University College London Hospitals NHS Foundation Trust

6. Mrs C complains about Mr C’s experience with University College London Hospitals NHS Foundation Trust (the Trust) on, and directly following, 13 March 2024. Specifically, she says:

• the Trust changed the location of Mr C’s appointment on 13 March after arriving at hospital at short notice and the Trust’s response to this aspect of the complaint does not make sense • the doctor Mr C saw on this day was rude, dismissive and lacked compassion • the letter Mr C received following this appointment contains inaccuracies about his condition and medical history. She feels the content was based on lies about what they discussed with Mr and Mrs C.

As a result of these concerns, Mrs C tells us that:

• moving location was extremely difficult due to Mr C’s fatigue and mobility issues and a car nearly hit him when they made the journey to another part of the hospital • the doctor’s attitude prevented Mr C from speaking and asking questions he wanted to ask about his condition. Mrs C has said this was upsetting and unnecessary • the inaccuracies within the clinical letter have led to the Trust discharging Mr C from its care. She says this will prevent future investigations and may mislead doctors he sees in the future.

7. Mrs C wants a full redaction of the letter dated 14 March. She also wants the opportunity to see other doctors to discuss his condition and potential alternative treatment options.

8. Mr C suffered a stroke in 2020. Since then, he has been under the care of the Trust. It appears that, since suffering the stroke, doctors have considered his stroke to be cryptogenic. This means that the cause of his stroke is unknown.

9. Mr C suffers with fatigue. He takes several forms of medication to treat his ongoing symptoms and with a view to preventing another stroke.

10. In September 2023, the Trust admitted him into hospital for 17 days. The records tell us this was due to a decompensation event following his original stroke. Decompensation events usually occur when a stroke patient is extremely fatigued, and the effects of these events often resemble those of a stroke.

11. Following this inpatient stay, Mr C had a follow-up appointment on 13 March 2024. The Trust changed the room of this appointment on the day, after Mr C had already arrived at hospital.

12. After travelling onwards to the new room at which the appointment was due to take place at, Mr and Mrs C had to turn back, and the appointment took place at the room it was meant to originally.

13. After the appointment, Mr C received a discharge letter which outlines the doctor’s observations following the appointment. The Trust has now discharged Mr C from its care as it considers it has investigated the cause of Mr C’s stroke thoroughly.

16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right.

17. Having done so, we consider that the Trust’s explanation and apology about the room change, and the doctor’s attitude at the appointment, was appropriate.

18. Regarding the concerns about the content of the letter that the Trust declined to change, we have not found any indications that something has gone wrong.

Room change

19. Mrs D says that the Trust changing the room, after she and Mr D had already arrived at the hospital, was frustrating and dangerous.

20. She has told us that Mr D was struggling to walk and was, at one point, almost hit by a car. She does not feel the Trust has adequately explained why this happened.

21. In its first response to this complaint, the Trust said there was confusion about the location of the appointment as, although it was moved, the database used to issue letters was not updated. As the appointment eventually went ahead in the room the Trust originally planned it to, Mrs D does not feel this explanation was adequate.

22. On the back of this, we contacted the Trust for more clarity. The Trust said that, after the original confusion, the doctor requested the use of the original room, as they realised that this was going to affect not only Mr C, but all the patients they were due to see that day.

23. It is unfortunate the Trust identified this at the time of Mr C’s appointment. This would have been frustrating, and we recognise it was more problematic given Mr C’s health at the time.

24. Our NHS complaint Standards say that organisations should explain why things went wrong and identify suitable ways to put things right for people. It says that organisations should give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned.

25. They go on to say that organisations should identify suitable and appropriate ways to put things right for people who raise a complaint.

26. The Trust acknowledged that the confusion on the day was an error, and it apologised for the distress this caused. The Trust also recognised that the impact of this was more significant given the extreme fatigue Mr C was dealing with at the time.

27. The Trust has confirmed that a meeting took place following this incident. It went on to say that, following this meeting, it subsequently implemented a change which will ensure its internal database updates to make sure the letters reflect the correct location of the appointment. The Trust also said that it will phone patients if staff feel there are any potential issues with the database.

28. We recognise that the Trust’s response does not, in Mrs C’s opinion, explain in enough detail as to how this issue occurred. We think it was enough for the Trust to tell her this was an error, because on balance, that’s what it was. It was also appropriate for the Trust to look into this further to prevent it happening again. By offering the apology it has, and by making improvements to its processes, we consider the Trust has taken this concern seriously and acted in accordance with our Complaint Standards.

29. We do not consider there is anything more we should ask the Trust to do in this instance.

30. Having spoken to both Mr and Mrs C, we recognise this was an unfortunate situation and caused them problems. Our decision should not detract from that.

The doctor’s attitude on 13 March 2024

31. Mrs C complains that the doctor Mr C saw on this day was rude, dismissive of Mr C’s fatigue and did not demonstrate compassion about his overall situation.

32. This is sad to hear. This experience, particularly after the difficulties Mr C had getting to the appointment, was without doubt an unpleasant one.

33. The Trust apologised for the upset and acknowledged that the doctor Mr C saw should have handled the situation better.

34. It confirmed that another doctor had met with the doctor who saw Mr C to discuss how better to communicate with patients. The Trust said this doctor has taken the feedback on board and intends to utilise this when they see patients in the future.

35. The Trust’s acknowledgement of the situation, and its apology, does show us that they took this aspect of the complaint seriously and acted in line with our Complaint Standards. Irrespective of our decision not to consider this aspect of the complaint further, we recognise this was a very difficult day for Mr C.

36. As with Mrs C’s concerns about the change of location, we consider that the Trust has dealt with this complaint appropriately and demonstrated actions it has taken to improve patients’ experiences in the future. Because of this, we do not consider there is any more for the Trust to do in relation to this aspect of the complaint.

The letter

37. Mrs C is unhappy with the discharge letter the Trust sent Mr C after his appointment. She feels, whereas previous doctors considered Mr C’s stroke to be cryptogenic, this doctor included weighted information which suggests the cause may relate to smoking. Mrs C is concerned this may prevent Mr C from getting treatment in future.

38. Mrs C believes the doctor was dishonest and knowingly included inaccurate information within the letter about things Mr C did not mention at his appointment – in particular, information about his father.

39. The Trust did make some amendments to the original letter. It has said there are other aspects of this which it will not change as it is clinically relevant to the overall consideration of the stroke.

40. Point 70 of the GMC’s Good Medical Practice says that doctor should take a proportionate approach to the level of detail, but patients’ records should usually include relevant clinical findings.

41. There were aspects of the letter the Trust had agreed to redact prior to Mrs C raising the complaint with us. Specifically, the Trust agreed to remove its original reference to Mr C’s father dying of a heart attack in his forties.

42. The Trust said the doctor believed Mr C had said his father had died of a heart attack at the appointment but accepted, retrospectively, this may have been a misunderstanding. Since this has been rectified, we consider the matter resolved and will not look at it further.

43. Mrs C believes the doctor included information dishonestly. Having received the letter written by another doctor following his appointment in January 2024, this contained the same inaccurate reference to Mr C’s father dying of a heart attack.

44. Mrs C considers this to be conclusive evidence that the doctor Mr C saw on 13 March based the information in the more recent letter on this and not, as the Trust said, on what was discussed at the appointment.

45. We do not know exactly what was said at the appointment or in what context. We could not say, even on the balance of probability, that the doctor did not mishear this or misunderstand something that was said. Importantly, the Trust has agreed to remove this statement from the letter. By doing this, we consider that it has done enough to rectify this issue, and we have decided not to investigate this concern further.

46. The Trust also redacted a statement which said Mr C struggled to accept his admission in hospital, in 2023, was not related to another stroke but, instead, a decompensation event.

47. At the time of bringing the complaint to us, there were still some statements within the letter which, based on what Mr C had apparently said at the appointment, Mrs C said were incorrect.

48. We contacted the Trust about these points. The Trust told us it would redact the reference to cardiovascular disease on the back of Mr C saying that there was no family history of this. It also said it would reintroduce ‘up to…’ to the statement ‘there was atheroma of his R ICA causing 25% stenosis’. This ensured this statement read the same as earlier records. This addresses Mrs C’s concerns about these aspects of the letter, and we consider it resolved. This means we will not look at it further.

49. Mrs C does not believe this has gone far enough and feels the Trust should also redact the statement about Mr C previously being a smoker.

50. The Trust explained why Mr C being an ex-smoker, however long ago, is relevant to the overall consideration of the stroke. Mr C has confirmed he did smoke in the past. Because of this, we consider that the doctor recorded this information correctly in line with Good Medical Practice.

51. The Trust has explained why it included the information it did and that, after investigating the complaint, several doctors agree that the remaining clinical information Mrs C wants removed is both correct and relevant.

52. Whilst Mrs C feels that the information is ‘weighted’, the Trust confirmed, in its second response to Mrs C, that the stroke is still considered to be cryptogenic. We hope this provides her with the reassurance she is seeking about that.

53. Mr and Mrs C have told us that he has another appointment planned with a stroke specialist under the care of another trust and we wish him well with this.

1. We have carefully considered Mrs C’s complaint about University College London Hospitals NHS Foundation Trust (the Trust).

2. Having looked into Mrs C’s concerns about the location change of Mr C’s appointment and the attitude of the doctor on the day, we consider the explanations given by the Trust, its apologies and the action it took following these concerns satisfactorily addresses these aspects of the complaint.

3. After we contacted the Trust, it agreed to make some amendments to the clinical letter it sent to Mr C following this appointment. We consider these changes adequate, and the Trust provided evidence-based reasons why it will not change the clinical aspects of the letter Mr and Mrs C disagree with.

4. For these reasons, we do not consider there is anything further for the Trust to do and we have decided not to investigate this complaint further.

5. We are sorry to hear about the difficulties Mr C encountered at his appointment on 13 March 2024. We recognise this, the clinical letter he received following this appointment, and his subsequent discharge from the Trust’s care, has caused both him and Mrs C upset.