The Walton Centre NHS Foundation Trust

5. Ms N complains about aspects of the care each organisation provided to her husband, Mr Y who was being treated for Parkinsons and Dementia. Mr Y has since sadly passed away.

WC Trust

6. Ms N complains WC Trust failed to properly safeguard her and her husband Mr Y from August 2021 to October 2021. Ms N also says during this period WC Trust:

• failed to respond to email outlining serious nature of Mr Y’s presentation and failed to deal with a high-risk patient as a matter of urgency • failed to respond to concerns Ms N had raised about Mr Y • imposed serious problems on services that were inadequate for Mr Y • inappropriately referred problems to practitioners when it was outside of their remit • failed to liaise with other care providers • failed to make timely decisions about appropriate treatment and care

7. Ms N says because of these failures Mr Y was left without the care and support he needed. Ms N says the poor treatment resulted in a downward spiral of ill health for Mr Y over significant period.

8. Ms N told us of the trauma she has experienced because of WC Trust’s failures. She says she felt desperate when they did not get the support they needed. She told us this has negatively impacted her own health and wellbeing.

WUTH Trust

9. Ms N complains about aspects of care and treatment WUTH Trust provided to her husband Mr Y from December 2021 to March 2022. Ms N says WUTH Trust:

• failed to meet Mr Y’s dietary needs and discharged him on 21 March 2022 when he was in a malnourished condition • Mr Y was healthy on admission and contracted severe infections after surgery • failed to provide physiotherapy and did not mobilise Mr Y • failed to meet Mr Y’s holistic needs • Mr Y was not reviewed by a doctor during his 12-week admission • failed to make a timely decision to remove Mr Y’s metal work • Consultant refused to comment when Ms N asked about her husband’s care and treatment • failed to keep Mr Y’s reoccurring infections under control • failed to exercise any damage limitation when considering Mr Y’s care plan • made poor clinical decisions about Mr Y’s care

10. Ms N says because of these failures Mr Y was left without the care and support he needed. Ms N says the poor treatment resulted in a downward spiral of ill health for Mr Y over significant period.

11. Ms N says because of the Trust’s failings relating to its management of Mr Y’s diet, her husband was seriously underweight when he was discharged. Ms N thinks if he would have been given the correct nourishment, he may have had the strength to recover from other illnesses.

12. Ms N also told us how the Trust’s failings have negatively affected her own health and wellbeing.

GP Practice in the Wirral area

13. Ms N complains about aspects of care and treatment Marine Lake Medical Practice provided to her husband Mr Y from August 2021 to December 2021. Ms N says:

• at an appointment on 16 August 2021 the doctor did not appear interested when she discussed Mr Y’s fall the previous day • the Practice did not use WC Trust’s emergency Neurology Registrar for help and support in August 2021 • the Practice did not do anything to help her when she was struggling to cope with Mr Y’s deterioration in October 2021 • she was left without support, help that was inconsistent and lacked continuity.

• the Practice did not take safeguarding measures when she reported concerns to them about her husband’s care home and associated risks

14. Ms N says because of these failures Mr Y was left without the care and support he needed. Ms N says the poor treatment resulted in a downward spiral of ill health for Mr Y over significant period.

15. Ms N also told us how the GP Practice’s failures have negatively affected her own health and wellbeing after she felt unsupported caring for her husband.

16. To resolve her concerns about WC Trust, WUTH Trust and a GP Practice in the Wirral area Ms N is seeking an acknowledgement of failures and service improvements to ensure this does not happen to others.

17. This very brief background is only intended to place the key events related to this complaint in context, not to provide a detailed chronological account of everything that happened.

18. Mr Y born in September 1946, was diagnosed with Parkinson’s disease in July 2012.

19. In 2021 records show Mr Y’s health started to decline and he had many falls. Ms N told us his behaviour started to worsen and he was presenting a risk to himself and others. Ms N says she raised concerns with the GP Practice that her husband was deteriorating rapidly. She says he was carrying out dangerous impulsive acts and showing signs of dementia.

20. In December 2021 Mr Y was admitted to WUTH Trust following a fracture to his hip after a fall.

21. Mr Y had surgery for his hip and remained at the Trust for three months. Mr Y’s records show he suffered from complications after his surgery. He was discharged on 21 March 2022.

22. Mr Y sadly died on 16 September 2023. His cause of death is listed as aspiration pneumonia, Parkinson’s disease and Parkinson’ disease dementia.

WC Trust

27. 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. We have discussed this with Ms N to understand the reasons why she could not do so. We have also considered the time the organisation has taken to respond to Ms N.

28. Ms N confirms the latest date she became aware of concerns about her husband’s care and treatment from WC Trust was October 2021. For Ms N’s complaint to be in time, she would have needed to approach our Office by October 2022. As her complaint was not ready for us until July 2024, nearly 1 year and 9 months late, we have considered the reasons for delay.

29. Ms N complained to WC Trust in October 2021, and it responded in the same month. Ms N wrote with further concerns in May 2024, and it provided a final response in June 2024. In total, this process took 2 months.

30. NHS Complaint Regulations 2009 say the organisation investigating a complaint should explain if it has not been able to respond within six months and respond as soon as it can. We do not consider the time taken by WC Trust unreasonable, considering the Regulations. We would not disadvantage Ms N for the 2 months taken by WC Trust to investigate her complaint.

31. We received Ms N’s complaint in February 2023 and decided it was not ready for us in May 2024. The time taken to reach this decision was one year and three months. We have not disadvantaged Mrs N for the time we took to reach this decision. We have identified periods where we think Ms N could have pursued her complaint more quickly. We discuss these in more detail below.

32. The WC Trust response of October 2021 said it had closed her complaint as it had completed local action requested by Ms N.

33. Ms N told us she did not know she could ask for a further response. Ms N told us she faced difficult personal circumstances which included caring for her husband who was becoming more unwell, along with experiencing a decline in her own health.

34. We can understand how difficult this must have been for Ms N and recognise this was a challenging time for both her and Mr Y. We are sorry to hear about all she has experienced.

35. WC Trust’s online complaint resources detail steps people can take if they remain unhappy with the response to their complaint. It says people should let the organisation know at the earliest opportunity and it will review the outstanding issues. It explains it can investigate and provide a further response or arrange a meeting to discuss concerns.

36. Given the information available to Ms N, we think it was reasonable for her to take independent steps to consider what options were open to her in October 2021.

37. Ms N contacted us in March 2022 about another organisation. She told us she did not send her complaint about WC Trust as she did not have enough space on the complaint form. She explains she felt it was better to wait for a caseworker to be assigned to her. She told us she was given advice to hold off on sending information until this had happened.

38. We cannot see evidence to suggest we advised Ms N to delay sending information but can see she contacted our Office again in May 2022 when she raised concerns about another Practice.

39. We assigned a caseworker in December 2022 and in a call shortly after, Ms N told us about her concerns with WC Trust. We asked Mr N to send this information in February 2023 and we received it the same month. Ms N could have completed another complaint form in March 2022, or asked us what she should do about this complaint.

40. She could also have told us about this complaint when she raised her other complaint in May 2022. We understand that Ms N’s complaint was not ready for us at this time, but we could have explained our position then and asked her to return to WC Trust. Unfortunately, as Ms N waited until February 2023 to put her concerns in writing to us, this meant her complaint was already 4 months out of time.

41. We understand Ms N chose to pursue complaints about other organisations and wanted to wait until she was assigned a caseworker so she could discuss her complaints as one. It remains that we cannot see any barriers which prevented Ms N from returning to WC Trust sooner to complete its complaints process or bring it to our office using a complaint form.

42. By the time Ms N wrote back to the WC Trust in May 2024 and received its final response in June 2024 her complaint was significantly out of time. Whilst we acknowledge our processes took a portion of that time, we have identified Ms N had an opportunity to pursue her complaint significantly earlier.

43. We think it was reasonable for Ms N to familiarise herself with WC Trust’s local complaints process and return to it much sooner to raise her remaining matters. It also remains that we cannot see good reason why she did not tell us about her complaint sooner, in March 2022 and May 2022 when she brought other complaints. For these reasons we cannot see good reason to waive the time limit.

44. We are very grateful to Ms N for being so open and honest about what happened to her husband and how these events continue to affect her. It is clear how much distress and emotional upheaval she has experienced. We are very sorry to hear about this.

WUTH Trust

45. Before we decide if we should conduct a detailed investigation of 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 have done this and have not found any indications that something went wrong.

46. Ms N raised several concerns about WUTH Trust (detailed in the complaint summary above). We will address Ms N’s concerns about WUTH in more detail below.

47. Ms N told us she is concerned WUTH Trust did not provide Mr Y with the nutrition he needed to recover from other illnesses. She explained because of his dramatic weight loss, Mr Y could not get stronger, and his health was not able to improve. Ms N is concerned her husband’s basic dietary needs were not met whilst an inpatient at WUTH Trust from December 2021 to March 2022.

48. In its response to Ms N, WUTH Trust explain on Mr Y’s admission the ward bed scales were not working and he was not sufficiently mobile to be weighed on a chair. It says because of this, it is not able to verify Mr Y’s weight at that time. The Trust explain this was resolved approximately 2 weeks later and it recorded Mr Y’s weight as 76.6 kilograms.

49. WUTH Trust said whilst there were issues with the bed scales, it recognised Mr Y lost a significant amount of weight whilst in hospital. It says it took appropriate steps to monitor and address this, this included a referral to a dietitian and supporting his nutritional needs with diet and supplements.

50. NICE CG32 guidance says staff should screen all patients for their risk of malnutrition on admission to hospital. Nurses should screen for malnutrition weekly, or where there is clinical concern for the patient. The guidance also says nutrition support should be considered for people who have eaten little or nothing for more than five days or are likely to eat little or nothing for the next five days or longer.

51. NMC guidance also explains how nurses should meet needs for care and support with a patient’s nutrition. It says nurses should observe, assess and optimise a person’s nutrition status and determine the need for intervention and support. It explains that staff should use nutritional assessment tools and assist with feeding and drinking, using aids if necessary.

52. Mr Y’s records show WUTH Trust assessed him for risk of malnutrition on his admission, this was using an estimated weight taken from Ms N of 75 kilograms. Mr Y’s records show his risk was assessed more than weekly on occasions from 10 January 2022, until his discharge in late March 2022.

53. We can see from Mr Y’s records WUTH Trust’s speech and language therapy team (SALT) reviewed him on 25 January 2022 after it was noted he was not managing to eat much. SALT recorded that there were no difficulties reported with Mr Y’s ability to swallow. SALT recommended ward staff feed Mr Y a minced and moist diet. It advised staff to re-refer Mr Y if a reassessment was needed.

54. On 2 February 2022, WUTH Trust’s dietician reviewed Mr Y after he scored highly on assessment for being at risk of malnutrition. Mr Y’s food charts reflect he had a varied intake ranging from ‘adequate’ to ‘very poor’ during this time.

55. The dietician prescribed additional nutritional supplements for Mr Y. The plan was to encourage Mr Y to eat and drink, along with taking supplements. We can see WUTH Trust attempted to follow the plan, as Mr Y’s food charts show he was offered food, drink and supplements.

56. WUTH Trust encouraged Mr Y to eat and drink but this was difficult for him. Mr Y reported not liking the soft diet and refused food and supplements. We can see on 2 March; the dietician reviewed Mr Y again after he scored highly for risk of malnutrition.

57. The dietitian noted Mr Y appeared to be sarcopenic. Sarcopenia is the loss of muscle mass related to ageing. They gave Mr Y a red tray and beaker to indicate to staff that he needed help during mealtimes. Mr Y agreed to try another supplement, and the dietician advised staff to continue to encourage him to eat and drink and to monitor his intake.

58. Mr Y did lose a lot of weight during his admission. WUTH Trust did not need to investigate this further because it knew why this was happening. The dieticians documented Mr Y was losing weight because he was not eating enough and was refusing nutritional supplements prescribed.

59. We can see near to his discharge in late March 2022, the dietician reviewed Mr Y again. They noted whilst there was a discrepancy between the bed weights and chair weight recordings taken for Mr Y, he had a 2.5% weight gain. The dietician also noted Mr Y reported an improvement in his appetite and agreed he may eat other foods, other than minced and moist, if he was able to tolerate it.

60. Whilst we are mindful there was a slight delay in assessing Mr Y’s weight due to broken scales, we do not consider this to be an indication of a failing. Our nursing adviser explained whilst there were known issues with the weight recordings this did not have an impact because WUTH Trust implemented interventions soon after his admission. We also share this view.

61. The evidence indicates during Mr Y’s admission, WUTH Trust screened his nutritional needs and nurses were actively monitoring his intake, referring him to the inpatient dietician when required. WUTH Trust also referred Mr Y to the community dietician team for a follow up review on discharge. Based on the information we have seen we have not found any indications of failings with the way the Trust managed Mr Y’s nutritional needs or found that it discharged him in a malnourished condition. We consider WUTH actions in line with the NICE CG32 guidance we have referred to in paragraph 50 and the NMC guidance in paragraph 51.

62. We have carefully considered Ms N’s other complaints about WUTH Trust. WUTH Trust decided not to investigate Ms N’s other concerns because they were out of time. We consider its decision was in line with relevant guidance.

63. We understand these matters still cause Ms N distress and upset. Our decision is not made without recognising the distressing circumstances around the events.

64. When Ms N first told us about her concerns with WUTH Trust, we noted she had not complained about all the issues to the Trust.

65. During our discussions with Ms N, we identified some of her concerns about WUTH Trust had evolved from those she sent to us in February 2023. In May 2024 Ms N wrote to us with her remaining concerns. We explained that she needed to put these issues to the Trust to investigate.

66. In July 2024, WUTH Trust wrote to Ms N and said it was not able to investigate her complaint as she raised it more than 12 months after she became aware of the issues. It explained this is the NHS time limit for complaints and her complaint was outside this.

67. We have carefully looked at WUTH Trust’s decision to not consider Ms N’s concerns further.

68. Ms N told us she did not pursue her all concerns at the same time because Mr Y’s health had dramatically worsened. Ms N also explained her own health and wellbeing had declined during this time and she needed time to consult with other clinicians about his care.

69. Ms N also said she lost faith in WUTH Trust’s complaint process and was not reassured it would address other aspects of her complaint based previous responses she had received. Ms N says she felt overwhelmed with all that was happening at the time. Ms N explained she felt it was better to wait for a caseworker from our Office to be assigned to her so she could go through her complaints all together.

70. Ms N told us about several reasons for why she did not raise her remaining concerns sooner with WUTH Trust. We are sorry that Ms N was distressed and experiencing health difficulties herself, as well as focussing on Mr Y’s health. We can see that this must have been a difficult time

71. NHS Regulations explain there is a time limit for making complaints to an NHS service. They say that a person must make a complaint within a year of the events, or if later, within a year of becoming aware of their reasons to complain. The Regulations explain this time limit may be set aside where there is good reason to do so, and the complaint can be investigated effectively and fairly.

72. In its July 2024 response, WUTH Trust said Ms N’s WUTH Trust also said it invited her to contact its Patient Experience Team if she wanted further assistance with her complaint at that time. It referred to a later complaint Ms N made in September 2023 to which it responded soon after. WUTH Trust considered Ms N had ample opportunity to raise her additional concerns during this period. It said because two and a half years had passed since events, it did not think there was sufficient grounds to set aside its time limit and re-open Ms N’s complaint.

73. In its July response, we can see WUTH Trust considered the date Ms N knew of her reasons to complain. It explained that Ms N was aware of her concerns about Mr Y’s care and treatment, as she had already raised complaints about different matters in 2021 and 2022. For Ms N’s complaint to have been in time, she would have had to raise her concerns by March 2023 (at the latest).

74. We consider WUTH Trust’s response is reasonable. It was open to Ms N pursue the additional concerns she had about her husband’s care and treatment when she raised other issues in 2021 and 2022. We note that Ms N was aware of advocacy services and their role in supporting people to complain, as WUTH Trust provided this information in an email dated 21 December 2021. The evidence also shows Ms N was able to engage with WUTH Trust on many occasions throughout its investigation into her complaints during 2021 to 2022.

75. We are sorry to learn of the concerns she raised with WUTH Trust and how they have affected her. Based on the evidence, we found no indication WUTH Trust has made the wrong decision, and we have no reasons to think Ms N could not have used the complaint process sooner. We are satisfied WUTH Trust made its time limit decision in line with NHS Regulations. We can see it has appropriately considered whether there is good cause to waive its time limit and applied the correct principles of the guidance. Taking all the above into account, we cannot investigate this aspect of Ms N’s complaint any further.

GP Practice in the Wirral area (the Practice)

76. Ms N has raised multiple complaints about aspects of care and treatment the Practice provided to Mr Y. We will address each of her concerns in turn.

Mr Y’s reported fall in August 2021

77. Ms N told us that when she attended the Practice in August 2021 it was not interested when she told them about a fall Mr Y had.

78. We have reviewed Mr Y’s medical records and cannot see a reference to Ms N disclosing Mr Y’s fall during a consultation on 16 August 2021.

79. We recognise there is a significant difference between the information shared by Ms N and the Practice’s account of this consultation in Mr Y’s records and its response to Ms N. Sadly, we can never be definitive about what happened during the consultation as the available evidence is limited.

80. Before we decide whether we will carry out a detailed investigation there are some checks we must carry out. One of these checks includes considering whether an investigation would be practical and reach a satisfactory conclusion. We may decide not to investigate when there would be no value in providing a response through an investigation.

81. Having carefully considered Ms N’s concern we have decided not to take any further action on this. Whilst we are not disputing Ms N’s recollection of events, we do not have the evidence available to robustly investigate this matter and provide a conclusion.

Failure to use emergency Neurology Registrar to obtain help in August 2021

82. Ms N says the Practice should have telephoned the WC Trust for support when Mr Y’s condition was getting worse. Ms N explains the Practice knew this service was available and it did not make any attempt to use it.

83. In its response to Ms N, the Practice explain in its response this service is usually reserved for times when a GP may be unsure whether a patient needs an urgent admission, rather than referrals for an urgent outpatient appointment, or chasing up a medication change. The Practice say as Mr Y was already under the care of a neurologist and specialist nurse team, it concluded the helpline would have resulted in advice to contact his secondary care providers for further input.

84. The Practice say it was reasonable for them to not contact this service as Mr Y had been recently reviewed by the neurology team on 12 August and it was waiting communication about his medication change. The Practice say the consultant would have prescribed Mr Y’s new medication the same day if they thought it was clinically urgent.

85. Our GP adviser explained it would be down to the clinical judgement of the Practice as to how they communicate with the neurology registrar. They told us there is no guidance to support this, but if the Practice felt Mr Y required admission to hospital under neurology, then contacting the emergency neurology service would have been appropriate. Our GP adviser explained for other situations, calling the nurse advice line or writing to his consultant would have been more appropriate, which is what the Practice did.

86. Mr Y’s records show the Practice did contact the nurse advice line on 20 August 2021 after Ms N called with concerns Mr Y had not received his new medication and was desperate for this. The notes show it did not get a response from the advanced neurology nurse and explained to Ms N it was limited in what it could do. The Practice advised Ms N to continue trying the specialist nurses and secretaries.

87. We understand this was a worrying time for Ms N and her husband. Considering the view of our GP adviser and the evidence we have seen; we believe the Practice acted reasonably when Ms N called for help to chase up a new prescription. This is because we can see it took steps to contact the service, but when it did not get a response, explained to Ms N what she could do. For this reason, we have not found any indication of failing.

Mr Y’s worsening condition in October 2021

88. Ms N told us she found it difficult to care for Mr Y as his health declined, with more falls and worsening behaviour. She believed he needed hospital admission and called the Practice for support, raising concerns about his care home.

89. The Practice said that it did not consider intervention necessary at that time. It offered suggestions to help meet their needs, noted Mr Y’s medication was under review, and the neurology team were considering alternatives. It explained that respite care was a social care responsibility.

90. The Practice did not consider an admission to hospital was needed but felt a face-to-face home review would be beneficial. It noted other healthcare providers were involved in his care and considering an admission for Mr Y. It says it was aware if this did not happen, a discussion was to be had about respite placement

91. GMC GMP guidance says clinicians must provide a good standard of practice and care. If assessing, diagnosing or treating patients, clinicians must refer a patient to another practitioner when this serves the patient’s needs and/or promptly arrange suitable treatment, advice or investigations where necessary.

92. NICE NG71 guidance recommends a comprehensive care plan for adults with Parkinson’s disease, with specialist input, accessible contact points, regular clinical monitoring, continuous support, and home visits if needed. A specialist nurse may assist with interventions and provide reliable information. Family members should also have opportunities to discuss the condition and care.

93. Mr Y’s records show he had several consultations with clinicians from the Practice. It also liaised with Mr Y’s neurology consultant and the specialist nurse. For example, when Ms N called on 4 October to raise concerns about Mr Y’s condition, the Practice arranged a consultation the next day. It examined Mr Y and took a detailed history. It planned to contact WC Trust’s neurology team about its lack of response to Ms N and confirmed a nursing home visit was due to take place on 25 October. The Practice said it would review Mr Y again in a weeks’ time.

94. On 7 October, the Practice consulted Mr Y over the phone with Ms N present. Ms N explained they had heard from WC Trust and Mr Y was due to be reviewed at a neurology multi-disciplinary meeting for consideration of an inpatient assessment. Ms N also explained she had discussed respite placement in a care home for Mr Y with social care.

95. We can see from Mr Y’s records he was reviewed by his neurologist on 12 October, who considered an inpatient admission was not necessary.

96. Mr Y’s records show he was admitted to a local care home on 15 October, but social services were not able to assess his capacity as he had a urinary tract infection. Social services said Mr Y needed a GP assessment to determine whether he required a hospital admission.

97. On the same day the Practice discussed Mr Y’s placement at the home with social services. It noted Mr Y recently had a memory assessment and assessment by the community nursing team in recent weeks, with support from therapists. The Practice discussed Mr Y with the social worker and concluded he needed to be in a place of safety. After concluding no other options were available, it arranged a hospital admission for Mr Y.

98. Our GP adviser has said there was no obvious point when Mr Y should have been admitted to hospital prior to 15 October. They explained it was not the Practice’s responsibility to arrange respite care and when it was appropriate for the Practice to refer Mr Y to hospital after discussion with his social worker, it did so. We consider the Practice acted in line with the GMC and NICE guidance quoted in paragraphs 91 and 92 above.

99. We can see leading up to Mr Y’s hospital admission he had become more unwell. We recognise this must have been a very hard time for him and Ms N. We cannot imagine how difficult this was and are sorry to hear about what happened.

100. Following review of the available evidence, we consider the Practice provided support to Mr Y. We can see it acted quickly when concerns were raised by the social worker about the suitability of Mr Y’s care home and arranged a hospital admission the same day. Mr Y’s records show the Practice referred him to community services and liaised with these services when required. Our adviser explained there was no obvious point where the Practice could have offered more support. We also share this view. For these reasons, we have not seen indications anything went wrong in this part of the complaint.

Support for Ms N between August and December 2021

101. Ms N says she contacted the Practice on many occasions to express her concerns about Mr Y’s worsening health. She told us she did not feel it did all it should have to support her during a time of crisis.

102. In its response the Practice say it consulted with Mr Y 17 times from August to December 2021. It explained the care it provided in this period and acknowledged Ms N had social services visiting. It says social prescribers offered help to Ms N which she refused as she knew respite was on the horizon. It said it understood she was in touch with Age UK for carer support.

103. GMC guidance outlines the standard expected for doctors. It says doctors should communicate effectively and be considerate to those close to the patient and be sensitive and responsive in giving them information and support.

104. We can see from Mr Y’s records the Practice where aware of Ms N’s concerns and discussed available support for her as his carer. In early August 2021 the Practice consulted with Mr Y with Ms N present. It acknowledged Ms N needed support with his care and arranged an appointment with a social prescriber for the following week.

105. Later that same month, Ms N had a telephone consultation with the Practice. We can see from Mr Y’s records she discussed the difficulties they were facing. The notes reflect support was offered to Ms N. It understood Ms N was in touch with a local support group. The Practice also sent information to Mr Y about other information and support available to people with Parkinson’s disease.

106. Mr Y’s records reflect on 27 August the Practice called Ms N to check if she needed urgent support. In early September, Ms N reported being at the end of her tether. The Practice understood Mr Y was waiting for an assessment from the community team for respite and was due to be reviewed by his neurologist.

107. In late September, Ms N contacted the Practice again, Mr Y’s records show she reported feeling unable to cope as Mr Y was still waiting for an assessment for respite care. The Practice advised it was social care’s responsibility to facilitate respite care and advised if the situation worsened to where she could not cope at all, it would consider an admission to hospital for Mr Y. Ms N said she would not want this due to the risk of COVID-19.

108. At the start of October, Ms N contacted the Practice again to raise concerns about the support she was receiving. Ms N reported feeling shackled by carers coming to the house at unpredictable times. She expressed feeling very upset and unhappy with the support she was receiving. The Practice acknowledged Ms N’s concerns and said they would discuss this with Mr Y’s district nurse. The Practice was aware social services was considering respite Mr Y at this time.

109. As we have already explained in paragraphs 99 to 103, Mr Y was considered for respite but was eventually admitted to hospital instead due to suitability concerns. This was after social services determined respite was not appropriate for Mr Y.

110. Our GP adviser has explained the Practice acted appropriately regarding the support it offered Ms N and said there was nothing more it could have done. We agree with this view as we can see from Mr Y’s records the Practice referred Mr Y to community services, as well as social services who later assessed him. Our GP adviser told us the Practice was not responsible for how much care was provided to Mr Y to help support Ms N.

111. We appreciate Ms N feels she was not supported enough during this time. We understand this must have been a distressing period. Based on the evidence we have seen we consider the Practice acted in line with the GMC guidance we have referred to in paragraph 103. This is because we can see when Ms N told the Practice about her distress and needing help, it took meaningful steps to provide support and signposted her and Mr Y to appropriate services which could offer help.

Safeguarding measures taken

112. Ms N told us she had relayed her concerns to the Practice that Mr Y was having falls every day while in a local care home in December 2021. She says it failed in its duty of care by not taking any safeguarding measures to intervene.

113. In its response to Ms N, the Practice said it was copied into emails where she had raised concerns about her husband’s care home. The Practice considered her contact with other healthcare providers and social workers and thought they were best placed to consider her concerns and respond to any safeguarding concerns. It said on review of Mr Y’s medical records it considered the care it provided was sufficient.

114. Mr Y’s records show in December 2021, Ms N contacted the Practice with concerns about Mr Y’s care home placement and risk due to frequent falls. The Practice said it would contact social services who had funded the placement to discuss a nursing assessment.

115. After speaking with Mr Y’s social worker, the Practice understood staff were aware of Mr Y’s risk of falls and were monitoring this. Mr Y’s records also show the Practice did visit him and he had already been assessed by the community physiotherapy team due to his risk of falls. In late December, the Practice spoke with Mr Y’s social worker again and understood they were looking into alternative placements for Mr Y, after Ms N raised concerns about this. Our GP adviser explained it was evident from Mr Y’s records that social services were involved, and Mr Y’s risk was due to his medical condition, rather than poor care.

116. We have carefully reviewed Mr Y’s medical records and considering the views of our GP adviser, have not identified any indication the Practice should have done more to intervene when Ms N raised concerns about the suitability of the care home he was placed in. This is because, as we have explained this responsibility lay with social services. This means we see no indication of a failing here.

117. We are sorry to learn about the events that led Ms N to contact us and the difficulties she has faced. We recognise she has been through a challenging time and do not doubt the impact this has had and continues to have on her. We thank her for sharing the details of her complaint with us. We recognise our decision may be disappointing for Ms N, we regret any further upset this decision may cause her.

1. We have carefully considered Ms N’s complaint about WC Trust, WUTH Trust and a GP Practice in the Wirral area. It is clear from what Ms N has shared with us these events have continued to cause her great upset and distress. We know how difficult this time has been for her and how much she has been affected by the sad death of her husband, Mr Y. We extend our sincere condolences for her considerable loss.

2. In relation to her concerns about WC Trust, this complaint falls outside of our time limit, and we have decided there is no good reason for us to put our time limit aside to consider it further.

3. Having reviewed all the information provided by Ms N about WUTH Trust, we have decided not to consider the complaint further. This is because we have seen no indication that anything went seriously wrong.

4. We have also considered Ms N’s concerns about a GP Practice in the Wirral area and have not seen any indications that the Practice did anything seriously wrong.