Miss W’s and Mrs W’s Story
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Miss W, who is in her 40s, has learning disabilities and epilepsy. She is cared for at home by her parents and needs significant support with her personal care and everyday tasks. On 3 September 2008 her parents found it difficult to wake her, so she was taken by ambulance to A&E at United Lincolnshire Hospitals NHS Trust. Doctors noted that Miss W’s anti-epilepsy medication had been changed during August 2008 and that since this change she had become drowsy. Miss W’s parents explained that Miss W was normally only incontinent during seizures but recently had become incontinent at other times. They also explained that she had been eating and drinking less and had lost weight. Miss W was admitted to hospital and the dose of her anti-epilepsy medication was increased. She remained in hospital until 18 September when she was discharged home.
Shortly after her daughter’s discharge Mrs W complained to the Trust about the care and treatment her daughter had received during her stay in hospital. She complained about a number of issues including: that nurses had not given her daughter her
anti-epilepsy drugs and other medication at the right times; that her daughter had been moved to another part of the hospital without a proper handover and without the bed space having been cleaned and prepared; and, that her daughter had been given Clexane injections without her or her parents’ consent or knowledge. (Clexane injections are used to stop blood clots forming abnormally in the blood vessesls.) Mrs W was concerned that nurses’ communication with the family had been poor.
Mrs W also complained that there had been a lack of basic nursing care and her daughter’s learning disabilities had not been taken into account. She said that hot drinks and meals had been left on her daughter’s bedside table without any regard for her inability to deal with a hot plate or hot food without burning herself, open containers, or cut food up. She said that cold drinks were not prepared for her daughter unless the family poured one and that her daughter’s personal hygiene needs (in terms of washing, bathing and menstruation) had not been met.
What our investigation found
We found that during her stay in the hospital Miss W did not receive appropriate nursing care. On admission doctors and nurses noted that Miss W ‘normally understands and talks quite slowly’ but nurses did not carry out a proper assessment of her communication and other needs. They did not develop care plans to address Miss W’s needs.
In addition, we found that the Trust did not deliver Miss W’s care in line with guidance issued by the Royal College of Nursing. This guidance states that people with severe learning disabilities may be very dependent on ward staff and might have difficulty expressing needs, such as hunger, thirst and the need to use the toilet, so staff should anticipate these. It states nurses need to work in partnership with people with learning disabilities and their carers, but that the support of families and carers should not be relied upon. However, in her complaint Mrs W had described instances where her daughter’s needs were not anticipated and where nurses had relied upon her family.
We also found that doctors and nurses did not give Miss W the help and support she needed to make her own decision about the need for Clexane injections and stockings designed to stop blood clots. By its own admission, there was no evidence that the Trust’s staff talked to Miss W or her parents about these treatments at all. The Trust’s staff failed
to assess appropriately Miss W’s capacity to consent to treatments. We found that the care and treatment the Trust provided for Miss W fell so far below the applicable standard that it amounted to service failure.
We found minimal evidence which demonstrated that either doctors or nurses had regard to the law or any guidance relating to the provision of services for people with disabilities when they planned and delivered Miss W’s care, or that Miss W’s rights under disability discrimination law were a relevant consideration in their decision making about Miss W’s care or in the way that care was then provided. Therefore, we concluded that in providing care to Miss W, the Trust did not have regard to its obligations to her under disability discrimination law. The Trust’s failing in this respect was so serious as to constitute service failure.
We found that when handling Mrs W’s complaint, although the Trust did acknowledge and apologise for many of the failings in Miss W’s care and treatment, it did not consider fully and seriously all forms of remedy. The failures in the Trust’s complaint handling fell far short of the applicable standard. That was maladministration.
The hospital would have been a frightening environment for Miss W and the Trust’s failure to explain procedures, like the administration of Clexane injections and the need to wear specialist stockings, would have added to Miss W’s distress. It would have been equally distressing for Miss W to be transferred within the hospital without anyone helping her to put her personal belongings away or getting her something to drink. Nurses did not listen to Mrs W when she explained what they would need to do to get her daughter to take her drugs and to help her with her everyday tasks. Mrs W and other members of Miss W’s family had to make special trips to the hospital to feed and look after Miss W.
We assessed whether injustice to Miss W and her mother arose in consequence of the service failure and maladministration we had identified and concluded that it had. Therefore, we upheld Mrs W’s complaint about the Trust.
What happened next
In recognition of the injustice Miss W and her mother suffered, the Trust agreed to write to Mrs W with an open and honest acknowledgement of the failings we had identified and an apology for the impact these failings had on her and on her daughter. The Trust also agreed to pay Miss W and her mother £2,500 to remedy the injustice arising from the service failure and the maladministration.
The Trust also agreed to prepare an action plan that detailed what it had done, or planned to do, to share the lessons learnt from the failings in its care and treatment of Miss W with its clinical teams and to avoid a recurrence of these failings in the future; and to avoid a recurrence of the failings we had identified in its handling of Mrs W’s complaint.
