15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.
16. We have done this and have not seen any indication that something has gone wrong for most of the issues Miss E is raising with us. We have explained our decision for each part of Miss E’s complaint below.
Treatment and diagnosis
17. Miss E complains that the Trust failed to treat her grandfather and did not give a diagnosis.
18. Our adviser has explained that there is no specific guidance for how to investigate Mr E’s symptoms as abdominal pain as it could indicate a range of conditions.
19. The GMC guidelines say that medical professionals should adequately assess a patient’s condition and promptly provide suitable advice, investigation or treatments where necessary. It also says that they should consult colleagues or seek advice from another suitably qualified practitioner when needed.
20. We can see the Trust investigated Mr E’s symptoms with a range of tests. This included:
• an endoscopy (a medical procedure using a long, thin, lighted tube with a camera (an endoscope) to view inside the body) • CT scans (a medical imaging test that uses X-rays and a computer to create detailed, cross-sectional "slices" of the body) • blood tests and biopsies.
21. The Trust also consulted other specialist teams for advice, including Speech and Language Therapy, and Gastroenterology. The Trust treated Mr E with amitriptyline for his bowel pain. This is used to treat chronic pain.
22. The Trust made a diagnosis of functional bowel disorder and the records show the Trust communicated this to the family. The records show a discussion with Miss E in late 2023 where the Trust explained it had not found a direct cause for the abdominal pain. It explained it had concluded it was functional bowel pain and the treatment would be amitriptyline.
23. We understand Miss E does not agree this is the case. We acknowledge a diagnosis like functional bowel disorder, where there are chronic symptoms without any structural or biochemical abnormalities, may have contributed to Miss E not feeling a diagnosis had been reached.
24. The Trust’s actions appear to be in line with the GMC guidelines. We think the Trust has undertaken relevant investigations to explore Mr E’s condition. Based on the results of these, and specialist advice, the Trust has reached a diagnosis, and started treatment for this. We have not seen an indication of a failing in the Trust’s actions here.
Care package
25. Miss E complains the Trust discharged her grandfather without an appropriate care package.
26. The Patient Experience guidelines say healthcare services should take an individualised approach to care. This means taking into account the patient’s ability to access services, personal preferences and co-existing conditions. It also says that the Trust should review the patient’s needs and circumstances regularly. The guidelines say the Trust should assess each patient’s requirement for continuity of care and how that might be met.
27. The Transition guidelines recommend that hospital and community based teams work together to address factors that could prevent a safe transfer from hospital. It says teams should work together to develop and agree a discharge plan.
28. The records show the Trust undertook a cohesive assessment of Mr E’s social circumstances. There were regular inpatient reviews from the Occupational Therapist throughout Mr E’s admission. We can also see discussion with the family about Mr E’s abilities and living arrangements.
29. During the second admission at the end of November we can see the Trust undertook an assessment which clearly outlines Mr E’s needs and recommendations. We can also see the Trust had referred Mr E to the Community Palliative Care team for ongoing support, and to the District Nurses.
30. At the end of November, the Trust completed a fast track assessment, and it submitted this to the ICB for funding approval. The plan was to arrange a package of care four times a day. The Trust requested this be arranged as soon as possible, but noted it had explained to Mr E’s family that it could not guarantee this would be available for the day Mr E was discharged. The Trust noted on more than one occasion Mr E’s family were happy to provide care until the package of care was in place.
31. It appears the Trust’s discharge consideration and planning is in line with the Patient Experience guidelines. We can see the Trust took Mr E’s preferences and coexisting conditions into consideration, and it assessed his needs regularly. We also think it appears to be in line with the Transition guidelines, as the Trust involved the Community Palliative Care team and the District Nurses.
32. We appreciate that Miss E does not agree, and that she was distressed at what she perceived to be a lack of care at her grandfather’s discharge. We have not seen an indication of a failing here.
Food and Fluid
33. Miss E complains the Trust did not monitor what Mr E was eating and drinking.
34. The Nutrition guidelines state that healthcare professionals should review the indications, route, risks, benefits and goals of nutrition support at regular intervals. It also says that people having nutrition support in hospital should be monitored by healthcare professionals with the relevant skills and training in nutritional monitoring.
35. The Fluid guidelines say that all patients continuing to receive IV fluids need regular monitoring.
36. The Trust referred Mr E to a dietician, and to Speech and Language Therapy (SALT), and there is evidence of ongoing reviews. SALT found Mr E was independent with eating and drinking, but he had a poor swallow. It recommended he had a soft and bite size diet.
37. This appears to be in line with the Nutrition guidelines, as relevant professionals were monitoring Mr E during his admission.
38. We can see that the fluid balance charts are poorly completed, and there is no evidence of food record charts. This does not appear to be in line with guidelines as we cannot see that the Trust monitored what Mr E was eating and drinking. At times we can see the Trust noted Mr E was declining food, and that he was feeling sick.
39. We consider the Trust has not properly recorded Mr E’s food and fluid intake. We are not able to say whether Mr E eating and drinking adequately due to a lack of evidence.
40. To help us try and reach a view on this, we have considered whether there is any indication in the medical records that there was an impact of this. We cannot see anything to suggest Mr E was suffering from dehydration. It is difficult to tell whether Mr E lost weight, but we can see it was noted on his admission that he had recently been losing weight.
41. We are not able to say whether there is a failing in Mr E’s fluid and nutrition intake as there is a lack of evidence as to what he was eating and drinking. If there is a failing here, we are satisfied that there does not appear to have been a negative impact on Mr E’s condition. We do however recognise that if this had occurred, it would have caused Miss E considerable worry.
42. We have gone on to consider the Trust’s response to this. It said that Mr E was drinking independently and was encouraged to drink throughout the day. It also said there was no indication Mr E was dehydrated and required treatment.
43. The Trust has said Mr E was eating and drinking while on the ward, and he did not lose weight while in hospital The Trust has also said that Mr E advised he did not like the food provided, and so it suggested ordering food more to his preference.
44. The Trust has acknowledged in its response the fluid balance charts were not completed throughout the day and it has apologised for this.
45. Our Complaints Standards state that staff should give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned. We consider the Trust’s apology is in line with these standards and so it has taken action to put things right here.
46. We acknowledge Miss E’s concerns here and that the lack of records is likely to exacerbate this worry. We appreciate the distress she felt at feeling her grandfather’s intake was not being adequately monitored.
47. It is difficult for us to say whether there is an indication of a failing in the nutritional support and fluids it was providing to Mr E. We do think there is an indication of failing in the Trust’s monitoring of this. We do not think this had an impact on Mr E, but we appreciate it caused Miss E worry. We think the Trust’s apology here is enough to put things right.
Communication of deterioration
48. Miss E complains the Trust did not communicate that Mr E’s heart condition had deteriorated, or that he was at the end of his life.
49. The GMC guidelines say that medical professionals should give patients information they want or need in a way they can understand. This includes information about their condition, likely progression and any uncertainties. This also includes options for treatments, and the potential benefits, risks and likelihood of success for each option.
50. The guidelines also say that medical professionals should be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information.
51. The records show several discussion with Mr E’s family during his hospital admissions. The main focus of these discussions in his earlier admission was his bowel pain, as this was his presenting issue at the time. Our adviser has said that as there were no new updates on his heart at this time it is reasonable this was not discussed.
52. In the second admission we can see clear documentation that the family were informed of his poor prognosis. For example, we can see that towards the end of November, the Trust spoke with Mr E’s son and granddaughter. The Trust noted the family were aware of Mr E’s poor prognosis and that he may die during the admission.
53. The following day there is another note that the Trust spoke to Mr E’s son and granddaughter, when the Trust explained Mr E’s condition and that he was dying. At this time, Trust noted his family understood this, and they agreed for a fast track palliative discharge.
54. We can see that the Trust discussed end of life care. During the same conversation, the Trust noted if Mr E did not improve after 24 hours of active treatment, he would be for end of life care.
55. Our adviser has said that although it could have ben helpful to discuss Mr E’s heart failure to give a thorough picture, it was not the main concern of the admission. Given Mr E was medically stable when he was discharged, our adviser has said it is understandable that this was not discussed during this admission.
56. We acknowledge how distressing it was for Miss E when Mr E became very unwell. We understand the distress she felt at her grandfather’s illness and that his death was a shock for her. We think the Trust did try and communicate Mr E’s prognosis with his family. We have not seen an indication of a failing here.