Liverpool Universities NHS Foundation Trust

5. Ms C complains about the following aspects of the care and treatment provided to her mother, Ms A in 2023. Specifically, Ms C says the Trust:

• did not appropriately communicate with the family with care and treatment decisions • did not communicate with empathy when her mother died, and • did not provide Ms A with appropriate hygiene care.

6. Ms C describes her mother’s experience as distressing and says this has left her feeling deeply traumatised and unable to sleep. Ms C expresses significant feelings of guilt for not being present at the time of her mother’s death and says she is struggling to stop replaying the experience in her mind.

7. As an outcome to her complaint, Ms C would like an apology and service improvements.

8. The following is a summary of events to put our understanding of the complaint into context.

9. Ms A was admitted to hospital in August 2022, with low haemoglobin (red blood cells) levels. As such, Ms A required a blood transfusion. A blood transfusion is a common medical procedure where donated blood or blood components (like red cells, platelets, or plasma) are given directly into a patient's vein through an IV drip, usually in the arm, to replace lost blood or boost blood levels due to illness.

10. During her inpatient stay in September 2025, Ms A was administered enemas with a pad placed underneath due to a lack of bowl movements. Enema is fluid that is placed in the rectum through the anus (back passage) to clear the bowel. Ms C believes this made her mother uncomfortable.

11. During her inpatient stay, the Trust conducted an X-ray of Ms A’s foot. Following this, the Trust also carried out a computed tomography (CT) scan of Ms A’s chest. The CT scan showed signs of a chest infection. To alleviate her symptoms, Ms A was prescribed antibiotics.

12. An X-ray is a quick and painless procedure commonly used to produce images of the inside of the body. A CT scan is a test that takes detailed pictures of the inside of your body. It's usually used to diagnose conditions or check how well treatment is working.

13. Ms C tells us she carried out a lot of her mother’s personal care between August 2022 to October 2022. Ms C said she was concerned about her mother’s hygiene standards and oral care. Ms A was immobile which meant she was unable to wash her hair.

14. In October 2022, Ms A’s blood pressure dropped, and staff contacted Ms C to inform her of her mother’s deterioration.

15. Ms A sadly died in October 2022, following a deterioration in her health.

Communication

18. In her complaint to us, Ms C tell us the Trust failed to appropriately communicate decisions regarding her mother’s care and treatment.

19. Specifically, Ms C says the Trust failed to inform her of the following:

• X-ray • CT scan • administration of enemas and • administration of antibiotics.

20. The Trust explains Ms A had an X-ray of her left foot on 1 September 2022. The indication for this X-ray was that Ms A had a dry left foot with gangrene present. This was discussed with the vascular team, and the medical treatment plan was to receive antibiotics. The Trust explains Ms C and her brother were informed of this.

21. In its response, the Trust explains Ms A attended a CT scan of her chest on 15 September 2022, which showed a likely infection for which she received intravenous antibiotics. This is when antibiotics are delivered directly into the bloodstream via a small tube (cannula) in a vein.

22. On 21 September 2022, the Trust explains it updated Ms A in length with up-to-date details and the treatment plans. The Trust apologises if Ms A’s attendance and the subsequent treatment that followed was not explained properly.

23. The Trust explains it prescribed Ms A a phosphate enema, which was then administered by the nursing staff. It is documented Ms A received several enemas during her admission, and these were prescribed for constipation. In its response it goes on to explain, when a phosphate enema is administered to a patient it can be difficult at times for the patient to retain the volume of fluid that is administered into the rectum (this is usually 118 millilitres), as well as then any faeces that is then passed; this can often occur with limited control. Therefore, patients will often have an incontinence pad placed underneath them during the administration of an enema.

24. The Trust apologised this particular aspect was not explained to Ms C and her family at the time.

25. The relevant standard we will refer to here is the GMC’s Good Medical Practice guidelines which state:

‘Communicating with those close to a patient

‘You must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information.’

26. We have reviewed Ms A’s medical records from the relevant period. We can see Ms C and her brother were informed of the X-ray results and were advised of the subsequent treatment plan. The records demonstrate a discussion has taken place with Ms C around Ms A’s current clinical situation. The records show Ms C was advised Ms A was too frail, and a management plan has been discussed with vascular team and the agreement for conservative management. During this period the main priority was to control symptoms, and that the Trust had referred Ms A to the palliative care team for review and advice regarding the management plan. The records show Ms C was happy to proceed with this plan.

27. With respect to Ms A’s concerns regarding the communication of the X-ray, CT scan and administration of antibiotics, we consider there is evidence to suggest the Trust acted in line with the GMC guidelines.

28. With respect to the administration of enemas, there is no evidence to suggest the Trust communicated this information to the family.

29. We can see from the Trust’s response that it has acknowledged the experiences Ms A had, as well as providing an explanation for why this happened. Further to this, the Trust has provided evidence of changes it has made to improve nursing standards on the ward such as speaking to staff regarding the importance of fully explaining all procedures to patient’s and relatives if required, so to avoid any worry, concern or confusion.

30. We consider the Trust has responded to the complaint in line with the NHS Complaint Standards (Summary of Expectations – December 2022) with regards to giving fair and accountable responses through meaningful and sincere apologies and explanations and promoting a learning culture.

31. For this reason, we consider the Trust has provided a proportionate remedy and has put into place the service improvements Ms C is seeking as an outcome to her complaint.

Duty manager

32. Ms C raises concerns about the Trust’s duty manager. Specifically, she says, on the day Ms A died, she questioned why she was not informed of her mother’s deteriorating health prior to her passing. Ms C says the duty manager showed no empathy and or compassion.

33. In its response the Trust explained it is documented by the ward manager that Ms C had become understandably very distressed when she arrived onto the ward, however while trying to explain to her that her mother had just passed away and express condolences, Ms C had become aggressive towards the ward manager, invading his personal space and putting her head against his face in an aggressive manner on two occasions. This made the ward manager step away. The ward manager then documented that he had to remind Ms C this was a hospital setting, and for her to refrain from being aggressive and abusive towards him or the nursing team, or she would have to leave the ward until she had calmed down.

34. The Trust apologised this was Ms C’s experience during such a sad and upsetting time, and that Ms C felt there was no compassion or empathy displayed from the ward manager or the ward staff. The Trust explained this feedback was passed onto staff.

35. We do not have an independent account of what happened within Ms A’s medical records. When considering this point, we paid particular attention to what Ms C told us and looked to see if there was any evidence in the medical records which we could use to support her account. We have been unable to identify any records or any other supporting information which would allow us to challenge or criticise the information provided by the Trust.

36. It is important to note that any indications of service failure we identify are supported by the evidence available to us and we must acknowledge where there is a lack of evidence to support a complaint.

37. We were sorry to learn this was the experience Ms C had during a difficult period of time, and we appreciate this is not what they would have expected. We would expect staff to display a caring and empathetic attitude for each patient, and if this did not happen, we recognise how distressing and concerning this would have been for Ms C. It is important to state we do not dispute Mr C’s recollection of events.

38. Unfortunately, we were not present at the time to independently know what, and how, things were said. We accept that the staff attitudes may not have been as expected. We also recognise that in some instances each person involved in the same conversation can come away with a different perception of its contents and what happened. One person’s perception of what was said does not invalidate another person’s opposing perception of the same comment.

39. We are left without independent supporting evidence that would indicate to us that a service failure took place. However, we can see from the Trust’s response it has acknowledged Ms C’s concerns and has provided an apology for the experience she had.

40. Further to this, the Trust has taken the feedback and shared this with the team to ensure service improvements going forward. Whilst we recognise this does not change the experiences Ms C had, we consider the Trust has responded to the complaint in line with the NHS Complaint Standards (Summary of Expectations – December 2022) with regards to giving fair and accountable responses and promoting a learning culture.

Hygiene

41. In her complaint to us, Ms C tells us she often provided most of Ms A’s personal care. She explains the Trust failed to wash Ms A’s hair and also failed to offer help with oral hygiene.

42. In its response the Trust explains it is documented with in Ms A’s medical records, Ms A was fully assisted with oral mouth care and that her dentures had been removed cleaned & replaced. It explains this is evidenced within the mouth care daily recording sheet within Ms A’s medical notes.

43. It adds in its response, on further review of Ms A’s medical & nursing notes, it is documented daily at least on one occasion that Ms A was assisted fully with washing and personal hygiene. However, it was unable to find any evidence that Ms A was assisted to have her hair washed with assistance from the nursing team.

44. GMC guidance explains that the failure to address basic needs like hygiene is seen as a serious breach of patient care and can constitute neglect.

45. We reviewed Ms A’s medical records. We have seen evidence to suggest assistance with oral hygiene was provided however we could not see any evidence to suggest Ms A’s hair had been washed. Based on the information available to us we consider the Trust did not provide the standard of care that would have ensured that Ms A was receiving the most appropriate and effective hygiene care based on her needs at the time. As this was not done, we consider there are indications of service failure relating to this part of the complaint.

46. The Trust has apologised Ms A was not assisted to wash her hair during her admission on the ward, especially given the length of time that she spent on the ward. It explained there are shower caps that contain shampoo so that the nursing staff can wash a patient’s hair if they are unable to have a shower. The Trust explained this would be discussed with all nursing staff within the division of surgery in the next matron and ward manager meeting, and also with the nursing team that had previously worked on Ms A’s ward.

47. We consider the approach taken by the Trust is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.

48. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.

49. The Trust has acknowledged staff should have provided support to Ms A and has explained what actions it has taken to address, so that service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.

50. We appreciate the time and effort Ms C has taken to bring her complaint to us. We were sorry to learn of her concerns and hope that our explanations provide her with reassurance.

1. We have carefully considered Ms C’s complaint about Liverpool Universities NHS Foundation Trust (the Trust). We were sorry to learn how Ms C and her late mother, Ms A, were affected by the concerns raised. It is evident both Ms A and her family experienced a difficult time.

2. We have also carefully considered the information provided by Ms C and the Trust as well as considering the standards and guidance relevant to Ms A’s period of care. We consider there are indications of poor care and communication.

3. We have considered the impact this had on Ms C and Ms A including the outcomes she seeks, and what the Trust has done to put things right for them and to improve its services. After doing so, we do not consider there is anything further for the Trust to do. We will explain the reasons for our decision in this statement.

4. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Ms C for sharing her experience with us. It is important to acknowledge that where we have not identified any indications something went wrong in relation to Ms A’s care, it does not detract from her experience, nor the impact this had on her and her family.