11. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of these events.
Conflicting information about salmonella
12. Mrs A says she was given conflicting information about whether her mother had salmonella when she was in hospital.
13. The Trust said the result of an initial Polymerase Chain Reaction (PCR) test detected salmonella in Mrs B’s stool sample. As results can depend on the sensitivity of the sample and Mrs B did not have clinical symptoms entirely typical of salmonella infection, further investigations were conducted. These came back negative for the presence of a salmonella infection.
14. We acknowledge that being given conflicting information by different members of staff about whether Mrs B had salmonella was distressing for Mrs A and must have caused her some uncertainty about her mother’s condition. The Trust added that unfortunately, Mrs B could not be moved into a side room immediately after the initial positive test result as they were already occupied by other patients. Mrs B was moved to a side room as soon as one became available.
15. The Trust has apologised to Mrs A for the distress caused by this miscommunication. It has also taken what we consider to be appropriate remedial action by reiterating the importance of timely and clear communication to relevant clinical staff. This has also been discussed in greater depth during team meetings. Given this, we consider there is no further action for us to take on this point.
Palliative care
16. Mrs A says a doctor did not explain what palliative care meant for Mrs B as a next step with her care. Conversations were conducted without tact or sensitivity.
17. The Trust has acknowledged that a doctor had conversations Mrs A and her husband on 3 and 5 February 2023 where Mrs B’s prognosis was discussed including palliative care. According to the Trust, Mrs B was very unwell by this point, and there was concern that if she did not respond to treatment, she may not survive the admission.
18. We were not party to these discussions or how certain information was conveyed to Mrs A and her husband. Therefore, we cannot be sure what was said about palliative care or whether an explanation was requested about what it involved. In hindsight, it is unfortunate that Mrs A and her husband were unsure about the implications of palliative care and what this meant for Mrs B. We appreciate that it was devastating news for them.
19. The Trust said the doctor was saddened and shocked to hear that these conversations caused Mrs A distress. The doctor does not believe the conversations were conducted without tact or sensitivity but has apologised if it was received in that way. The Trust has provided assurances that Mrs B was regularly reviewed by the Palliative Care Team to ensure she was comfortable, and an end-of-life care plan was put in place. It has also reiterated to all relevant staff the importance of an honest, open, and compassionate style of communication. Given this, we consider there is no further action for us to take on this point.
Staff attitude
20. Mrs A says a nurse was rude in the way she spoke to her when she raised concerns about her mother’s condition deteriorating.
21. The Trust said it had spoken to the nurse about Mrs A’s concerns. The nurse had been left temporarily alone at the time as her colleague was on a ward transfer, but she has apologised for any perceived rudeness as this was certainly not her intention. Furthermore, Mrs A’s concerns about her mother’s condition deteriorating were raised by the nurse with the medical team, once her colleague had returned. The nurse does not recall making any comment about giving Mrs B something to calm her down.
22. Nevertheless, the Trust says the nurse will be attending further training in communication skills which is the type of remedial action we would expect to see in the circumstances.
23. We were not present when this verbal interaction occurred, but we acknowledge Mrs A’s perception that a nurse was rude to her when she raised concerns about her mother’s condition. This was no doubt a worrying time for Mrs A who was concerned about her mother, but it may also have been a stressful time for the nurse who had been left alone. The Trust has acknowledged that the nurse’s communication was not ideal by arranging appropriate training for them. Given this, we consider there is no further action for us to take on this point.
Delirium
24. Mrs A says it is incorrect that her mother was suffering from delirium throughout when she was in hospital, as stated in the complaint response.
25. The Trust’s first complaint response dated 6 October 2023 states that Mrs B was delirious (confused) throughout her admission due to her active medical issues. When Mrs A raised concerns that this was incorrect, the Trust clarified its view in the second complaint response dated 24 May 2024.
26. It said that Mrs B was showing signs of delirium (during her time in hospital) including hallucinations and confused communication/inappropriate word finding. It is noted that Mrs B was frail and suffering from an infection. It is also noted that one of the causes of her death was dementia. The Trust said that Mrs A was concerned that her mother was confused during her time in hospital. Confusion can be a sign of delirium. We also know, as the Trust has acknowledged, that delirium symptoms can fluctuate in some patients. This could be the reason Mrs B was able to hold some conversations with visitors.
27. Overall, we consider the use of the word ‘throughout’ in the Trust’s first complaint response was, in hindsight, misjudged, as it could be interpreted as Mrs B was delirious the whole time she was in hospital. This is unfortunate and does not concur with Mrs A’s recollections of when she and others visited Mrs B. We consider the Trust rectified this by clarifying it’s view with a satisfactory explanation in the second complaint response after Mrs A raised concerns. Given this, we consider there is no further action for us to take on this point.
Heart attack
28. Mrs A says she was not told that her mother had suffered a heart attack when she was in hospital, and only found out from the complaint response.
29. The Trust said in its first complaint response that Mrs B suffered a heart attack on 20 January 2023. It is unclear if Mrs B was able to tell her family about this, but we understand why it must have come as a shock for Mrs A if she was unaware until she read the complaint response.
30. When Mrs A raised concerns about this, the Trust replied in its second complaint response. It said that the type of heart attack suffered by Mrs B (Type 2 Myocardial infarction) is not a typical kind of heart attack that most people think of with symptoms like sudden chest pain. It is more related to an underlying medical condition causing stress on the heart.
31. This does not excuse the Trust failing to inform Mrs A about her mother’s heart attack promptly if, as indicated from the wording of the complaint response, it was authorised to do so. Nevertheless, the Trust has apologised for this omission, and we consider the remedial action outlined in its complaint response about clear communication with families and next of kin appropriately addresses this matter. Given this, we consider there is no further action for us to take on this point.
32. We recognise that the sad death of Mrs B was a devastating experience for Mrs A and her family. Indeed, we note that some of Mrs A’s existing health conditions as well as some of her husband’s conditions, have got worse since these traumatic events. We are sorry to hear this and hope that both parties can get appropriate treatment for their conditions and their health improves. We appreciate that Mrs A’s experiences when she was visiting her mother in hospital and subsequently when she read the complaint response, were far from ideal. In response, the Trust has acknowledged this in its complaint response. It has provided sincere apologies and outlined significant remedial action which we consider addresses the relevant issues. As such, there is no indication of unremedied injustice for Mrs A and therefore no further action for us to take.