A healthcare provider in the Medway area

5. Mrs L complains Mr E contracted COVID-19 while he was a patient at the hospice (part of the Trust). She says he had tested negative prior to the transfer from hospital (not part of the Trust) to the hospice. She says Mr E had remained well for about a week after the transfer, before showing signs of COVID-19 and later testing positive.

6. Mrs L says there was a lack of empathy and compassion shown by the hospice. She complains:

· The family were not able to visit Mr E, apart from one 15-minute visit for one family member, just before he died. She says other local hospices were allowing visits during this time.

· The hospice discussed discharging Mr E with him, rather than speaking to the family first.

· How the hospice returned Mr E’s belongings. Mrs L says these were left in plastic bags, just inside the hospice entrance, and when she went to collect them nobody spoke with her.

7. Mrs L also complains the death certificate was completed inaccurately. She says the hospice should have waited for all the test results before completing the death certificate.

8. Mrs L says these events have caused anxiety and distress. She also says the events impacted the family’s ability to view Mr E’s body after he died and affected her ability to move on. Mrs L would like the Trust to acknowledge failings and apologise for these. She would like service improvements, to prevent others having a similar experience.

9. Mr E had metastatic lung cancer and bone marrow blood cancer. He had been in hospital but moved to the hospice on 7 May 2020. The hospital tested Mr E for COVID-19 several times, most recently on 5 May, before he moved. Those tests were negative.

10. On 17 May, Mr E became unwell. The hospice arranged a COVID-19 test. Mr E sadly died on 19 May 2020. The COVID-19 test result was received after Mr E had died and showed a positive result.

Contracting COVID-19

13. Mrs L says Mr E must have contracted COVID-19 while he was a patient at the hospice. She says he had tested negative prior to his transfer and had remained well for about a week, before showing signs of COVID-19 and testing positive.

14. The Trust acknowledged the hospice was caring for patients with COVID-19 at the time but said it treated all patients as suspected COVID-19 positive. It said staff had used personal protective equipment (PPE) in line with government guidance and had adhered to infection prevention requirements.

15. Guidance from PHE explains it can take up to 14 days for someone to develop an infection after being in contact with an infected person. The BMJ explains that testing for COVID-19 is not one hundred percent accurate. It is possible to have a false negative – that is when the person tests negative but has COVID-19.

16. We recognise that Mrs L believes Mr E must have contracted COVID-19 while he was a patient at the hospice. We can understand why she might think this. When considering the information above, it would not be possible for us to say Mr E testing positive for COVID-19 was an indication of a failing by the Trust.

17. There was a ten-day period between Mr E moving to the hospice and his symptoms starting. It is possible the test Mr E had in hospital on 5 May was not accurate and had given a false negative. It is also possible that Mr E contracted the COVID-19 virus at the hospital, or during the transfer, and then went on to develop symptoms of COVID-19 while he was at the hospice.

18. Considering this, it would not be possible for us to say that, even if there was an indication of a failing by the Trust, this led to Mr E developing symptoms of COVID-19.

Visiting

19. Mrs L complains the family were not able to visit Mr E, apart from on 15-minute visit for one family member before he died. It was clear when speaking to Mrs L the distress this caused her, and her family.

20. Guidance from NHSE (dated 8 April 2020) explains that visiting was suspended with immediate effect. The guidance says that only in exceptional circumstances, such as when the patient is receiving end-of-life care, will one visitor (an immediate family member) be allowed to visit.

21. Further guidance from NHSE (dated 13 May 2020) says that the number of visitors at the bedside is limited to one close family contact, although where it is possible to maintain social distancing throughout the visit, a second additional visitor could be permitted.

22. Considering the guidance, and the Trust’s response, we cannot see there is any indication that something has gone wrong. It appears the Trust was following the guidance in limiting visiting to one person.

23. In its response to the complaint, the Trust said it did not allow visiting into the garden area because this was accessed through the building, which posed a risk of COVID-19 to all parties. It said that even if it had been able to allow access to the garden this would not have helped, as the windows to the building were covered with a reflective film to maintain privacy.

24. It appears from this the Trust had considered accommodating additional visitors but had decided there were risks involved that prevented this.

25. Mrs L says other local hospices were allowing visitors during this time. We acknowledge this is likely to have added to Mrs L’s distress, and her sense of injustice, but we cannot see this indicates a failing in the Trust’s actions.

Communication

26. Mrs L complains the hospice discussed discharging Mr E with him, rather than speaking to the family first. The Trust agreed it had discussed the possibility of discharge planning with Mr E. It apologised for the distress caused by discussing this with Mr E.

27. We can understand why both Mrs L and Mr E were distressed about the discussion around discharge. Particularly as they had understood (from the hospital) that on admission to the hospice, Mr E would remain there until he died.

28. Both the GMC’s Good Medical Practice and the NMC’s Code of Conduct explain that doctors and nurses should communicate effectively and should discuss care with the patient. Given the guidance, we can see no indication of a failing in the Trust discussing arrangements with Mr E.

Empathy

29. Mrs L complains about how the hospice returned Mr E’s belongings. She says these were left in plastic bags, left just inside the hospice’s entrance, and when she went to collect them nobody spoke with her.

30. The Trust said the hospice team had acknowledged and apologised it had not returned Mr E’s belongings in a supportive and empathetic manner. It apologised for Mrs L’s experience. The Trust said it had made staff aware of Mrs L’s experience and that procedures would be changed as a result.

31. Based on the information available, it appears there are indications the Trust failed to act in an empathic manner with Mrs L. We can understand why she found this experience distressing and it is clear this had a lasting impact on her.

32. However, we can see the Trust has acknowledged it got this wrong, and it has apologised for this. It has also taken steps to change its processes, to stop similar events happening in the future. Considering this, and what Mrs L told us she was hoping we could achieve; we believe the Trust has already taken steps to put things right. We think there is likely to be little more that we could achieve in relation to this.

Death certificate

33. Mrs L complains the death certificate was completed inaccurately. She says the hospice should have waited for all the test results before completing this.

34. The ONS/HMPO guidance says medical practitioners should certify causes of death ‘to the best of their knowledge and belief’. It says that (if appropriate) to avoid delay, medical practitioners can share additional information when it becomes available, rather than waiting for that information before completing the form.

35. The Trust said the doctor who had completed the death certificate had done so shortly after Mr E had died. It said it was the doctor’s opinion that Mr E did not have COVID-19. It said that when the positive result was received, the registrar had been contacted.

36. We understand from speaking to Mrs L that this caused some problems for the family in being able to see Mr E after his death, which was understandably distressing for the family. It also caused some inconvenience until the family were able to resolve the issues.

37. Based on the information available, we have seen no indication of a failing. It appears the doctor completed the death certificate to the best of their knowledge at the time.

1. We have carefully considered Mrs L’s complaint about the care offered by a healthcare provider in the Medway area (the Trust) to her father, Mr E. We were sorry to hear of her concerns and about the distress and anxiety she has experienced following these events.

2. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We also look at whether there are signs the events complained about had a negative effect which has not been put right.

3. Having done so, for the most part, we have not seen any indications that something has gone wrong.

4. We have seen an indication of a failing in how the Trust treated Mrs L when she went to collect Mr E’s belongings. We believe the Trust has already done enough to put right the impact of these events.