Part 6 - Complaint about Southend Hospital NHS Trust (the Trust) and the Healthcare Commission (the Commission)
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Complaint about the care provided to an elderly dying man, the attitude of staff towards him and his wife, and about the way a complaint was handled by both the Trust and the Commission
Background to the complaint
Mr V was 86 years old when he was admitted to Southend Hospital in December 2002, complaining of abdominal pain, intermittent vomiting and diarrhoea. He had a history of diverticulitis (a digestive disease caused by inflammation of pouches which have formed on the outside of the colon) and irritable bowel syndrome with chronic abdominal pain. On this occasion, the doctors diagnosed a small bowel obstruction: he was given intravenous fluids as the diarrhoea and vomiting had made him severely dehydrated.
Mr V was cared for in the Intensive Care Unit for two days and, having made an initial recovery, was transferred to a surgical ward and then, 13 days later, to a medical ward. Within a few days of this latter transfer, Mr V became less well. He complained of abdominal and back pain, became constipated and had a poor appetite. His left arm became swollen and pressure sores developed on his elbows; MRSA was detected in the left elbow. He appeared depressed and was given an antidepressant. It seemed that a long-standing thyroid function problem was not being adequately addressed, so his thyroxine daily dose was increased.
Mr V then developed a fever and blood tests indicated an infection, so he was given intravenous antibiotics. Nine days later, Mr V complained of back pain and was prescribed an opiate painkiller. Over the following fortnight, Mr V’s chest condition improved. By the end of January 2003, he appeared to be better and was sitting out of bed, although he was still very depressed. Over the next week, his condition fluctuated as he became drowsy and uncommunicative, and unwilling to eat or drink. He refused further intervention and said that he wanted to be left alone. As time went on, he was in more pain; his opiate painkiller dose was increased and given on a regular basis. He became unresponsive, and his condition deteriorated further. He died in mid-February 2003.
The complaint to the Trust and the Commission
Mrs V, Mr V’s wife, complained to the Trust in December 2003. She attended a meeting with them in February 2004 at which statements by nurses (which detailed their communications with Mrs V about her husband’s care) were read out. Mrs V was extremely upset by those statements; the Trust then wrote to her expressing regret that the meeting had not resolved matters, but gave no explanations about her husband’s care. An exchange of letters followed and, in August 2004, Mrs V requested a further meeting; the Trust refused and said that she could approach the Commission.
In May 2005 the Commission referred Mrs V’s complaint back to the Trust, asking that a conciliation meeting be held. Neither Mrs V nor the Trust agreed to this. In September 2005 Mrs V complained to the Ombudsman. As the complaint had not been investigated by the Commission, it was referred back for review. In January 2006 the Commission wrote to Mrs V, with their final decision, suggesting that she contact the Information Commissioner if she wished to have medical records corrected. Mrs V contacted the Ombudsman again in February 2006.
What we investigated
Mrs V remained concerned about the care her husband received on the ward and subsequent complaint handling. Her complaints correspondence made clear that she believed that Mr V had been caused undue suffering and stress and that she had been caused unnecessary distress by the way in which her complaints had been handled. The main elements of her complaint were:
- the nursing care provided to Mr V on the medical ward was inadequate;
- staff were unhelpful and unsympathetic to both Mr and Mrs V; and
- neither the Trust nor the Commission had responded adequately to her complaints.
We had access to Mr V’s medical and nursing records and all of the complaints correspondence. We also took clinical advice from a Hospital Consultant with experience in the Care of the Elderly and a Senior Hospital nurse.
In framing the recommendations on this case we made particular reference to the NHS Modernisation Agency’s benchmarking tool ‘Essence of Care’ (2003).
What our investigation found
We found that while there was evidence of reasonable medical and nursing care in most areas, there had not been adequate planning for communication with Mr and Mrs V. Mrs V had also been very concerned to see her husband in pain, and we found that pain relief interventions could have been made at an earlier stage.
There was also evidence in the nursing records and statements made by nursing staff that they had found it difficult to deal with Mrs V. It appeared that they had held negative perceptions of Mrs V and had provided little support when her husband died. We found that junior staff had not been well supported by their seniors in dealing with a difficult situation.
We found that the Trust had failed to address Mrs V’s complaint adequately by not responding to her original concerns about Mr V’s care and that this served to increase her distress.
We found that the Commission failed to adequately address Mrs V’s concerns about the Trust as it misunderstood her complaint, believing it to be about inaccuracies in medical records and therefore advising her to approach the Information Commissioner.
The investigation concluded in October 2006 and we upheld Mrs V’s complaints against the Trust and the Commission.
Outcome
As a result of the Ombudsman’s recommendations the Trust:
- wrote to Mrs V in October 2006 to apologise;
- said that the Deputy Ward Manager would attend a specialist external training course on record keeping and then facilitate training sessions for staff on record keeping. These elements would also be emphasised in staff induction and in ongoing training;
- put in place a programme to implement the ‘Essence of Care’ communication standard and all other ‘Essence of Care’ standards, with the assessment of the medical ward to take place as part of that programme; and
- reviewed and republished their complaints policy and procedure (along with other supporting documentations) with particular emphasis on the support available to staff members in handling ‘Difficult situations or complainants’, the need to avoid judgmental statements and a designated framework for conducting local resolution meetings. back to top
