Delay in arranging for Mr L to have his eye drop medication prescription
17. To decide if we should conduct a detailed investigation into a complaint, we consider whether there are any indications something went wrong that the organisation has not yet put right. If so, we then consider whether we can resolve a complaint quickly by delivering the outcomes a complainant asks us to achieve at an earlier point in our case handling process.
18. The Trust explained in its complaint response that the hospital pharmacy became aware that it would be unable to provide the prescription of eye drops that Mr L needed on 27 January 2023. It said that it then referred Mr L to another Trust, who were licenced to provide him with the eye drops.
19. Mr L said that he first made the Trust aware that there was a change in the supply of his eye drops in December 2022. He explained that he does not feel that the Trust did enough to ensure that he had his prescription when he needed it and that because of this he had eight weeks without his medication.
20. The commissioning policy explains that the eye drops that Mr L was using would become unavailable in December 2022. This policy was published in July 2021. It appears that no one at the Trust was aware of the detail of the commissioning policy prior to December 2022.
21. Our Principles of Good Administration say that ‘in their decision making, public bodies should have regard to the relevant legislation.’
22. Our adviser explained that when the commissioning policy was published in July 2021 the Trust should have been aware at this time that there would be future issues with the supply of Mr L’s eye drops. They explained that the Trust should have referred Mr L to one of the specialist centres, who would have been able to discuss medication options and prepare Mr L for when the medication ceased to be produced in December 2022.
23. As the commissioning policy was published in July 2021 it is difficult for us to conclude why the Trust were not aware of its existence until December 2022. Our adviser explained that the commissioning policy regarding Mr L’s eye drops would have been easily available for the Trust to access.
24. Therefore, we consider there is an indication of a failing here, as the Trust were not aware of the relevant policies and legislation when making decisions about patient care, which is not in line with Our Principles.
25. The GMC guidance says doctors should ‘promptly provide (or arrange) suitable advice, investigation or treatment where necessary’ and ‘refer a patient to another suitably qualified practitioner when this serves their needs’.
26. The Trust made a referral to another Trust in February 2023. After this, the issue was resolved as quickly as possible, and Mr L was supplied with appropriate medication.
27. We asked our adviser if the Trust could have made the referral to another Trust any sooner than they did. The adviser explained that in December 2022, when the Trust were aware of an issue with the supply, they could have referred Mr L then.
28. As the Trust should have been aware of the issue with the medication in December 2022, we consider the Trust should have made a prompt referral at this stage, in line with the GMC guidance. The Trust delayed doing this until mid-February, which was not prompt and not in line with the GMC guidance, and therefore is an indication of a failing.
29. When Mr L was referred in mid-February 2023, he had his medication by March 2023, a period of a few weeks. We can therefore conclude that had Mr L been referred in December 2022, he would likely have received his eye drops by January 2023 rather than March 2023 meaning that the time he was without his medication would have been reduced by around two months.
30. We considered the impact of Mr L being without his medication for two months when he should not have been.
31. Mr L explained that he was extremely stressed during this period as he was worried about the effects of not using his medication when he needed to be. He also said that he had lost faith in the Trust. Mr L explained that fortunately, there are currently no indications that being without his medication has had an adverse effect on his health.
32. Our ‘Guide to Financial Remedy’ sets out our ‘severity of injustice scale’ (our scale). This is a guide which helps us decide an appropriate amount of financial remedy, depending on the injustice the person has suffered. The scale has six bands ranging from levels one and two lower-level injustices of frustration and pain, up to level six with loss of life or profound effects on a person being able to live a normal life.
33. In this instance, we would place Mr L’s injustice at a level 2 on our scale. This is because Mr L experienced excess stress and worry for around two months more than he should have because of the Trust’s failure to refer him to an alternate Trust when they should have done.
34. Our scale explains that level two injustices where a person has experienced ‘distress, worry, annoyance and similar injustice of the sort which a healthy adult would be expected to deal with on a regular basis without external support… for a period from 1-2 weeks to about six months’ we recommend a financial remedy of between £120 and £550.
35. We also conduct precedent checks to look for similar themes to help inform our thinking on remedy and checks on similar sorts of awards to ensure consistency.
36. As part of this process, and with that information in mind, we contacted the Trust to discuss our findings with it. We explained that we found that it caused unnecessary delays to Mr L receiving his medication. We outlined the stress and worry this will have unnecessarily caused Mr L.
37. The Trust acknowledged the mistakes that it made in Mr L’s treatment and agreed with our findings. It said that it will apologise for its failings and also make a payment of £250 to Mr L in recognition of the worry and distress that its failings have caused him.
38. We then spoke to Mr L to explain our proposal. Mr L agrees that this apology and payment appropriately remedies his complaint.
39. Taking this into account, we are satisfied that this payment made by the Trust is in line with our severity of injustice scale and is enough to remedy its failings as fair, proportionate and reasonable. Mr L is also happy with this outcome. Therefore, as the Trust has already agreed to take appropriate action, we will not consider this complaint any further.
Failure to tell Mr L to stop taking his medication while he was an inpatient
40. Mr L told us that he was an inpatient at the Trust from 26 June 2023 to 30 June 2023. When he was admitted to the Trust on 26 June 2023 he was already taking doxazosin (a medication used to treat high blood pressure and hypertension), and Mr L continued to take this on discharge.
41. Mr L explained that in mid July 2023 he received a call from his GP who informed him that he could start taking doxazosin again. Mr L told us that he was confused as he had never been told to stop taking it while he was an inpatient. This made Mr L worried about the potential impact of taking doxazosin, when he should not have been, on his health.
42. We can see in Mr L’s records that he had requested that he manage his prescribed medication himself while he was an inpatient. We can see that Mr L had multiple prescribed medications, and respect that he was knowledgeable and capable of administering his own medication when possible. As Mr L was administering the medication himself from a supply he brought from home, there is no record of doxazosin on his prescription charts.
43. the Trust explain that it did advise Mr L to stop taking doxazosin while he was an inpatient. The records do not show whether he was told to stop taking doxazosin or not. When Mr L was discharged, a note was made to request Mr L’s GP to review his doxazosin prescription. There is nothing further in the notes to indicate if this review was to decide if Mr L should start taking doxazosin again.
44. Mr L recounts that he was never told to stop taking doxazosin while he was an inpatient.
45. We have considered the information provided by Mr L and the information provided by the Trust and feel that we would be unable to reconcile the differing accounts.
46. Although this does not mean that we do not believe Mr L’s account, we do not feel there is sufficient evidence to allow us to make a decision on the balance of probabilities if Mr L was told to stop taking the medication or not. Reassuringly, our adviser indicated that Mr L would have experienced no adverse effects by continuing to take the medication over the period in question.
47. As we cannot say what happened here, and there is no further evidence we can gather to help us reach a decision, we consider that we would not be able to reach a satisfactory conclusion so there would be no value in taking this forward for further investigation. Therefore, we will not be looking into this matter further.
48. We recognise that Mr L had difficult experiences while under the care of the Trust, we understand that these will have been stressful and worrying for him. We hope this statement will offer him some closure on this matter. We would like to thank both Mr L and the Trust for their cooperation and understanding during this process.