Radiotherapy treatment 15. Ms M is understandably concerned the Trust delayed arranging radiotherapy treatment for her mother. She told us she finished chemotherapy at the end of May 2023, and it did not organise radiotherapy treatment in a timely manner following this. She says her mother may have lived longer if she had radiotherapy treatment sooner.
16. We were sorry to hear Ms M’s concerns about the Trust’s actions and how this impacted her mother’s sad outcome. From what she told us, it is clear that her concerns about this, continue to cause her ongoing distress.
17. NICE guidelines on lung cancer diagnosis and management say clinicians should consider carrying out radiotherapy to the chest and lung area, alongside radiotherapy to the head, for patients with extensive-stage disease small cell lung cancer who have responded well to chemotherapy. This guideline does not dictate how soon radiotherapy should be offered following chemotherapy.
18. The medical records show Ms M’s mother completed chemotherapy treatment for extensive small cell lung cancer in June 2023. The Trust carried out a CT scan mid-June and reported on this six days later. The CT scan showed she had a good response to the chemotherapy treatment. The Medical Oncology team at the Trust reviewed Ms M’s mother at the end of June and decided she should see the Clinical Oncology team for possible radiotherapy treatment as she had responded well to chemotherapy. This is in line with the NICE guidance above. The Trust made the referral at the beginning of July.
19. The Clinical Oncology team reviewed Ms M’s mother at the beginning of August and planned for her radiotherapy to start at the end of the month. Sadly, this did not go ahead as Ms M’s mother became too unwell and sadly died at the end of August.
20. As the NICE guidelines on lung cancer diagnosis and management do not say when radiotherapy should be offered to patients following chemotherapy, it is difficult for us to say if the Trust should have organised radiotherapy sooner for Ms M’s mother. As there are no guidelines for the timescales, we cannot say the Trust got this wrong. However, we have considered if sooner treatment would have altered Ms M’s mother’s outcome.
21. Our adviser explained that ideally the Trust would have organised for the Clinical Oncology team to see Ms M’s mother sooner than it did as she waited around four weeks to be reviewed. They explained that they would expect the Clinical Oncology team to have seen Ms M’s mother within two weeks of the referral, so around mid-July. It saw her four weeks after the referral instead.
22. They went on to explain that Ms M’s mother had extensive small cell lung cancer and the prognosis for this disease is poor. The disease often responds to chemotherapy but only briefly and sadly, the survival rate is often less than one year. They explained that even if the Clinical Oncology team had seen Ms M’s mother sooner than it did and started radiotherapy treatment two weeks earlier, sadly her outcome would not have changed, and it is highly likely that her disease would have continued to progress as it did. It is understandable that this may be difficult news for Ms M.
23. Based on the evidence we have seen, we consider the Trust followed NICE guidelines on lung cancer diagnosis and management when it offered Ms M’s mother radiotherapy following her good response to chemotherapy. This is because the guidelines say to consider this option of treatment for patients with extensive-stage disease small cell lung cancer (as in Ms M’s mother’s case).
24. We cannot say the Trust took too long to organise the Clinical Oncology team to review and plan Ms M’s mother’s radiotherapy as the guidelines do not say when it should do this. That said, we have considered if earlier treatment would have changed the outcome for Ms M’s mother, and it does not appear that this is the case. We will take no further action on this aspect of the complaint for this reason.
25. It is understandable that Ms M is concerned that earlier radiotherapy treatment may have improved her mother’s sad outcome. We hope our findings and the information from our clinical adviser goes some way to reassure her the Trust followed relevant guidelines when it managed her mother’s radiotherapy care and we have seen no indications that anything went wrong. Sadly, it appears her mother’s outcome was not preventable, and we are sorry this is the case.
Communication 26. Ms M complains the Trust did not communicate her mother’s disease progression to her and her family during her mother’s last admission to hospital in August, before her sad death. She says the Trust told the family it planned to drain fluid from her mother’s lungs but then cancelled this procedure and did not explain why.
27. She told us the Trust knew her mother’s disease had progressed when it carried out a CT scan at the end of August, but it did not tell the family this information until later on the same day. She says the Trust was not transparent about her mother’s condition and this impacted the family’s ability to say goodbye to her.
28. From what Ms M told us, this was a significantly distressing time for her and her family. We were sorry to hear her concerns about the Trust’s communication at an already upsetting time for her and her family.
29. GMC guidance on communicating effectively say doctors must give patients the information they want or need to know in a way they can understand. They must be considerate to those close to the patient and be sensitive and responsive in giving them information and support.
30. The medical records show the Trust admitted Ms M’s mother at the end of August as she was short of breath. It planned to carry out a procedure to drain fluid from her lung. It carried out a CT scan of Ms M’s mother the following day and this showed a progression of Ms M’s mother’s cancer.
31. From the medical records, it appears the Trust updated Ms M the afternoon of the CT scan and explained that it planned to drain the fluid from her mother’s lung. Approximately three hours later, Ms M raised her concerns to the Trust that her mother had not yet had the procedure it planned to do.
32. Following this, the Trust discussed her mother’s CT scan results with senior clinicians and radiologists. It decided not to proceed with the procedure to drain fluid from her lung as this would no longer be beneficial for Ms M’s mother as it was unlikely to improve her symptoms. This is because it appears her mother had a mass rather than fluid on her lung.
33. The Trust discussed this with the family after it decided to cancel the planned procedure. The medical records document the Trust asked Ms M’s mother if she was happy to discuss her medical issues with her family present and it is noted that she agreed. We can see evidence the Trust had an extensive discussion with Ms M’s mother and her family about her disease progression and why it decided not to carry out the planned procedure as the CT scan showed a mass in her lung.
34. It explained that it had taken time to speak with other specialists such as Imaging team to get further advice. From what we have seen, it appears Ms M’s mother, and her family was made aware of her disease progression during this discussion. We cannot say with certainty what was actually said on these occasions or how this was understood by Ms M and her family, but it does appear her mother’s deteriorating condition was discussed with them.
35. Our adviser explained that the Trust’s decision to cancel the procedure to drain fluid from Ms M’s mother’s lung was correct as it was no longer beneficial for her mother to have this based on the limited amount of fluid in her chest and a very large tumour. They explained the Trust’s communication with the family about this was clear and the decision appears to have been well explained.
36. They went on to say that it is clear this experience was distressing for Ms M and her family as her mother initially had a good reaction to the chemotherapy, but she sadly deteriorated extremely quickly.
37. Based on the evidence we have seen, we consider the Trust followed GMC guidance on communication when it explained the reasons why it cancelled Ms M’s mother’s procedure to drain the fluid from her lung and communicated her disease progression to the family. This is because it communicated effectively and gave them the information they needed and was considerate to those close to Ms M’s mother when it sensitively gave them this information. Based on this, we will take no further action on this aspect of the complaint for this reason.
38. We recognise that Ms M thinks the Trust should have told the family about her mother’s disease progression and cancelled procedure straight after the CT scan. However, we can see evidence in the medical records to show the Trust discussed the results of the CT scan with different teams before it made the decision to cancel the procedure and before it communicated this information to the family.
39. Although Ms M felt she prompted this discussion, we recognise the discussions between clinicians took time and based on the medical records, it appears the Trust had not made any decisions about the procedure before this and gave the family this information as soon as it was able to. We hope this information helps to reassure Ms M that the Trust did not deliberately delay providing her and her family with information about her mother’s deterioration and cancelled procedure.
40. We hope our findings and the information from our clinical adviser goes some way to reassure Ms M the Trust followed relevant guidelines when it told her about her mother’s disease progression and her cancelled procedure, and we have seen no indications that anything went wrong.
Belongings 41. Ms M complains the Trust did not appropriately manage her mother’s belongings after her sad death despite the family's instructions to save her clothing. She told us the Trust destroyed her mother’s nightie and vest, and she specifically asked it to keep these items.
42. We were sorry to hear Ms M’s concerns about how the Trust managed her mother’s belongings after her sad death. It is understandable that this concern has caused her significant distress given it was already an extremely difficult time for her and her family.
43. The medical records document the Trust gave Ms M’s mother’s belongings to her family following her sad death at the end of August. After reviewing the medical records, we cannot see any documentation about items of clothing that remained with Ms M’s mother, what specific items the Trust gave to Ms M following her mother’s sad death, or her request to keep specific items such as her mother’s nightie and vest.
44. In its response to the complaint, the Trust acknowledged that it cut Ms M’s mother’s gown to wash her before she left the ward after she sadly died and it apologised that staff did not make sure her mother’s belongings remained with her. As we have found above, it is not clear which items the Trust is referring to here as this information conflicts with the information in the medical records.
45. Based on the evidence we have seen, we do not know what belongings the Trust gave to Ms M following her mother’s sad death or what items she requested to keep. We cannot see any clear documentation in the medical records to say what happened to her mother’s clothing. It is unlikely that we would be able to provide any further information to Ms M about what happened and why, through an investigation.
46. Therefore, we will decline to investigate this aspect of the complaint and take no further action as it is unlikely that we would be able to reach a satisfactory decision about what happened, or why it happened based on the conflicting information available.
47. It is understandable that this will be disappointing for Ms M. Although we cannot reach a decision on this aspect of the complaint, we are pleased to see the Trust has implemented service improvements in response to it as it will now telephone family members to clarify what they would like the Trust to do with personal belongings.
Complaint handling 48. Ms M complains the Trust handled her complaint poorly. She says it delayed providing her with a response to her concerns about her mother’s delayed radiotherapy treatment. She told us she had to wait one year and three months for the Trust to provide this information and now she feels the complaint process has been dragged out.
49. From what she told us, it is clear the complaints process caused Ms M additional distress at an already stressful time, and we are sorry to hear this.
50. The NHS complaints standards say organisations should give people a clear, balanced account of what happened based on established facts and be open and honest when things have gone wrong or had an unfair impact and take accountability for this. The NHS Complaints Regulations say that organisations must provide a response within six months from the day the official complaint was made.
51. Ms M raised her initial concerns to the Trust in December 2023, four months after her mother’s sad death. In this complaint, Ms M asked the Trust why there was a long gap between the end of her mother’s chemotherapy in June 2023 and her first radiotherapy appointment at the beginning of August.
52. The Trust responded to this complaint in February 2024, two months later. This is in line with NHS complaints regulations that says organisations must respond to complaints within six months. We can see it gave Ms M a timeline of what happened when her mother was referred for radiotherapy treatment. However, it does not appear it answered her concerns about the gap between the chemotherapy and radiotherapy treatment.
53. At the end of April, Ms M reiterated her concerns about the wait for her mother’s radiotherapy treatment as she felt the Trust had not answered her question about this in its first response. The Trust responded to Ms M’s concerns two months later at the end of June.
54. In this response the Trust apologised it did not address Ms M’s concerns about her mother’s radiotherapy treatment in its previous response. It explained that when her mother finished her chemotherapy treatment in June 2023, it had to arrange a staging CT scan to assess her response to the treatment and decide if further treatment would be beneficial to her.
55. It apologised that her mother had to wait four weeks to be seen in clinic by the Radiotherapy team following the referral and explained this was the earliest appointment available at the time. It explained how much planning and checking the team must do before a patient starts treatment and it would have liked to offer her mother an appointment to see the Radiotherapy team earlier than it did as this would have given her an earlier radiotherapy start date.
56. It acknowledged that sadly, Ms M’s mother’s disease progressed very quickly, and it considered radiotherapy treatment would have not impacted her mother’s sad outcome or extended her life.
57. Following this response, Ms M raised further concerns at the beginning September 2024. In this complaint, she asked the Trust to explain the NHS timescale for patients starting radiotherapy after chemotherapy. She requested a meeting with the Trust about her concerns.
58. The Trust and Ms M met in January 2025 to discuss her overall concerns about her mother’s care. The Oncology team was not present at the meeting however we can see it provided an answer to Ms M’s question about NHS timescales. Ms M asked further questions during this meeting to find out why her mother waited 87 days for radiotherapy treatment based on the guidance the Trust provided. The Trust agreed to ask the Oncology team to provide a further response about this to address her concerns.
59. In March, the Trust provided Ms M with a detailed response from its Oncology team about the wait for her mother to be offered a proposed radiotherapy treatment start date following the completion of her chemotherapy. It provided further advice about relevant guidance and apologised for not responding more fully to her initial concerns about the waiting time.
60. From the evidence we have seen, it appears the Trust did not initially answer Ms M’s concerns about radiotherapy in its first response to her complaint and this is not in line with the NHS complaint standards which say organisations should give people a clear, balanced account of what happened.
61. However, we can see it did provide information about the wait for radiotherapy in its second response in June 2024, six months after Ms M raised her initial concerns and when she flagged to it that it had not addressed her initial question. From what we have seen, the information in this response appears to address the concerns Ms M raised in her complaint about the delay for her mother to be offered radiotherapy treatment.
62. Based on this information, we are satisfied that although the Trust did not initially follow the NHS complaints standards when it provided its first response, we consider it did during the second response. This is because it acknowledged its error in not addressing this particular concern and gave Ms M the information she requested based on what happened.
63. As it appears the Trust did not follow the NHS complaint standards consistently when it initially responded to Ms M’s concerns, we have considered how this impacted her. She told us that she felt the Trust dragged out the complaints process by not giving her the information she needed.
64. Our Principles of Remedy say that to put things right, organisations should provide an apology, explanation, and an acknowledgement of responsibility.
65. We can see the Trust acknowledged and apologised it did not address Ms M’s concerns in its initial response when it provided further responses to her complaint in June 2024 and March 2025. We can also see that both of these responses addressed Ms M’s concerns at the time. We recognise that Ms M had further concerns during the local resolution meeting and the Trust needed to do further work with the Oncology team to respond to her new concerns.
66. We recognise that it would be extremely frustrating for Ms M to not get the information she requested the first time she requested it. We can see the Trust has acknowledged this which is in line with our Principles above and rectified the initial injustice by giving her the information she asked for, six months later (in line with the timeframe set out by The NHS Complaints Regulations).
67. Ms M told us she wants service improvements and a financial remedy to resolve her complaint, so we have considered these outcomes alongside our Severity of Injustice scale. The impact of failings we found relating to complaint handling, appears to fall into the lower levels of our Severity of Injustice scale. We would expect an apology to remedy the impact that flowed from the failings, which in this case, appears to be distress and frustration. It does not appear the Trust’s actions have caused Ms M an ongoing wider impact as it appears it resolved this impact when it provided her with the information she requested.
68. Based on the information we have seen, we are satisfied that the Trust has apologised for and acknowledged what went wrong and addressed Ms M’s outstanding concerns which is in line with our Principles. It appears its actions here remedy the impact on Ms M. For this reason, we will take no further action on this aspect of the complaint.
Conclusion 69. Overall, it appears the Trust followed relevant guidelines, and we have seen no indications anything went wrong when it planned Ms M’s mother’s radiotherapy treatment and communicated with her and her family about her disease progression in August 2023.
70. We are sorry we cannot reach a decision on Ms M’s concerns about how the Trust managed her mother’s belongings following her sad death due to lack of objective evidence and we will decline to investigate this aspect of the complaint for this reason.
71. Although we have seen indications the Trust did not consistently follow relevant guidelines when it handled Ms M’s complaint, we consider it has remedied the impact this caused by apologising and giving Ms M the information she requested. We will take no further action on this complaint for this reason.
72. From our conversation with Ms M, it is clear that her mother’s disease progression and sad death was significantly distressing for her and her family. We hope our report reassures her that it does not appear the Trust’s actions impacted her mother’s sad outcome and helps to clarify any information she was unsure about.