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Hull University Teaching Hospitals NHS Trust

P-005052 · Statement · Decision date: 18 March 2026 · View Hull University Teaching Hospitals NHS Trust scorecard
Referral Referral Referral Treatment Referral
Complaint (AI summary)
Mrs. Z complained the hospital provider did not pick up Mr. Z’s stroke referral around the time of his stroke.
Outcome (AI summary)
The complaint was closed. There were no indications the provider did anything wrong.

Full decision details

The Complaint

3. Mrs Z complains the provider did not pick up Mr Z’s stroke referral made to it around the time of his stroke.

4. As an impact, Mrs Z said Mr Z has been left with dyspepsia and the volume in his voice has decreased. This makes it hard for him to communicate at work. Mr Z has now had to work reduced hours; he has fatigue and experiences depression. Mrs Z said Mr Z also has to take medication for blood pressure and Raynaud's phenomenon (a medical condition).

5. As an outcome, Mrs Z wants an acknowledgement of failings, service improvements, and financial compensation.

Background

6. Mr Z had a stroke on 7 June 2024. An MRI scan he had at a local hospital showed a bleed in his brain causing the stroke. He had elevated blood pressure. The hospital’s doctors gave him medication to lower his blood pressure. After a couple of hours, A&E staff discharged Mr Z to the care of his GP with blood pressure medication. A&E staff advised Mr Z a community-based adult stroke team would contact him.

7. On 20 March 2025, Mrs Z received a letter from the provider explaining its community stroke service received no referral for Mr Z. As by March 2025 it was nine months since his stroke, the provider said any input from its team would not now be beneficial.

Findings

10. Mrs Z considers the provider received a stroke referral for Mr Z and should have actioned it.

11. In a letter from the provider to Mrs Z dated 20 March 2025, the provider said Mr Z was not referred to it at the time of his stroke.

12. In a letter to Mrs Z on 6 June 2025, the provider said it was not aware of Mr Z’s stroke in June 2024. The provider stated its stroke nurses enter the stroke wards on a weekly basis and maintain regular contact with them. The provider said it was not contacted around the time of Mr Z’s stroke, and its staff were unaware of this.

13. In our correspondence with the provider, it explained it did not receive a referral when Mr Z had a stroke in June 2024. The provider said a referral was made to its speech therapy team in November 2024. However, due to the origin of the issue, it was agreed with the referrer (a different organisation) that Mr Z should be re-referred to the acute speech and language therapy team, and his care would continue with them.

14. Good Medical Practice says, in ‘providing good clinical care’, doctors should ‘promptly provide (or arrange) suitable advice, investigations or treatment where necessary’. This means we would expect the provider’s staff to action any referral they received from a hospital.

15. In this case, as the provider did not receive a referral, we see no breach of Good Medical Practice.

16. We appreciate we have conflicting accounts from Mrs Z and the provider on whether the provider received a referral. Having reviewed the available evidence, we find the provider’s account more compelling.

17. We saw the provider’s letters in March and June 2025 consistently explained it did not receive a stroke referral regarding Mr Z. It maintains this position now.

18. We asked the provider to send us, from the records it holds for Mr Z, any stroke referral made to its service. It said it could not do so because it received no such referral. As it could not do so, this adds to the evidence it received no referral.

19. At the same time, the provider was able to give us specific details about referrals it did receive about Mr Z. For example, about his speech and language referrals. This suggests it kept accurate records of referrals other services sent the provider. All this, and the absence of stroke referral paperwork, points to the provider never receiving a referral regarding Mr Z’s stroke.

20. For this reason, we have found no indications the provider failed to act on any stroke referral it received. This means we see no evidence the provider got things wrong on this matter.

21. We are sorry to hear about the stressful time Mr Z has gone through. We hope our decision provides Mrs Z and Mr Z with assurance about their complaint, and we gave it careful consideration.

Our Decision

1. We are sorry to hear about the distressing time Mrs Z’s husband, Mr Z, has clearly experienced as a result of not receiving a referral for his stroke. We would like to thank Mrs Z for sharing the details of her concerns.

2. We have carefully considered Mrs Z’s complaint about the independent provider in East Yorkshire (the provider). We have seen no indications the provider did anything wrong.

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