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Leeds Teaching Hospitals NHS Trust

P-004390 · Statement · Decision date: 3 December 2025 · View Leeds Teaching Hospitals NHS Trust scorecard
Complaint (AI summary)
Ms E complained the Trust missed opportunities to diagnose her mother's cancer sooner, failed to provide adequate pain relief, and excluded family from DNR discussions.
Outcome (AI summary)
The complaint was closed. It fell outside the ombudsman's time limit for investigation, and no sufficient reason was found to extend it.

Full decision details

The Complaint

3. Ms E complains about the care and treatment her mother Ms H received from the Trust. Ms E complains the Trust: • missed opportunities to diagnose Ms H’s cancer sooner due to delayed appointments and only scanning the upper oesophagus until July 2021 • did not give adequate pain relief when required between July 2021 and January 2022 • did not include the family in discussions relating to do not resuscitate (DNR) decisions.

4. Ms E has told us due to the issues she complains about she has been through a protracted bereavement process which caused her emotional distress. This caused a negative impact on her mental health caused by added stress and anxiety leading to low moods.

5. Ms E would like an apology from the Trust and well as financial remedy in recognition of the impact on her. She would also like the Trust to make service improvements to make sure it does not repeat the same mistakes in the future.

Background

6. Ms H very sadly passed away on 25 January 2022.

7. Ms E raised a complaint with the Trust in October 2023. Ms E complained about late diagnosis of her mother’s cancer as well as a lack of care during her hospital visits. Following further correspondence with the Trust it could not resolve the issues Ms E complained about. As such, on 17 April 2025 Ms E approached our office.

Findings

10. The Health Service Commissioners Act 1993 says a person needs to make a complaint about the service they have received from an NHS Trust within a year of becoming aware of the problem. We call that the date of awareness. We cannot investigate complaints brought to us after more than one year, unless we can see there is a good reason to do so. We have discussed this with Ms E to understand the reasons why she could not do so. We have also considered the time the organisation has taken to respond to Ms E.

11. We can see that Ms E would have been aware at the time of her mother’s death about the issues she later complained to the Trust about. Ms E’s concern about a delayed diagnosis was something she would have been aware of at the time. That means, for our time limit purposes, Ms E’s date of awareness was January 2022.

12. We understand that this was an incredibly difficult time for Ms E, and we do understand why she did not feel ready to raise a complaint straight away. We can see that Ms E raised her complaint with the Trust in October 2023, which was one year and nine months after her being aware that she had a reason to complain.

13. As Ms E made her complaint to the Trust outside our one-year time limit we asked her the reasons for the delay. Ms E told us she was extremely distressed at the loss of her mother and was struggling to come to terms with it. At this time, Ms E said she could not even think about going through the complaints process. Ms E told she was extremely distressed so attended a bereavement peer support group. It was then that she got more information about raising a complaint.

14. Ms E told us she worked through the majority of 2022 until March 2023. She explained that during this time her mood was deteriorating until, in March 2023, she sought support from her GP. We are sorry to hear that Ms E was feeling struggling to cope during this time and understand that she would need time to grieve following her loss.

15. We do take account of the difficulties that people go through following a death of a close family member and, where we can, we try to exercise some discretion over the time limit. We do also have to bear in mind the law which gives us our powers, however, and expect people to complain promptly in line with that legislation.

16. Ms E did not start the complaints process until one year and nine months after she knew she had reason to complain. We did not receive her complaint until April 2025, which was more than 3 years after she knew she had reason to complain. This was also nearly six months after she had received the Trust’s final response, issued in October 2024. We do not see we can put our time limit to one side considering just how far outside our time limit Ms E has raised her complaints.

17. We have also considered how long the Trust took to respond to Ms E when she raised her complaints. We can see Ms E contacted the Trust three times. Ms E made a complaint to the Trust in October 2023. The Trust replied to this complaint on 2 February 2024. Ms E then made a further complaint, which the Trust received on 2 May 2024. The Trust responded to the second complaint on 9 July 2024. Ms E sent a further letter to the Trust on 2 October 2024. The Trust send its final complaint reply on 29 October 2024.

18. In total we can see Ms E was waiting for replies from the Trust for six months. That was not in her control so have taken this into consideration and deducted this time from the overall time it has taken Ms E to raise her complaint with us.

19. Ms E also told us that once the Trust sent its final response, she was unaware that there was a time limit to approaching our office. We can see that the Trust issued three complaint responses and in each response told Ms E that if she was not satisfied she could approach our office. On each of these occasions the Trust included a link to our website as well as our customer helpline telephone number, in case Ms E wanted any further information. Information on our time limits is readily available on our website. As this is the case, we would not consider that being unaware of our time limit would be a good reason to put our time limit to one side, especially considering the Trust directed Ms E to this information three times.

20. We understand as Ms E used an advocate to make her complaint bringing it to our office did take her longer than usual. We have taken that into account. As she is still so far outside our time limit we do not see that as being a good reason to put the time limit to one side, as if this was not the case she would have still been some time outside our time limit.

21. We have carefully considered Ms E’s reasons for bringing her complaint to us when she did. Unfortunately, even after taking those into account, we have not seen good reason to put the time limit to one side, so we have decided not to consider this complaint further.

22. We understand this will be a disappointing decision for Ms E. We hope we have shown we have thought about the reasons she gave and have fully considered her circumstances before we made our decision.

Our Decision

1. We have carefully considered Ms E’s complaint about Leeds Teaching Hospital NHS Trust (the Trust). We have decided the complaint falls outside of our time limit and we have not seen good reason to put our time limit to one side.

2. We were very sorry to also hear about the circumstances of Ms E’s complaint and the impact it has had on her.

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