Source · PHSO decision

The Dudley Group NHS Foundation Trust

Ref: P-002306 Statement Decision date: 7 November 2023 Jurisdiction: NHS in England Closed After Initial Enquiries

Mrs D complained her mother developed fatal pressure sores due to neglect, citing poor communication and frequent ward changes as contributing factors to her deteriorating health.

Outcome

AI summary
The ombudsman decided not to investigate the complaint further, stating Mrs D could pursue legal action regarding the matters raised.

The complaint

2. Mrs D complains about the care and treatment her mother had from the Trust between February 2022 and her death in July. She is concerned the Trust: • allowed Mrs F to develop pressure sores • failed to effectively communicate details of Mrs F’s care or condition with her family • kept moving Mrs F between wards • moved Mrs F to a care home the family found it difficult to visit • neglected Mrs F.

3. Mrs D says that because of the pressure sores, Mrs F developed osteomyelitis (an infection in the bone) which then caused her death. She is concerned a lack of care prevented Mrs F from healing properly and caused her more avoidable pain. Mrs D told us poor communication meant the family were not accurately informed of her prognosis, causing distress. She explained that regularly moving Mrs F left her frightened and confused. Mrs D said moving Mrs F to a care home in Walsall made it difficult for her family to visit her.

4. Mrs D wants a financial payment of over £10,000 and for the Trust to update its procedures so the same failings do not happen again.

Findings

6. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We do not consider whether legal action would succeed but whether it would be a reasonable option to look into.

7. A key part of the complaint is Mrs D’s concern that the Trust’s neglect led to Mrs F getting pressure sores that did not heal. This part of Mrs D’s complaint falls under the scope of clinical negligence. Clinical negligence is something complainants can take to court.

8. Mrs D wants a financial payment and service improvements. She could potentially achieve a financial payment by making a clinical negligence claim. Mrs D wants a payment of over £10,000. This is likely more than we would recommend if we were to uphold the complaint. But a solicitor could possibly achieve this outcome if they decide to take on the case. We think it is better for Mrs E to take legal action so she can achieve the outcome she is looking for.

9. Mrs D said the only barrier to her was the cost of a solicitor. But she realises she has the option of a ‘no win, no fee’ solicitor.

10. A clinical negligence claim would not consider the complaints about communication, movement between wards, or the move to the care home. But we would not be able to reach a decision on these parts of the complaint without looking at her mother’s overall care because they are linked. We do not think it would be right to consider some of the complaint while Mrs D explores legal action for the other part of her complaint.

11. Mrs D also wants service improvements. Mrs D cannot achieve this outcome as a direct result of legal action. But she may be able to achieve this as a by-product. Mrs D may return to us if she does not achieve this through legal action and we will review if we can help.

12. We thank Mrs D for taking the time to talk us through her complaint.

Our decision

1. We have carefully considered Mrs D’s complaint about The Dudley Group NHS Foundation Trust (the Trust). We are sorry to learn of her concerns about the care her mother, Mrs F, had from the Trust. We think Mrs D could take legal action on the matter that she has brought to us.

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Decision details

Reference
P-002306
Decision type
Statement
Jurisdiction
NHS in England
Decision date
7 November 2023
Outcome
Closed After Initial Enquiries
Responsible body
The Dudley Group NHS Foundation Trust

Complaint summary

AI
Summary
Mrs D complained her mother developed fatal pressure sores due to neglect, citing poor communication and frequent ward changes as contributing factors to her deteriorating health.

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Data from PHSO under Open Government Licence.