Bradford Teaching Hospitals NHS Foundation Trust

4. Mrs P complains about aspects of care and treatment provided by the Ambulance Trust and the Trust to her son, Mr P, on 21 and 22 October 2023. Specifically, she says: •both the Ambulance Trust and the Trust ignored her concerns surrounding Mr P’s shunts being blocked •the Ambulance Trust misdiagnosed Mr P at the scene when it first assessed him •the Trust delayed diagnosing and treating Mr P appropriately in the emergency department (ED) •the Trust did not communicate the urgency of Mr P’s situation to the Ambulance Trust when it arranged for him to be transferred to another Trust.

•the Ambulance Trust delayed the transfer to another Trust.

5. Mrs P says the confusion around the diagnosis caused delays at the scene, and when Mr P arrived at the Trust’s ED, which spanned approximately 20 hours. She says this resulted in a build-up of pressure on Mr P’s brain, which led to his death. The family were not listened to during this time, and Mrs Cooper believes the confusion and delays could have been avoided if their concerns had been taken seriously.

6. By bringing this complaint to us, Mrs P is seeking acknowledgements of the failings and an apology. She would also like systemic improvements and a financial remedy.

9. 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. Simply put, if someone has a legal route available to achieve the outcomes they are looking for. And if it is reasonable for them to pursue that route, we are not able to look at the complaint further.

10. To understand Mrs P’s situation and desired outcomes, and whether it would be reasonable for her to explore legal action, we reviewed the documents she submitted to us and discussed this with her. Our role is not to assess whether legal action would be successful but rather whether it is a reasonable option to consider.

11. Mrs P has raised several concerns about the clinical care provided by the Ambulance Trust and the Trust. Mrs P is concerned that both organisations made mistakes which contributed to the death of her son. As such, Mrs P may have legal recourse through the courts with a clinical negligence claim.

12. We have therefore, considered whether legal action could help her achieve the outcomes she is seeking, and whether it is reasonable for her to take that route.

13. Mrs P has indicated she is seeking financial compensation for the avoidable death of her son. Based on this, we can see the courts may be better placed to achieve this financial outcome.

14. We also considered possible barriers to pursuing legal action and any reasons why it might not be reasonable for Mrs P to take legal action. Mrs P confirmed she had spoken to a solicitor previously but decided to come to ourselves. Therefore, we can see there are no barriers to her pursuing that action because we can see she has been able to engage with a solicitor.

15. With the above in mind, we can see Mrs P has a legal route available to her and it would be reasonable for her to pursue it to achieve the financial remedy she seeks.

16. In addition to financial compensation, Mrs P also seeks an apology, acknowledgement and service improvements. This is not something courts are likely to directly achieve for her, although they may be achieved as a byproduct of any legal action.

17. If Mrs P pursues legal action which does not achieve all of the outcomes she is seeking, she can return to us after legal action is complete.

18. It is also open for Mrs P to return to us if she explores legal action and it becomes clear that it is no longer reasonable for her to pursue that route.

19. If Mrs P does return to us in future, it is important she does so promptly because we would need to consider our own one-year time limit, in line with the ‘Health Service Commissioner Act 1993’. We can set this limit to one side where there is good reason to do so.

20. Any delays in returning to us may affect our ability to set the limit aside, so if she decides to return to us, we encourage her to contact us as soon as possible.

21. We understand that this is a difficult time for Mrs P, and we would like to thank her for sharing her loss and experience following her son’s death. We appreciate the openness she has shown in describing the events and her concerns. We hope this statement clearly sets out how we thought about what she told us and how we reached our decision in this case.

1. We have carefully considered Mrs P’s complaint about Yorkshire Ambulance Service NHS Trust (the Ambulance Trust) and Bradford Teaching Hospitals NHS Foundation Trust (the Trust).

2. Mrs P complains about aspects of the care and treatment the Trust and Ambulance Trust provided to her son, Mr P, when they delayed his treatment for blocked shunts (a shunt is a small device placed inside the body to drain extra fluid from the brain). We are very sorry to hear about the loss of Mrs P’s son and the impact this has had and continues to have on her and her family.

3. Having carefully thought about what Mrs P has told us we have decided to take no further action at this time. This is because we can see Mrs P has a legal route available to her to achieve the financial remedy she is seeking, and we consider it is reasonable for her to explore that route. We explain further below.