone who was not currently completing this role.
132. We therefore considered what impact this had on Mr T, and whether the Trust has already taken any steps to put things right.
133. Mr T tells us the Trust’s handling of the complaint impacted the length of time it took for the investigation to progress, and this caused him frustration.
134. We are unable to say how quickly the PALS team would have called Mr T back if the case handler had still been working on the team. As it was three weeks between Mr T’s initial call on 13 March, and the Trust reopening his complaint on 6 April 2023, we consider this delayed his complaint by a maximum of three weeks. We acknowledge it will have been frustrating for Mr T to find out why he did not receive a call back.
135. Our NHS Complaint Standards say: ‘Wherever possible, staff explain why things went wrong and identify suitable ways to put things right for people. Staff give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned.’
136. The Trust has taken steps to put this right by reopening the complaint when Mr T called and made it aware of its mistake.
137. The complaint file also shows the PALS manager called Mr T on 28 April 2023, as the Trust has said in its final response. The call notes say the manager apologised to Mr T for his general experience, and for the upset and frustration he experienced. The manager explained why the issue happened and it told Mr T the PALS team had taken steps to improve its telephone service, and it had also delivered training to the PALS team. The PALS team manager also assured Mr T he could contact the manager by either telephone call or email if he experienced any further issues with the team.
138. Having thought about what action the Trust has taken in response to Mr T’s concerns, we consider it has done enough to put right this potential failing, in line with our ‘NHS Complaint Standards’. Because of this, we do not need the Trust to take any further action.
139. We realise this is unlikely to be the outcome Mr T was looking for when he approached us. We were sorry to hear of the circumstances which led to his complaint. We do not underestimate how difficult things have been for Mr T and we do not wish to diminish the impact that this has had on him.
140. We hope this clearly explains the reasons why we will not be considering the complaint further. We would like to thank him for bringing his concerns to our attention.