Nottingham University Hospitals NHS Trust

4. Mr B complains about aspects of care and treatment his wife, Mrs B received from the Trust in January to February 2022. In particular, he says his wife was incorrectly sent home form hospital with a brain aneurysm. He also says his wife was wrongly moved to a low dependency ward whilst in hospital and says there was poor communication from hospital staff regarding his wife’s condition.

5. He says his wife died because of the Trusts actions, which caused him and his family a great deal of distress and upset.

6. As an outcome he is seeking an acknowledgement of failings, an apology, service improvement and financial remedy.

7. The complaint relates to care and treatment Mrs B received in January to February 2022.

8. On 20 January the Trust identified Mrs B had a brain aneurysm, which appeared to need operating on. It has said tests and discussions were carried out and a brain haemorrhage was ruled out the following day and she was later discharged as there was no evidence she had a bleed on the brain.

9. On 31 January 2022, Mrs B arrived back at hospital with severe headaches and tingling in the left side of her face. The Trust made plans to discuss Mrs B’s case with a neurologist.

10. The Trust made plans to carry out a procedure on 3 February 2022. However, it appears Mrs B thought the procedure was being carried out on 2 February.

11. The Trust carried out the procedure on 4 February 2022.

12. Mrs B was in the intensive care unit (ICU) between 7 and 10 February, where the Trust carried out physiotherapy. The Trust transferred Mrs B back to the ward, where she continued to receive physiotherapy. Mrs B’s health deteriorated, and the Trust arranged a for a scan to be carried out which identified that she had suffered a stroke.

13. Tragically, she passed away on 21 February 2022.

16. The Ombudsman’s powers are set out in the Health Service Commissioner’s Act 1993. Section 9 (4) of this legislation (the law) says a person needs to make their complaint to us within a year of becoming aware of the problem. It says we cannot investigate complaints brought to us after one year, unless we see there is a good reason to do so.

17. Sadly, Mrs B died on 21 February 2022. In Mr B’s complaint form he told us he initially became aware of issues with her care and treatment on 28 January 2022 and raised a complaint with the Trust on 27 February 2023. The Trust acknowledged his complaint the same day and issued a full response on 17 July 2023, where it referred Mrs R to us.

18. He then brought the complaint to our office on 13 August 2024 but did not complete a complaint form. This was completed and sent to us on 20 September 2024.

19. This meant there was a delay of two and a half years before the complaint was brought to our office.

20. We discussed this with Mr B, to understand the reasons for the delays and he explained he was not made aware of the time limit and was struggling with the death of his wife. He also told us his mother sadly died in 2022. He explained he has unfortunately had issues with his health and has been diagnosed with depression and heart failure. Mr B also explained he has tried to emotionally support his family too.

21. Following his initial response, we contacted him again for more information in order to understand the gaps in time.

22. In his response on 22 May, he explained he was not aware of any time limit and reiterated the significant impact the loss of his wife had on him and delays in getting a diagnosis for depression.

Our decision

23. We fully acknowledge the emotional difficulties Mr B and his family have experienced and the issues with depression and heart failure and the impact this has had. We do not underestimate this at all. We must however consider that most people complaining about the death of loved ones are significantly impacted emotionally.

24. It is reasonable to expect that if he was unhappy with the Trust’s response in July 2023 he could and should have brought the complaint to us much sooner than September 2024. We recognise the emotional impact he has faced and issues he has experiencing with his health, but he could have contacted a local advocacy service to bring the complaint on his behalf.

25. We can see the Trust provided a leaflet in its letter to Mr B on 27 February 2023 signposting him to his local POhWER advocacy service. Furthermore, although we accept, he says he was not aware of the time limit, again we would expect individuals to bring the complaint as quickly as possible in order for us to be able to robustly investigate issue.

26. Ultimately, the longer time that passes the more difficult it is for us to investigate issues or make recommendations to Trusts (given procedures may have already changed etc).

27. In conclusion, although we accept the initial twelve months delay in him making a complaint is reasonable given the tragic death of his wife and his mother, we would have expected him to continue to progress the case as quickly as possible once the process was started.

28. We have decided we will not take further action on Mr B’s complaint. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it.

1. We were very sorry to learn of Mr B’s concerns about the care his wife Mrs B received between January and her tragic death in February 2022.

2. We have decided not to consider Mr B’s complaint further because he has come to us considerably outside of our time limit. We carefully considered the reasons Mr B, gave for this. We did not think there was sufficient reason to set our time limit aside.

3. We recognise and we are grateful for the time and effort that has gone into making this complaint. We are sorry for any disappointment caused by our decision.