An independent provider in the Bury area

3. Miss S complains about the care the organisations provided her mother, Mrs S, between June and August 2023. Specifically, she considers the organisations missed opportunities to identify her mother was seriously unwell.

4. She explains her mother’s health deteriorated during the period of complaint, meaning she was too unwell for a lifesaving operation. She considers this led to her mother’s death. She says this has negatively impacted her mental health and caused her distress.

5. In bringing the complaint to us she would like the organisations to properly acknowledge their failings and make a financial payment in line with level six of our scale.

6. What follows is a summary of events. We have not included all details as all parties are aware of this.

7. Mrs S was 67 years old during the period of complaint. She had a history of portal hypertension (high blood pressure in the major vein that leads to the liver), hiatus hernia (a problem affecting the stomach that can cause stomach acid to travel up to the throat), osteoporosis (a health condition that weakens bones), duodenitis (inflammation of the small intestine), cervical spondylosis (age related wear and tear affecting spinal disks in the neck) and migraines.

8. On 6 June 2023 an advanced nurse practitioner (ANP) from the Practice visited Mrs S at home, examined her and recommended she attend same day emergency care for a vascular review. Mrs S went to the Trust’s emergency department and two doctors examined her, diagnosed her with cellulitis (a bacterial infection involving the inner layers of the skin), prescribed antibiotics and sent her home.

9. On 8 July a GP from the Practice visited Mrs A at home. They examined Mrs S and considered she had Raynaud’s (a condition where blood stops flowing properly to fingers and toes) not cellulitis.

10. On 4 August an ANP from the Service visited Mrs S at home. They were not sure what was wrong with Mrs S and got a second opinion. This led to a diagnosis of cellulitis. The Service prescribed her antibiotics and pain relief.

11. On 14 August Mrs S’s daughter called NHS 111 who agreed to send out an ambulance. NHS 111 staff advised it could be a long wait as it was not an emergency. A paramedic assessed Mrs S and considered she had gout (a type of inflammatory arthritis that causes pain and swelling in the joints) not cellulitis. The paramedic said Mrs S needed a GP review and did not take her to hospital.

12. On 15 August a GP from the Practice visited Mrs S at home which led to them contacting the Trust to ask if the vascular department would offer a same day appointment. The Trust said it could not offer this and asked the GP to make a referral.

13. The GP sent an urgent referral to the Trust’s vascular department who advised it would look at the referral and arrange an urgent appointment within a few days. The Trust offered an appointment for between 26 and 27 September.

14. On 23 August Miss S contacted NHS 111 as she had found her mother on the floor. An ambulance arrived and paramedics took Mrs S to hospital. A junior doctor performed a doppler scan which showed Mrs S had no blood flow from her hips downward. Staff admitted Miss S to a medical ward around 8pm where she remained for the rest of her admission.

15. Doctors moved Mrs S to end-of-life care as she was not responding to treatment and not well enough for surgery. Mrs S sadly died on 1 September 2023.

18. The Health Service Commissioners Act of 1993 (HCSA) says we cannot investigate a complaint where a person has, or had, the option to take legal action. This is unless we consider this is (or was) unreasonable in the circumstances.

19. Miss S brought this claim to us on behalf of her mother, who sadly died on 1 September 2023. Whilst Miss S is the complainant, she is supported by her sister who is the executor of their mother’s will.

20. We consider Miss S, and her sister may be able to make a clinical negligence claim. This is because she has told us each organisation’s actions led to her mother’s deterioration and contributed to her death. As clinical negligence claims are only open to the executor of the will, her sister will need to pursue this.

21. Miss S is seeking a financial remedy. Whilst she was unable to specify a figure, she reviewed our severity of injustice scale (SOI) which sets out our approach to recommending financial remedies and said she would like a financial remedy within level six on our SOI. She is therefore seeking a significant sum, possibly higher than we might recommend if we were to uphold her complaint. Miss S may be able to achieve a higher amount if any legal action she and her sister takes is successful.

22. After establishing there is a possible legal route, we have gone onto explore with Miss S if it reasonable for her to pursue. During our call Miss S said she was open to seeking legal action and had already been considering this as an option. She said she came to us first because the Trust’s complaints response directed her to do so.

23. During our discussion Miss S did not make us aware of any surrounding circumstances which leads us to consider it unreasonable to pursue a legal route.

24. We consider it is reasonable for Miss S and her sister to pursue legal action before she asks us to consider her concerns about her mother’s care. If she is unsuccessful or cannot achieve her desired outcome, she can bring her complaint back to us. We cannot look at concerns a court has already examined, but we may be able to consider if there is anything remaining we can look at, and if there are any other outcomes we may be able to achieve for her.

25. If Miss S wants to bring her complaint back to us, she should do this as soon as she can. This is because complainants must come to us within 12 months from the date they were aware they had reason to complain. We do have some discretion when applying our time limit but there must be good reason for us to put this to one side.

26. For the reasons we have provided, we shall take no further action on the complaint. We hope we have explained our decision clearly. We recognise the significant distress her mother’s death has caused her and thank her for bringing her concerns to us.

1. We have carefully considered Miss S’s complaint about the Practice, North West Ambulance Service NHS Trust, an independent provider in the Bury area (the Service) and Northern Care Alliance NHS Foundation Trust. We are sorry to hear of her mother’s death and the significant impact this loss has had for Miss S.

2. In speaking to Miss S, we consider she could explore taking legal action on her complaint, and it is reasonable for her to do so. We have explained the reasons for this within the following statement.