Hearing aid
18. Mrs O says the Trust lost Mrs R’s hearing aid which cost her £1,395. She complains the Trust did not provide reimbursement for this or provide hearing aids of an equivalent quality.
19. The Trust explained that as per its policy, it replaces any lost hearing aids with NHS replacements. It said it was unable to reimburse the cost for privately obtained hearing aids.
20. The Patient Property policy says the Trust would not routinely offer a new replacement item, but that it may consider a contribution towards a replacement. When dealing with the loss of essential personal items such as hearing aids, financial redress will typically be considered in line with the standard NHS help for health costs.
21. When the Trust admitted Mrs R to hospital, she only had one hearing aid – the other was left in her room at the care home. Mrs R’s hearing aids were from a private provider. They were rechargeable, lightweight and had a receiver-in-canal (RIC). RIC is a small device that sits behind the ear, with a thin wire connecting to a small receiver that sits in the ear canal. These are also known as receiver in the ear (RITE).
22. Two days later, Mrs O visited her mother. At this point, the Trust had moved Mrs R to a different ward, but she still had her hearing aid in place. The next day, Mrs O visited and discovered her mother’s hearing aid was missing. Mrs O reported this at the time and the Trust investigated. The Trust concluded that it would take responsibility for the loss of the hearing aid. It provided Mrs R with NHS hearing aids.
23. The NHS usually provide behind the ear (BTE) hearing aids. Mrs O told us that these hearing aids are ‘clumpy’, need batteries, and were not as good as the ones she bought.
24. NHS patients often need to pay towards the cost of things such as dental care, prescriptions and eye care. NHS hearing care (including the provision of hearing aids) does not require a patient to contribute to the cost. The Trust explained that if the item is something that the NHS does not provide, the Trust would offer a contribution.
25. In this case, the NHS replaced Mrs R’s hearing aids with NHS hearing aids. The Trust did not offer a contribution because the hearing aids were funded by the NHS. The Trust explained the specific hearing aid Mrs R owned were not available on the NHS.
26. The Trust has followed its policy in that it has considered the standard NHS help for health costs for Mrs R’s hearing aid. Mrs R had hearing aids she has not needed to privately fund.
27. That said, we acknowledge Mrs R’s RITE hearing aids were better than the NHS version she was later provided with. Mrs O says the NHS replacement hearing aids were uncomfortable for Mrs R and were of poor quality.
28. We understand the type of hearing aid is individual to each person and how the different types can be more beneficial to someone, based on their preference. Considering the different type of hearing aid the Trust offered Mrs R, compared to the ones she bought, we acknowledge that it would have been uncomfortable.
29. The Trust’s policy also says it can consider a contribution towards a replacement. In response to Mrs O’s complaint about the Trust, the Trust did not offer a financial contribution. This is not in line with the Trust’s policy. The NHS Complaint Standards say organisations should identify suitable ways to put things right for people.
30. During our investigation, we asked the Trust for further clarification about aspects of its policy. Specifically, the part where the Trust could consider a financial contribution towards a replacement.
31. The Trust agreed to cover the purchase of replacement hearing aids for Mrs R. This is in line with our NHS Complaint Standards. However, during our investigation into the complaint, Mrs R sadly died. This means Mrs R died without getting hearing aids she could comfortably use.
32. We will consider the impact of this later in the report.
Skin care
33. Mrs O complains the Trust did not provide Mrs R with basic skin care or regularly reposition her during her admission.
34. In its response to Mrs O’s complaint, the Trust said it provided appropriate patient skin care to Mrs R throughout her admission.
35. The Trust’s Pressure Ulcer Policy says a registered practitioner must assess a patient’s risk status of pressure ulcers within six hours of admission. The risk assessment is conducted using a tool called the ‘Waterlow Pressure Ulcer Risk Assessment Scoring System’. This tool provides a score which indicates whether a patient is not at risk, at risk, high risk and so on.
36. If the Trust assesses a patient as being at risk, the Pressure Ulcer policy says it should reposition the patient at least six-hourly. If the patient is at high risk, it says to reposition at least four-hourly. It says everyone at risk of pressure damage should, as a minimum, be placed on a support surface (mattress, cushion) with pressure reducing systems. If a patient’s clinical condition changes, it should update the risk assessment.
37. The Pressure Ulcer policy also says a registered clinician should conduct a skin inspection. This skin inspection should include checking pressure areas, noting if there is any redness present, incontinence or moisture present (list is not exhaustive).
38. The Trust conducted a skin inspection Mrs R’s skin approximately 11 hours after it admitted her to hospital. This assessment noted Mrs R’s sacrum (the bone at the bottom of the spine) and buttocks were intact, and it noted no redness. The Trust provided Mrs R with a pressure relieving mattress for her skin.
39. We found these actions are in line with the Trust’s Pressure Ulcer Policy, as the Trust has inspected Mrs R’s skin, and provided her with a pressure reducing mattress.
40. The Trust does not appear to have risk assessed Mrs R’s risk level of developing pressure ulcers, as there is no Waterlow score recorded. As outlined earlier, a patient’s risk level can help determine how often a patient should be repositioned.
41. Furthermore, in the record of the Trust’s skin inspection of Mrs R on admission, there is a section where the Trust should note the frequency of pressure area care. For example, two-hourly, four-hourly, six-hourly. The Trust has also not noted the frequency on the skin inspection document.
42. We have found the Trust’s actions here are not in line with its Pressure Ulcer policy. It did not conduct its assessment within six hours of Mrs R’s admission to hospital. The Trust also did not record a Waterlow score, meaning we do not know how at risk Mrs R was for developing pressure ulcers. Therefore, we do not know how often the Trust should have been repositioning Mrs R.
43. During Mrs R’s time in hospital, there are inconsistencies and variations in how frequently the Trust checked her skin.
44. For example, shortly after the Trust first assessed Mrs R’s skin, it checked her skin two hours later, then four hours later, then every three hours until it stopped at 8pm. The skin inspection resumed the next day at 2am. Two days after admission, the Trust noted redness to Mrs R’s skin, but the records do not say where. The Trust note redness on Mrs R’s sacrum the day after but did not note any redness two days after.
45. In the three days prior to Mrs R’s discharge, the Trust noted Mrs R’s sacrum was red at every check. The Trust also reviewed Mrs R’s skin on the day of discharge. It noted there was redness on her buttocks. The notes do not indicate whether the Trust took any further action following these observations.
46. In terms of repositioning, there are also variations and large gaps in how often the Trust repositioned Mrs R. Similarly to the gap when the Trust last assessed Mrs R’s skin at 8pm and checked it again the next day at 2am, this is the same for repositioning. The notes document the Trust repositioned Mrs R at 8pm, then next at 2.15am the next day. This is a gap of just over six hours. There is also a gap of nine hours between 5pm and 2.15am the day after, and another gap of 12 and a half hours the day after that between 9.30pm until 10am.
47. Given the Trust provided a pressure relieving mattress, we think it is likely Mrs R was at least ‘at risk’ of pressure damage. This is because the Trust’s Pressure Ulcer policy says a pressure relieving mattress or cushion should be provided to patients at risk of pressure damage.
48. Without a Waterlow score, we do not know how at risk Mrs R was at developing pressure ulcers, and how often the Trust should have repositioned her. From the actions the Trust took, we think we can say Mrs R was at least ‘at risk’, but we cannot say whether she was ‘at high risk’ because of the absence of the assessment.
49. Given this, the Trust should have repositioned Mrs R at least every six hours, in line with the Pressure Ulcer Policy. We can see examples of several occasions where the Trust took longer than six hours. The records show inconsistencies and large gaps in terms of checking Mrs R’s skin, as well as how often it repositioned her.
50. Based on the evidence, it is likely the Trust did not consistently care for Mrs R’s skin, including repositioning. We have found the Trust failed to act in line with the Pressure Ulcer policy, as it did not consistently reposition Mrs R every six hours.
51. We will consider the impact of the failings below.
Impact
52. Mrs O said Mrs R had NHS replacement hearing aids from the Trust which were uncomfortable and poor quality. We understand these were fitted in August 2024. Mrs R died in April 2025, without receiving hearing aids that worked for her. We recognise this was distressing and frustrating for both Mrs R and Mrs O, as it led to barriers in communication for them.
53. As explained earlier in paragraph 29, the Trust’s policy says it can consider a financial contribution towards a replacement. It did not do this at the time Mrs O complained. For Mrs O, now knowing that the Trust could have covered the cost of hearing aids while Mrs R was still alive, is understandably frustrating. This time includes Mrs O spent trying to resolve things through the Trust’s complaint process.
54. The Trust’s failing here has led to distress and frustration for Mrs O. We will outline our recommendations for this at the end of the report.
55. Mrs O says Mrs R developed a grade 2 pressure sore on her sacrum due to the Trust not providing basic skin care or regularly repositioning her.
56. When Mrs R returned to the care home after being discharged, the care home assessed Mrs R’s skin. The care home documented a grade 2 pressure sore on her sacrum. A grade 2 pressure sore is the partial loss of dermis (the middle layer of skin) presenting as a shallow open ulcer with a red, pink wound bed, but without any dead tissue.
57. Pressure ulcers can happen to anyone as they are caused by something rubbing on the skin. There are factors, however, which can increase a person’s chance of getting a pressure ulcer. For example, having problems moving and increased moisture. Therefore, if a patient is incontinent, this can present a higher risk. The records show Mrs R was doubly incontinent.
58. From the records we do have, we can see the Trust’s repositioning and skin checking of Mrs R was inconsistent, with large gaps.
59. It is recognised that not all pressure ulcers can be prevented and the risk factors for each person should be considered on an individual basis. Our nursing adviser explained the Trust not ensuring Mrs R’s position was changed frequently would have contributed towards pressure damage. However, as Mrs R was doubly incontinent, this also would have contributed towards skin damage and pressure area breakdown.
60. We cannot say the Trust’s failure led to Mrs R developing the pressure sore. We think it is likely a combination of factors contributed to the pressure ulcer Mrs R developed. That said, we also recognise that without knowing how at risk Mrs R was, and therefore how often she should have been repositioned, this causes uncertainty. The uncertainty is not knowing whether the Trust took all the steps it should have done to minimise the risk factors of Mrs R developing a pressure ulcer.
61. We recognise this uncertainty will cause Mrs O distress and frustration. We will outline our recommendations to address this below.