University Hospitals of Leicester NHS Trust

4. Mr C complains about the following aspects of care the Trust provided to Mr B in August 2023:

• an ascites drain inserted to remove excess ascites fluid from Mr B’s abdomen did not occur until 11 August. Mr C says the Trust had originally planned this for 9 August • the Trust cancelled a barium swallow (an X-ray imaging test which can help diagnose several conditions in the throat) and a gastroscopy (a test which checks the inside of the throat) planned for 14 August. He says this then did not occur until 16 August • whilst waiting for the above procedures, the treating team kept Mr B nil by mouth • on 14 August he requested an X-ray for Mr B but this did not occur until days later • the treating team did not prescribe antibiotics for Mr B’s pneumonia.

5. Mr C believes the actions of the Trust resulted in the death of Mr B on 21 August, causing him untold distress, leaving him unable to sleep or to come to terms with Mr B’s death. He also says the failings reduced Mr B’s quality of life.

6. As an outcome to the complaint, Mr C would like an explanation, an acknowledgement of failings, an apology, and service improvements.

7. Mr B was diagnosed with pancreatic and other cancers from 2017 onwards. Mr B was admitted to hospital with ascites (a condition where fluid collects in spaces in the abdomen) on 9 August 2023.

8. The treating team made a request for ascitic fluid draining on the day of admission and inserted a drain on 11 August. Mr B’s symptoms did not improve and so staff made a request for a gastroscopy on 12 August. The gastroenterology team advised Mr B should have a barium swallow prior to the gastroscopy which the treating team requested on 13 August. Mr B had the gastroscopy on 16 August.

9. On 17 May, Mr B was requiring increased oxygen support, so the Trust requested an urgent X-ray which it performed the same day.

10. Mr B died at 4.30pm on 21 August. His death certificate stated his cause of death as pneumonia with his pancreatic cancer being a contributing factor.

Ascites drain

14. 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 has gone wrong in this area of the complaint.

15. Mr C complains an ascites drain insertion originally planned for 9 August did not occur until 11 August. We were sorry to hear of the distress this delay caused Mr C and Mr B.

16. The GMC guidance says doctor should promptly provide or arrange suitable advice, investigations or treatment where necessary. We have considered if the Trust arranged this procedure in a prompt way in line with this guidance.

17. In response to this part of the complaint, the Trust explained Mr B was admitted to hospital at 1pm on 9 August. However, it explained that before Mr B could have the drain inserted, he required blood tests. When the blood results returned, these showed Mr B’s potassium levels were high and required correcting overnight.

18. We can see that although the Trust had initially planned for the acute oncology service to perform the drain at Mr B’s bedside, the treating team instead requested an ultrasound guided drain insertion by the radiology team.

19. Our adviser explained the type of drain that Mr B required needed a more complex procedure than other drains and required a radiologist to perform the procedure. This is because oncology patients with a limited life expectancy can have a drain left in place which allows fluid drainage as soon as any build up starts to cause symptoms.

20. Our adviser explained the treating team correctly identified a trained radiologist would need to insert the drain as opposed to the oncology team inserting this at Mr B’s bedside. Our adviser was not concerned about the short delay in this occurring and explained that this was relatively timely. The need to correct Mr B’s potassium levels also contributed to this delay.

21. Taking this advice into account, we have seen no indications of failings in the length of time taken to insert Mr B’s drain. This was done promptly in line with the GMC guidance. In reaching this decision, we are in no way underestimating how distressing this period was for Mr B and Mr C.

Barium swallow and gastroscopy

22. Mr C complains the Trust cancelled a barium swallow and gastroscopy originally scheduled for 14 August. He says these did not occur until 16 August.

23. Again, we have considered whether the Trust performed these procedures promptly, in line with the GMC guidance.

24. In its response to this complaint, the Trust said Mr B’s symptoms did not improve after draining the ascites and so the clinical team made a request for a gastroscopy on 12 August. The gastroenterology team advised Mr B should have a barium swallow prior to the gastroscopy. The clinical team requested this the same day.

25. The Trust explained that unfortunately it could not complete the barium swallow the same day as there was no service for this over the weekend. The Trust performed the barium swallow on 14 August at 12.04pm. The Trust said Mr B had the gastroscopy on 16 August after the report for the barium swallow was available.

26. Our adviser said the barium swallow took place within 48 hours of the team requesting it which was a reasonable timeframe in the context of symptom relief. They also advised the time which elapsed from the barium swallow result becoming available up to the gastroscopy being performed was also reasonable.

27. Taking this advice into account, we provisionally consider there are no indications of failings in the actions of the Trust here. Although there were some delays in these procedures occurring, we do not consider these were delayed so significantly that we consider this would indicate a failing in the care provided.

Complaint that Mr B was kept nil by mouth

28. Mr C complains whilst waiting for the barium swallow and gastroscopy the Trust kept Mr B nil by mouth and so he was unable to have any food or fluids. We understand why Mr C is so concerned about this.

29. Again, we have referred to the GMC guidance which says doctors must provide a good standard of practice and care. It says if they assess, diagnose or treat patients, doctors must:

• adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient • promptly provide or arrange suitable advice, investigations or treatment where necessary.

30. The treating team arranged for Mr B to have a barium swallow and gastroscopy as he was experiencing dysphagia (difficulty swallowing) due to recurrent achalasia (a rare swallowing disorder). The Trust said Mr B was kept nil by mouth whilst waiting for the above procedures to prevent him from aspirating. It said during this time, the treating team supported him with intravenous fluids to maintain nutrition.

31. Our adviser agreed there was a risk oral intake could result in aspiration due to Mr B’s dysphagia. He explained being nil by mouth was essential until the investigation (and subsequent treatment) was complete. He also said the fluid administration charts show the treating team appropriately prescribed Mr B intravenous fluids during this time.

32. We understand that in a palliative care setting, keeping a patient nil by mouth may impact their quality of life. Our adviser said it was appropriate for the treating team to keep Mr B nil by mouth whilst waiting for the procedures. This was in line with the GMC guidance as the team had assessed Mr B’s dysphagia and provided suitable advice and investigations to address this. We have seen no indications of failings in relation to this part of the complaint.

X-ray

33. Mr C says he requested an X-ray for Mr B but this did not occur until days later. Again, the GMC guidance is relevant here as this says to promptly provide or arrange suitable advice, investigations or treatment where necessary.

34. The Trust advised the treating team requested the chest X-ray on 17 August. Mr C says he first requested this days earlier on 14 August as he suspected Mr B may have pneumonia. There is no documentation of this request in Mr B’s medical records, but we do not dispute Mr C requested this.

35. The first documented mention of Mr B suffering respiratory symptoms was on 17 August when a doctor noted Mr B had a new oxygen requirement. At 1:33pm, a doctor requested a chest X-ray to be performed urgently (within 12 hours). The Trust performed this the same day at 3:18pm.

36. We consider the Trust requested the X-ray at the earliest opportunity in line with the GMC guidance. In reaching this decision, we considered Mr C’s account that Mr B was showing signs of pneumonia earlier than 17 August. However, there was no mention of any respiratory symptoms prior to this across numerous detailed entries in Mr B’s medical records. We therefore consider that, on balance, the 17 August was the first occasion Mr B had clear respiratory symptoms requiring an X-ray. We have seen no indicated failings here.

Antibiotics

37. Mr C complains the Trust did not treat Mr B’s pneumonia with antibiotics.

38. In response to this part of the complaint, the Trust assured Mr C that it had treated Mr B with antibiotics which would cover pneumonia including co-amoxiclav and tazocin.

39. The NICE guidance for pneumonia outlines the antibiotics which can be used to treat this condition, and this includes both co-amoxiclav and tazocin.

40. The records show Mr B was receiving intravenous tazocin following his chest X-ray. We consider the Trust acted in line with the NICE guidance here and so we have seen no indication of failings in this part of the complaint.

41. We would like to thank Mr C for bringing this complaint to us. Although we have decided not to take his complaint forward, we are in no way underestimating how much these issues have affected him. We hope our decision provides him with some closure around his concerns about Mr B’s care.

1. We were sorry to hear of the death of Mr C’s partner, Mr B. We can see the issues Mr C has raised in this complaint have had a profound impact on him.

2. We have carefully considered Mr C’s complaint about University Hospitals of Leicester NHS Trust (the Trust). We have seen no indication that anything went seriously wrong in the care the Trust provided to Mr B.

3. We appreciate this decision will be disappointing to Mr C as we know how strongly he feels about these issues. We have explained the reasons for our decision below.