Barts Health NHS Trust

3. Miss A states that, from August 2020 onwards, the Trust repeatedly failed to provide her with safe, timely and appropriate life preserving medication. She also reports significant clinical inaction by the Trust and says it breached accepted clinical standards.

4. Miss A says the Trust’s actions exposed her to an avoidable risk of adrenal crisis, metabolic collapse and death. She explains that she is now fearful of seeking hospital care because of her ongoing safety concerns. She also reports that these events have affected her health and wellbeing and that she has been left traumatised by the Trust’s actions.

5. To resolve her complaint, Miss A is seeking an apology from the Trust, service improvements and a financial remedy.

6. Miss A originally made the complaint to the Trust on 4 August 2020. This was a lengthy complaint, which outlined many areas of dissatisfaction. It did not make clear what time period the complaint related to. The Trust provided a full response to the issues raised on 4 February 2021.

7. Miss A, her family and her care givers communicated with the Trust over the next few months, providing feedback and asking questions about her care plan. This included communication with clinicians and contact from a legal representative for Miss A.

8. Miss A’s aunt brought a further complaint to the Trust on 29 November 2021. This related to a recent admission to hospital, the attitude of staff and the care and treatment given. The Trust provided a full response to these issues on 20 May 2022.

9. Miss A was dissatisfied with this response and there was communication between both parties from May until November 2022, when the Trust arranged a meeting to discuss the issues.

10. The Trust shared the minutes in December 2023, and Miss A provided feedback on some perceived inaccuracies in January 2023. She raised a query about the Trust’s Self Administration of Medication (SAM) Policy and whether the nurses caring for her in the community would be able to administer her medication if she were admitted to hospital.

11. There was ongoing communication between the Trust and Miss A’s representatives in January and February 2023 about this. Trust correspondence showed it was waiting for advice from its legal team. The Trust sent a copy of the SAM policy to Miss A on 28 February.

12. Miss A’s family replied on 28 February 2023, saying that if they did not hear from the Trust about this matter, and Miss A was admitted to hospital, they would use the SAM form from the policy (that allows patients to detail self-medication preferences), so her personal nurses could manage her medication.

13. Miss A wrote again to the Trust more than a year later, in June 2024. She again raised the issue of her nurses administering her medication if she were to be admitted to hospital and asked whether the Trust had the answers from its legal team.

14. The Trust provided the final response on 25 July 2024.

15. Miss A brought her complaint to this office on 20 November 2024.

18. The law says a person needs to make their complaint to us within a year of becoming aware of the problem (we call this their date of knowledge). We have taken the date of Miss A’s complaint, 4 August 2020, to be her date of knowledge. This is because, as outlined in paragraph 6, we did not know what time period her complaint covered.

19. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to set aside our time limit. For her complaint to be in time Miss A would have needed to complain to us by August 2021.

20. Miss A made her complaint to us in November 2024, three years and three months outside of our time limit. We discussed this with Miss A to understand the reasons why she did not bring her complaint sooner. We also considered the time the organisation took to respond to Miss A.

21. The regulations say the organisation investigating a complaint should send the complaint response within ‘the period of six months commencing on the day on which the complaint was received’.

22. We can see this happened, as the Trust replied on 4 February 2021, within six months of receiving the complaint. For this reason we have not seen any indications of delays on the part of the Trust.

23. The Trust response explained Miss A’s right to bring the complaint to the Ombudsman, if she was dissatisfied. We think it would have been reasonable for Miss A to have raised her complaint with the Ombudsman at this point.

24. There was then a gap of almost 10 months before Miss A’s representative returned to the Trust to raise ongoing concerns, on 29 November 2021. At this point the complaint was three months outside our time limit.

25. We asked Miss A about this gap. She told us she, and her representatives, were involved with ongoing communication with the Trust over the months between February and November 2021. We have seen the evidence Miss A has provided, which includes: • feedback on the complaint response • a legal letter sent to the Clinical Commissioning Group (CCG) • request for a meeting to draw up a care plan for future hospital admissions • a meeting to agree a care plan • emails direct to doctors to outline care needs • judicial review letter from legal representatives to the CCG in relation to continuing health care and personal health budget matters • a request for details of medication to be added to Miss A’s health records

26. We accept Miss A’s health care needs are complex and that there was ongoing communication about meeting these needs. We do not think it reasonable to consider this part of the complaint process. Some of the communication was to a different organisation about different matters. For this reason we do not think the ongoing communication relating to ongoing care needs is reason enough to set aside the large gap between receiving the complaint response in February 2021 and returning to the Trust in November 2021 with ongoing issues.

27. The Trust provided a full response to the further complaint of 29 November 2021 on 20 May 2022. This was again within the six months allowed by the regulations.

28. There was a long period between May 2022 and February 2023 where Miss A, her representatives and the Trust communicated about ongoing concerns Miss A had about care support for her in hospital, and who would be able to administer her medication.

29. We can see that the communication about this ceased in February 2023, as outlined in paragraph 12. We agree that at this point the Trust had not given a definitive answer about the legal position on SAM. We can also see Miss A made clear how she would manage the system going forward.

30. If Miss A was unhappy with this conclusion we think it would have been reasonable for her to have approached the Ombudsman at this point. Instead she waited a further 17 months, until June 2024, before returning to the Trust to ask for clarification on the Trust’s legal position on the administration of medication.

31. When we asked Miss A about this she explained she had been in continuous correspondence with the Trust. We have not seen evidence of this and so do not think there is reason enough to set aside the time limit.

32. The Trust provided a final response to the complaint about this matter on 25 July 2024. It again signposted Miss A to this Office. It provided a further response in August repeating the information it gave in July.

33. Miss A brought her complaint to the Ombudsman almost four months later on 20 November 2024. We asked Miss A about this final delay. She said it had taken this time to compile the complaint bundle for the Ombudsman. While we accept there may have been a lot of information Miss A wanted to send, we think it would have been reasonable to approach this office at any of the early stages outlined in paragraphs 23 and 30, and certainly as soon as she received the final response.

34. Miss A gave some additional information about the things that were happening during the whole complaint period: • emerging from the COVID-19 lockdown was a difficult and disruptive period • Miss A was admitted to hospital • Miss A’s representatives were dealing with hospital and safeguarding teams and liaising with the MP • some delays were caused by this office.

35. We acknowledge there were competing demands on Miss A’s time and can see she was dealing with her own health issues. We think in this circumstance it would have been reasonable to have sought some support to prevent her complaint falling so far outside our time limit.

36. We can see the first Trust complaint response gave details of how to seek support from an advocacy organisation, should she need help with her complaint. Advocacy organisations are there to help in such circumstances, and we think Miss A could have sought such support to help her with her complaint. This would have alleviated some of the barriers as outlined in paragraph 34.

37. We accept this has been a frustrating process for Miss A and we think there is more the Trust could have done to give an answer sooner about the legal position on the administration of medication by nurses not employed by the Trust.

38. While we recognise the frustration, we do not think this is what led to the complaint falling outside our time limit, as there were several earlier opportunities for Miss A to approach the Ombudsman. The Trust has properly apologised for this delay.

39. We also acknowledge a delay on the part of this office, as the complaint received on 20 November 2024 was misfiled, and so was not immediately actioned. We have not counted this period in our consideration and will write separately to Miss A on this point.

40. To conclude, Miss A’s complaint was brought to us significantly outside our time limit. We do not think the explanations are reason enough to set our time limit to one side.

41. It is important we act within the law, and that we apply our current approach and process fairly and consistently. We are sorry for any upset this decision may cause. We hope this statement clearly explains the reasons why we will not be considering the complaint further.

1. After careful consideration, we have decided not to consider Miss A’s complaint further as it falls outside of our time limit.

2. We were sorry to hear about Miss A’s concerns about her care and treatment. We recognise that what happened continues to cause her considerable ongoing upset and we thank her for taking the time to share the details of her complaint with us.