East and North Hertfordshire Teaching NHS Trust

5. Mrs D complains about the care and treatment her late husband, Mr D, received from East and North Hertfordshire NHS Trust between January and April 2022.

6. Specifically, she complains the Trust did not offer Mr D the treatment he needed for his liver condition during his six-week admission. She also says it did not allow her to see her husband during his admission, and that there was a lack of communication from the Trust about his illness and prognosis.

7. Mrs D says had her husband received the correct treatment for his liver, she believes this could have prolonged his life. She says this time could have been spent at home with his family prior to his death.

8. She also says the memories of her husband’s last few months were awfully painful, and as her husband’s death was sudden and unexpected, this has left her and the family struggling to move on following his passing.

9. In bringing the complaint to us, Mrs D is seeking service improvements.

10. Mr D was admitted to hospital in January 2022, via his GP, due to drink-related liver disease. He was discharged home in early March. In April, he was readmitted due to declining health and referred to the Palliative Care team.

11. Mr D had an ascitic tap (a procedure where a doctor uses a needle to remove excess fluid from the belly), which appeared to ease his symptoms. Mr D was discharged home a few days later with a view to a permanent drain being fitted in May.

12. Mr D sadly died at the beginning of May.

13. At the beginning of November, Mrs D complained in writing to the Trust. The Trust acknowledged Mrs D’s complaint and requested confirmation from Mrs D of her proposed complaint points. In mid-November, Mrs D responded to confirm the points proposed.

14. At the end of April 2023, Mrs D emailed the Trust to request an update of its investigation. The Trust responded in May with an update and apologised for any delay.

15. In August the Trust sent its final response. The response explained the reasons for its delay and advised Mrs D of her right to escalate her complaint to us.

16. In November, Mrs D returned to the Trust with further concerns. At the beginning of December, the Trust responded to confirm the proposed complaint points, and sent its final response to Mrs D in March 2024. The response again advised Mrs D of her right to escalate her complaint to us.

17. Mrs D sent a further letter to the Trust at the end of June, to which the Trust responded advising Mrs D to come to us. This also offered a local resolution meeting should Mrs D wish to talk to the Trust about her concerns.

18. Mrs D sent PHSO a copy of the letter sent to the Trust in July. She also sent a further copy of the same letter to us at the end of October. We had been unable to respond to the letters, until this time as the July correspondence did not contain any contact details for Mrs D.

19. At the beginning of November, we wrote to Mrs D to explain we had received insufficient information from her to raise a complaint and provided further information about or processes. We explained what information she would need to provide to properly raise a complaint and enclosed our website details and a paper complaint form.

20. At the end of December, Mrs D sent the Trust’s responses with no complaint form or details of the complaint she wanted to bring.

21. At the beginning of January 2025, we again wrote to Mrs D to acknowledge the information she had sent and advised that we were unable to raise a complaint without a completed complaint form (website details and paper form enclosed).

22. Mrs D returned a completed complaint form to us at the end of February, of which we acknowledged and raised her complaint at the beginning of March.

24. Section 9(4) of the Health Service Commissioners Act, 1993 says a person needs to make their complaint to us within one year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

25. We have considered Mrs D’s reason for delay alongside the timeline of the complaint and periods of delay identified.

26. We recognise this was a very difficult time for Mrs D and do not want to underestimate the significant impact this has had. We have listened to Mrs D’s reasons for delay between receiving the Trust’s response in September 2023 and coming to us in February 2025.

27. Mrs D says she first became of her reason to complain in April 2022, following Mr D’s discharge from hospital, as she was unhappy with the care and treatment he had received during his admission between the end of January and March.

28. We think Mrs D would have been aware she had cause to complain by the end of April 2022, at the latest.

29. This means to be within our time limit Mrs D needed to come to us at the latest by April 2023.

30. Mrs D did not bring her complaint to us fully until February 2025 and is therefore outside of our time limit by one year and ten months.

31. As Mrs D is outside of our time limit, we considered whether there are strong reasons she could not complain to us sooner. We have discussed this with Mrs D to understand the reasons why she could not do so and considered the amount of time it took to resolve the complaint locally.

Time taken for local resolution

32. Mrs D complained to the Trust at the end of October 2022, seven months after the death of her husband. The Trust responded to Mrs D in August 2023.

33. Mrs D went back to the Trust in November, to raise additional concerns of which the Trust responded in March 2024, four months after the complaint was received. Mrs D also raised further concerns in June, of which the Trust responded to in July, one month later, meaning further local resolution took around five months.

34. We have next considered Mrs D’s reasons for delaying in progressing the complaint.

Reasons for delay

35. Mrs D told us the delay from becoming aware of the reason to complain in April 2022, and when she complained to the Trust in November, (approx. seven months later), was as she had been grieving for her husband, Mr D.

36. Mrs D told us the delay in bringing the complaint to us in February 2025, (eighteen months after receiving the Trust’s final response in August 2023, eleven months after receiving the Trust’s final response in March 2024, seven months after receiving the Trust’s final response in July 2024), was because she and the family thought PHSO would do nothing and she did not want to relive the events.

37. Mrs D told us the family wanted to try and live a normal life after grieving and create some happiness in things that were happening such as births, weddings and happy memories without this being tainted by their grief.

38. Mrs D also told us she and her family were aware of PHSO as her children worked in the medical profession. She said she had returned to the Trust with her additional concerns about Mr D’s care to try and bring closure.

Consideration of Mrs D’s reasons for delay

39. We have considered Mrs D’s reason for delay alongside the timeline of the complaint and periods of delay identified.

40. Firstly, we recognise this was an extremely difficult time for Mrs D and her family and do not want to underestimate the significant impact this has had. We have listened to Mrs D’s reasons for delay between becoming aware of her reason to complain in April 2022 and complaining to the Trust in November.

41. We appreciate it would have been very hard for Mrs D to complain at this difficult period of her life.

42. We have also listened to Mrs D’s reasons for delay between receiving the Trust’s responses in August 2023, March 2024 and July 2024, and properly complaining to us in February 2025.

43. As above, the local complaint process caused around 9 months of delay to her initial complaint. We can see the Trust communicated with Mrs D during this period. It explained in its response that, due to the nature of its investigation and the number of staff involved and workload pressures, this had led to the initial delay in its first final response.

44. The further local complaint process caused around five months delay to the additional concerns raised. We can see the Trust responded promptly and carried out a review of the new additional concerns raised, as well as offering to meet with Mrs D.

45. We can see other significant periods of delay which led to the complaint being out of time. These are:

• between receiving the Trust’s final response August 2023, and returning to it with further concerns in November (three months) • between receiving the Trust’s further final response March 2024 and returning to it with further concerns in June (three months).

• between receiving the Trust’s last final response July 2024 and bringing the complaint properly to us in February 2025 (seven months).

46. We note the final responses from the Trust in August 2023, and March 2024, clearly provided details of how Mrs D could contact PHSO via various communication channels should she remain unhappy with its investigations and responses. It therefore seems she would have been aware of us at this point.

47. The information shows Mrs D continued to communicate with the Trust frequently up to July 2024. This is a considerable period for Mrs D to remain unhappy with the Trust’s responses. We would have expected her to approach our service shortly after she realised, she was unhappy and shows she would have been able to approach our service.

48. We also provided information to Mrs D about our complaint process and how to properly make a complaint to us, including our time limit for making a complaint, in November and December 2024, as well as what support might be available to complain. Mrs D would therefore have been aware she needed to bring her complaint to us promptly.

49. Considering the above contacts Mrs D made with the Trust about remaining unhappy, we cannot see any clear reason why Mrs D could not have contacted us about our processes or brought her complaint sooner.

50. We would have expected her to have followed up on our communication and to have contacted us sooner to discuss any concerns and what we could do further. She did not appear to do so.

51. We therefore do not think this is a strong enough reason to put our time limit to one side.

Our decision

52. We can see the Trust was responsible for around one year and two months delay. We appreciate this is a significant amount of time for a Trust to respond, and we have taken this into account when considering the time limit. We found this does not account for all the delay in bringing the complaint to us.

53. We have carefully considered Mrs D’s reason for the delay between April 2022, and her complaint to the Trust in November. We recognise this was a difficult time for Mrs D and her family following the sad loss of her husband. She explained she was grieving and we agree this is a strong reason to explain some delay during this period.

54. There were further delays of around eighteen months, eleven months, and seven months after Mrs D received the Trust’s final responses in August 2023, March 2024, and July 2024 respectively. These delays significantly contributed to the complaint being brought to us outside of the time limit.

55. Mrs D explained she and her family wanted to ‘live a normal life’ after grieving. We have carefully considered whether this would have prevented her from complaining sooner and whether this would justify putting our time limit aside.

56. Our view is that we do not consider her reasons fully explain the overall considerable delays in escalating her complaint, or that she was unable to complain for such a significant period.

57. We can see Mrs D was able to communicate with and complain to the Trust during this time and cannot see any clear reason why she could not have returned to the Trust with her further concerns sooner.

58. We have also seen lengthy gaps when Mrs D did not pursue her complaint. We think the Trust made her aware to contact us early in the complaint process, that she and her family were aware of our service, and was likely able to come to us sooner.

59. We cannot see any clear reason why she could not have contacted us to find out further information about our service or time limit and what support might be available to complain sooner. We do not think there are sufficient grounds for us to put our time limit to one side. Therefore, in line with our legislation, the complaint is out of time, and we will not take any further action on it.

60. We recognise this will not be the decision Mrs D will be hoping for, and that this has been a very difficult time for her. We hope our statement sets out the careful consideration we have given to her reasons for delay. We have the utmost sympathy with her circumstances and appreciate how distressing this must have been for her and her family.

1. We have carefully considered Mrs D’s complaint about a hospital in the Hertfordshire area (the Trust). We are very sorry to hear about the sad loss of her husband, Mr D, and for the events that surrounded the complaint. We understand this must have been a very difficult and distressing time.

2. We are also sorry to hear of Mrs D’s concerns about the lack of treatment she says he received for his liver condition and the impact this had on his prognosis.

3. We have decided not to consider Mrs D’s complaint further. This is because the complaint falls outside of our time limit. We have not seen strong enough reasons to put our time limit to one side to consider it further.

4. It is important we consider and act within the law and we regret any further upset this decision may cause. We hope this statement clearly explains the reasons why we will not be considering the complaint further.