Manchester University NHS Foundation Trust

3. Mrs L complains about aspects of her son’s, Mr N’s, care and treatment from Manchester University NHS Foundation Trust (the Trust) between January 2018 and January 2024.

4. Mrs L says the failings led to Mr N experiencing an adrenal crisis and sepsis requiring intubation in the paediatric (children’s) intensive care unit (PICU), which could have been avoided. She also says this has had an emotional and psychological impact on Mr N by causing him significant anxiety. She says Mr N has also experienced an educational impact, as he has missed large periods of school to recover and so he now has private tutoring.

5. Mrs L says the claimed failings have caused the family significant distress. Mrs L receives private therapy to help her process the trauma.

6. By bringing the complaint to us Mrs L would like compensation, an acknowledgment of what went wrong and service improvements.

7. What follows is a brief background to the complaint. We have not included all details as both parties are aware of these.

8. Since 2019, the Trust had been treating Mr N for asthma.

9. In September 2023, Mr N became unwell and was transported to the Trust. Doctors informed the family he was in septic shock and his cortisol (a hormone) levels were low. The Trust transferred Mr N to the PICU (children’s) intensive care unit (PICU) and intubated (a tube inserted into the mouth or nose and then into the airway to hold it open) him.

10. Mrs L said from discussion with clinicians at the Trust they established Mr N had adrenal insufficiency (the adrenal glands do not make enough hormones) which was likely the cause of the sepsis. Mrs L said since this, doctors have confirmed Mr N was experiencing significant adrenal insufficiency and he now has to take daily replacement hydrocortisone (steroid medication).

11. In January 2023, the Trust informed Mr N and family he may not have asthma and may have tracheomalacia (where the cartilage in the windpipe is weak, floppy or damaged causing it to partly collapse).

12. In early March 2023, Mr N stopped using all inhalers. In early April, he became unwell with a virus. On 11 April, the Trust referred Mr N to an allergy specialist. On 26 April, Mr N had an appointment with the allergy specialist. They prescribed multiple different medications and Mrs L said Mr N responded immediately to these.

13. On 6 June, Mr N had a bronchoscopy (a thin, lighted tube used to look directly into the windpipe and lungs). Mrs L said this showed Mr N has; unusually large adenoids (small lumps of tissue at the back of the throat) cobbling around his larynx (voice box), collapsed windpipe, slightly collapsed left bronchi (air passages connecting windpipe to the lungs) and inflammation. Mrs L believes these findings are likely to explain Mr N’s chronic cough and his wheeze.

16. 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.

17. We have discussed this with Mrs L to understand her circumstances and the outcomes she and Mr N want. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

18. In general terms, clinical negligence takes place when a person suffers harm because of mistakes in their care and treatment. Failure to carry out appropriate treatment can also amount to negligence. Clinical negligence can only by established in the courts.

19. Mrs L believes her son was put at risk and suffered harm because of failings in his care. If she is correct and there was a significant failing in Mr N’s care which caused him harm, they would have legal action for clinical negligence available to them.

20. We understand Mrs L feels strongly the Trust’s failings in care caused Mr N to experience an adrenal crisis and sepsis requiring him to be intubated in PICU. We understand she says this has also impacted Mr N emotionally and psychological as he experiences anxiety because of the failings and he has missed out on long periods of school to recover.

21. One of the outcomes Mrs L seeks is compensation. Where people have the option to pursue legal action the law says we should expect them to do that first, rather than look at the complaint ourselves.

22. A court will be able to carefully consider and assess whether Mr N’s care was negligent and whether any of his current difficulties are attributed to that, as well as determining accountability, including awarding an appropriate amount of compensation if applicable.

23. Mrs L was unsure on the amount of compensation she is seeking for Mr N. We sent Mrs L our Severity of Injustice scale (SOI) so she could see the types of financial recommendations we make for the corresponding level of injustice.

24. We explained if we were to uphold the complaint and thought it appropriate to make financial recommendations, we may recommend anywhere between level one and five on our Severity of Injustice scale. Mrs L said she needed some time to think about how much money they were hoping for.

25. We followed up by email with Mrs L and explained if she was seeking compensation in line with level four or five on our scale, we may still consider it reasonable for her to pursue this route, as this is a significant amount of money, and the law says legal action needs to be explored in the first instance. We also asked Mrs L to let us know if she had decided on amount of money and if she thought there were any barriers to her pursuing the legal route.

26. In response, Mrs L told us she had spoken to a solicitor who said the case may reach £10,000 compensation through the courts. She said as this sits within levels four to five on our Severity of Injustice scale, she would be happy for us to investigate the complaint.

27. Based on the above, we recognise Mrs L seeks a significant amount of money and so we consider it reasonable to say this is an important outcome to her. Mrs L may be able to achieve more compensation through a legal approach than we might be able to if we were to uphold the complaint.

28. Additionally, our decision around the legal route is not solely based on complainant preference. We consider this but also other factors. Taking everything into account, we have to consider if it is unreasonable to expect Mrs L to follow that route. We also want to ensure Mrs L has the best opportunity to achieve compensation for Mr N.

29. There are several independent and charitable organisations who can assist people who wish to make legal claims against the NHS, and we have shared details of those with Mrs L.

30. Mrs L said they would not be able to afford legal action. We discussed the option of no win, no fee solicitors, which Mrs L said she had not yet contacted. Also, given the significant amount of compensation sought, we do not consider the costs of legal action disproportionate to this.

31. Mrs L also seeks other outcomes, of service improvements and an acknowledgement. Whilst these are not remedies legal action can directly provide, these may occur as a byproduct of the legal route.

32. In our initial call, Mrs L explained she had spoken to a solicitor previously about the concerns and they advised to wait from a view from us in the first instance. Again, we are not a precursor to legal action. We also recognise this shows Mrs L is able and willing to speak to solicitors about her concerns.

33. Mrs L did not tell us about any other barriers to her seeking legal advice.

34. In summary, we understand the claimed impact to Mr N is significant. Mrs L seeks a significant amount of compensation, has already spoken to solicitors on two occasions, and the other outcomes she seeks may also be achieved as a byproduct of the legal route.

35. Having explored reasonableness, we understand Mrs L is within the time limit to pursue a legal claim on Mr N’s behalf and we do not consider there are any barriers to her pursuing this for him. On this basis, we conclude it is reasonable for Mrs L to explore this avenue first. We believe this is the best option for Mr N, given the severity of the complaint.

36. If after fully exploring legal action, Mrs L is not able to pursue it or does not achieve all the outcomes they are seeking, Mrs L can bring her complaint back to us and we will consider it again. At that point, we would need to carefully consider the outcome of any legal enquiries and the time she has taken to complain to us. This is because we have a time limit of one year.

1. We have carefully considered Mrs L’s complaint about Manchester University NHS Foundation Trust (the Trust). We were sorry to hear of the concerns Mrs L brought to us and the distress her son, Mr N, and their family have experienced. We were also sorry to learn Mr N was really unwell and needed admitting to hospital. We do not wish to underestimate how difficult this has been for all of them.

2. We decided to take no further action on Mrs L’s complaint, for the time being at least. This is because we considered it is reasonable for her to take legal action the matter she bought to us.