Kingston Hospital NHS Foundation Trust

5. Dr X has complained about the care and treatment the Trust provided to her daughter over the period 2015-2020.

6. Dr X wrote to the Trust 25 March 2021 to complain about the care and treatment her daughter had received from her paediatrician. The Trust responded to this complaint on 9 July 2021.

7. Dr X wrote a further letter on 19 July 2021 and the Trust responded on 23 February 2023.

8. Dr X had ongoing concerns and wrote to the Trust again on 29 March 2023. The Trust responded to this letter on 8 August 2023.

9. Dr X still had outstanding concerns and wrote to the Trust regarding these on 26 November 2023. The Trust advised local resolution was concluded and signposted Dr X to PHSO.

10. Dr X brought her complaint to us on 5 December 2023.

13. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

14. When considering whether there was good reason to set aside our time limit we asked Dr X for more detailed information about the timeline of her complaint to understand the reasons why she could not bring her complaint sooner.

15. Dr X complained that the Trust mismanaged her daughter’s dietetic care in November 2015. We note there was a meeting with PALS (patient and liaison service) on 17 November 2015, but this did not resolve her concerns. We further note that that Dr X’s request for a change of dietitian was made the day after the meeting and was not acted upon. Dr X explained that she was not in a position where she would have been able practically or emotionally to revisit this issue at the time.

16. We have considered her explanation as to why she did not complain further at the time. We recognise that this was a difficult time for her in trying to deal with her daughter’s care. Furthermore, we note that Dr X did not feel she could challenge a clinical decision through a complaint and that she was not advised of the Trust’s complaint policy by staff. However, we note that Dr X did complain about aspects of her daughter’s care at that time and therefore appeared to be aware that she could raise complaints.

17. We consider the date Dr X became aware of the issues she is complaining about in November 2015. We call this awareness the date of knowledge. She made a written complaint in March 2021 which was over 5 years after you had knowledge of these events. Furthermore, her complaint was brought to us 8 years after the events complained about and 7 years outside our time limit.

18. Dr X complained that her daughter’s paediatrician did not discuss possible referral to a geneticist in February 2016 to rule out Silver-Russell syndrome (a rare congenital growth disorder). We considered Dr X’s comments regarding this issue. We note Dr X raised the request for a referral again at the 6-month review and were told by the consultant this was not indicated. Dr X said she did not feel able to do anything else other than to keep raising concerns. We also note that Dr X was feeling the strain of her caring role and having to deal with ongoing matters. We again recognise that this was a difficult time for her. Dr X made a written complaint in March 2021 which was over 5 years after she had knowledge of this issue. This aspect of the complaint was brought to us 7 years and 10 months after the event complained about and over 6 years and 10 months outside our time limit.

19. Dr X also complained the paediatrician did not arrange follow-up reviews in March and October 2017. Dr X received copies of clinical letters dated March and October 2017 which referred to follow up reviews which did not happen. We further note that Dr X did not pursue this with the Trust. She said she felt demoralised by the care received. She indicated she felt responsible for not following this up at the time. Dr X made a written complaint in March 2021 which was over 3.5 years after she had knowledge of these events. This aspect of her complaint was brought to us over 6 years after the events complained about and over 5 years outside our time limit.

20. Dr X complained that the paediatrician in September 2019 refused to refer her daughter for genetic and endocrine investigations despite this being recommended following a cardiology review. Dr X was aware of this decision at the time but a complaint regarding this was not made to the Trust until March 2021. This was 18 months after the event. Furthermore, this was brought to PHSO over 4 years after she had knowledge of the event which was over 3 years outside our time limit. As above, we recognise that there was some delay on the part of the Trust in responding to her letter dated 19 July 2021.

21. Whilst we have taken on board Dr X’s explanations regarding delays, we do not consider they provide sufficient reasons for us to set our time limit aside regarding this period of care. We note that Dr X did not pursue a complaint regarding these aspects of her complaint until a considerable time had elapsed. We think it is reasonable to expect her to have acted sooner. In the circumstances, we consider these issues are out of time and therefore in accordance with the law we cannot investigate them or any others during the above period of care. This also means we cannot consider the complaint responses or the further outcomes Dr X is seeking from the Trust which relate to these issues.

22. Dr X further complained that the paediatrician failed to adequately monitor her daughter’s growth during 2019 and 2020. Furthermore, she complains the Trust failed to record her daughter’s height accurately in 2019. Dr X said that as a result of these potential failings her daughter did not receive growth hormone therapy. In her complaint letter Dr X explained that it was a review of an information leaflet by Child Growth Foundation in Oct/Nov 2020 made her aware of a parental mid height calculation and the paediatrician had failed to conduct one. Dr X also became aware of the inaccurate height calculation in 2019. In December 2020 she met a new appointed endocrinologist who said her daughter may have been entitled to growth hormone therapy from age 4. This was clarified in subsequent appointments in January/February 2021, and Dr X made a decision to complain to the Trust. Dr X advised that during this period her daughter was undergoing investigations, and she did not have the practical or emotional resources to complain to the Trust until March 2021.

23. In the circumstances, whilst Dr X brought these issues to us outside our time limit, we note she only had knowledge of these issues in October 2020. Whilst she took five months to then raise her concerns we have noted her explanation for the delay. We further note that the subsequent delays in the matter were due to the Trust. Therefore, we have set the time limit aside regarding these issues.

24. We have considered what the Trust has already said and done to address these issues.

In its response dated 9 July 2021 the Trust acknowledged the height measurement in September 2019 was inaccurate which can only be explained by the staff member not following the correct procedure. The Trust indicated it had taken steps to remind staff about good practice when measuring height. We note that the Trust did not provide an adequate response to the issue regarding parental mid height calculation which Dr X raised in your subsequent letter dated 19 July 2021.

25. In its response dated 27 February 2023 the Trust apologised for the inaccurate measurement taken in September. The Trust also said that the paediatrician agreed best practice would have been to revisit the question of mid parental height. The Trust said that the paediatrician agreed there were unfortunate omissions in care and apologised for these.

26. In Dr X’s letter dated 29 March 2023 she said she was grateful for the Trust’s acknowledgement that there had been omissions her daughter’s care. She thanked the Trust for acknowledging the impact this had had on her daughter’s care and the mental health of the family. She was also grateful about the improvements made to the height and weight monitoring and that clinical policies and procedures were being updated in line with guidance. She also asked the Trust to make a commitment for changes to its paediatric service. The Trust response dated 8 August 2023 addressed these. However, Dr X remained unhappy and raised further concerns in a letter dated 26 November 2023. The Trust indicated local resolution had come to an end and signposted her to us.

27. We note that regarding the issues we are able to look at, Dr X appears to some extent to have achieved acknowledgement of failings, an apology for the impact on her and her daughter and service improvements by her own efforts. We would only consider carrying out a detailed investigation where we are likely to add any significant value to what has already been achieved. We asked Dr X to confirm what further outcome she hoped to achieve.

28. Dr X has said she would like to see the following actions from the Trust.

• “The Trust to detail clearly how they have improved, or plan to improve their engagement with parents and carers: What concrete measures have they taken to ensure partnership working with families? Are there parent/ carers advisory groups or forums? Is formal feedback from family and carers collected, for instance through regular experience surveys? If not, why not?

• The Trust to detail how they have improved, or plan to improve on being transparent and proactive with parents and carers regarding their complaints policy.  Are mechanisms in place now to ensure parents are being given information about the Trust complaints process and signposted to PALS?”

29. We approached the Trust to give it an opportunity to consider if it will provide a further response to address the above with a view to resolving this complaint. The Trust has agreed to provide a response within eight weeks from the date of this statement. In the circumstances, we consider this work by the Trust should resolve this matter and therefore we are not taking any further action.

Conclusion

30. We recognise Dr X and her daughter have experienced a difficult time during the above period and we understand how much this complaint means to Dr X. It is important we consider and act within the law and we regret any further upset this decision may cause. We hope that this statement clearly explains the reasons for our decision not to look at certain aspects of her complaint. We also hope that the further actions agreed by the Trust will provide Dr X with the reassurance she is seeking.

1. We have carefully considered Dr X’s complaint about the Trust. We were sorry to hear of her concerns about her daughter’s care and treatment and of the impact this had had on them both.

2. After considering the relevant information, we have seen that some aspects of the complaint falls outside of our 12-month time limit. We consider the time taken by Dr X to bring her complaint to us are the reasons the complaint is outside our time limit. For this reason, we will not consider those aspects of the complaint further.

3. Regarding those aspects of the complaint that we could look at it has been agreed that the Trust will carry out further work with a view to resolving this complaint.

4. We appreciate the time Dr X committed to making this complaint and we explain in this statement the reasons for our decision.