The Trust failed to respond to Mrs H’s GP following the blood test on 28 June
17. Mrs A says the Trust’s gastroenterology department failed to respond to the GP’s requests to review Mrs H’s blood test from 28 June. We appreciate this must have been an incredibly worrying time for her and her mother.
18. Mrs H’s records show her GP contacted the gastroenterology department on 23 July to request it contact Mrs A. The Trust emailed Mrs A on 24 July to confirm it had reviewed the blood test results.
19. The National Institute for Health and Care Excellence (NICE) gives advice to help professionals work well together and with patients, so care is clear, respectful, and well-organised.
20. Section 1.4 of NICE CG138 says professionals should communicate clearly and respectfully with each other and with patients.
21. The email from the GP practice on 23 July 2024 asked the Trust to review the results and organise an iron infusion if required and to respond to Mrs A directly. The Trust actioned this within 24 hours.
22. In line with the NICE guideline detailed above, the Trust actioned the request from the GP. It contacted Mrs A by email to confirm it had looked at the results and what further action it had taken.
23. We have not seen any indication anything went wrong. There is evidence the Trust responded to the GP’s request to review the bloods and contact Mrs A. We will not consider this part of her complaint any further.
The Trust left Mrs H without consultant care/oversight between 8 July and 21 August 2024
24. We then looked at Mrs A’s complaint the gastroenterology department failed to oversee her care following her usual consultant’s departure from the Trust.
25. Mrs A described the impact of not having appropriate consultant oversight being a missed opportunity for her mother to have an iron infusion. While this would not have prolonged her life, it would have made her feel more comfortable
26. The records show the Trust reviewed Mrs H’s blood test result from the 28 June on 24 July.
27. The head of the gastroenterology department sent Mrs A an email on 24 July. It confirmed the consultant had reviewed her mother’s blood test results and referred her to the iron infusion unit at another hospital.
28. Further correspondence on 31 July between Mrs A and Mrs H’s GP confirmed Mrs A had contact with the iron infusion unit. They had agreed Mrs H would have a further blood test before she had an iron infusion.
29. Mrs H’s GP arranged a further blood test on 1 August. A consultant reviewed these test results prior to the scheduled meeting on 21 August.
30. Due to Mrs H’s deterioration in August, her GP detailed in her medical notes dated 16 August, she was now on end of life care.
31. The Trust made the decision to discharge Mrs H from the gastroenterology department on 21 August.
32. We appreciate this was a really difficult time for Mrs A and Mrs H. We have not seen any indication anything went wrong in the Trust’s management of Mrs H’s case, or that Mrs H was left without consultant care during the period from 8 July to 21 August.
33. Mrs H’s blood test results from the 28 June showed she did not have an iron deficiency and would not require an iron infusion. This was shown by her haemoglobin level of 87g/L and her serum ferritin level (which shows how much iron is stored in your body) assessed as ‘normal’.
34. GMC Point 40 details that doctors must weigh the benefits and risks of life-prolonging treatment. When a patient is nearing the end of life, it may be more appropriate to focus on comfort and symptom management rather than active treatment.
35. We have not seen any evidence the Trust did not follow the above guidance when making the decision not to offer any further iron infusions to Mrs H following her blood test on 1 August. In coming to this view, our clinical adviser told us this decision was consistent with Point 40 of the GMC guidelines.
36. We know Mrs A was worried about Mrs H’s care and has concerns about the fact Mrs H’s consultant had left the Trust. We have seen evidence the Trust was monitoring her care in line with what we would expect to see.
37. We hope this offers Mrs A some comfort her mother was getting the care she should have. We will not consider this part of her complaint further.
The Trust failed to monitor Mrs H’s blood results every two to four weeks as per her discharge form
38. Mrs A says the Trust failed to monitor her mother’s blood test results in line with the plan it set out in her discharge form.
39. The discharge form says Mrs H’s GP was to monitor her bloods every two to four weeks and for the GP to determine rate of decline of Hb dropping.
40. NICE Guidance NG94 Discharge Planning says discharge summaries must include follow-up plans with clear responsibilities, and GPs should get specific instructions on monitoring and who to contact for ongoing care.
41. We cannot see any failings relating to the Trust, as the discharge form related to the GP and its monitoring of Mrs H. As we cannot see something went wrong, we will not consider this part of her complaint any further.
42. We would like to reassure Mrs A that, while the discharge form was not relating to the Trust, there is clear evidence that the Trust reviewed each of Mrs H’s blood test results within four weeks of the date they were taken.
43. We would again like to thank Mrs A for bringing her complaint to us. Our decision is not intended to minimise the distress she has experienced. We hope the explanation has provided clarity as to why we are unable to take her complaint further.