An independent provider in the Basildon area

3. Mr A complains about aspects of care that St Luke’s Hospice provided to his wife, Mrs A. He specifically complains: • his wife had a urinary tract infection (UTI) which was not picked up in June 2024 • a safeguarding referral regarding his behaviour was made on 20 June 2024 • his wife was left to sleep in a chair overnight on 20 June 2024 while at her cleaner’s house.

4. He says as a result his mental health has suffered. He says he was separated from his wife which was distressing, and he has been worried and anxious that her care and treatment could have been better.

5. He is seeking an apology.

6. Mrs A was 72 years old at the time of the events.

7. Mrs A was diagnosed with metastatic cancer of unknown origin in September 2023. Repeated scans in December 2023 showed progression of cancer. She was receiving community palliative care input from the Hospice.

8. She was admitted to the Hospice for respite care on 21 June 2024, and she was discharged home on 22 June 2024.

Urinary tract infection (UTI)

12. Mr A complains his wife had a UTI which was not picked up on by the Hospice.

13. According to the NHS web page on UTIs, the typical symptoms of a UTI can include pain or a burning sensation when peeing (dysuria), needing to urinate more often than usual, blood in your urine, a high temperature, urine that is cloudy and lower tummy pain or pain in your back, just under the ribs.

14. We have seen from the records the first discussion of any urinary symptoms was with the hospice nurse on 14 June 2024. The records show Mrs A often had blood in her urine due to her diagnosis of bladder wall cancer. Therefore, this may not be an indicator of a UTI for Mrs A. The records state she had told the nurse from the Hospice that she had begun to struggle to pass urine (obstructive uropathy) on 14 June 2024. The nurses questioned if her struggling to empty her bladder was a UTI or an irritable bladder. At this time, Mrs A was already under the continence clinic so the nurse recorded she would ask them to assess her.

15. At this time, Mrs A reported no other symptoms other than struggling to pass urine. The NHS England ‘Diagnostic decision tool for adults over 65 years with suspected UTI’ states a urine sample should be taken if the patient has new onset dysuria (pain or discomfort when urinating), or two or more of the following symptoms:

• Fever • New frequency of urgency • New incontinence • New or worsening delirium • New suprapubic pain • Visible haematuria 16. Our adviser said as Mrs A only had one symptom set out above, and she did not have pain while urinating, and so a urine sample was not required. It is therefore appropriate the nurse to record they would ask the continence clinic to assess her.

17. The next visit was on the 18 June 2024 and no complaints of any urinary symptoms were raised. Nurses requested a GP review following this visit.

18. We have seen from the records the first symptom of a possible UTI was reported to the Hospice doctor on 21 June 2024. The records detail Mrs A said she is feeling like she is starting to get a UTI, and she is avoiding drinking as she did not want to use the toilet. The nurse encouraged her to drink and stay well hydrated.

19. Following this, on 21 June 2024, Mrs A was reviewed by the Hospice Consultant, and a urine dip was requested.

20. On 22 June 2024, the records note Mrs A had symptoms of a UTI including a burning feeling when passing urine. It is noted that Mrs A always felt like this when a UTI is developing. Leucocytes (white blood cells) were documented in her urine dip. The antibiotic nitrofurantoin was prescribed on the same day.

21. Our adviser directed us to NICE Guidelines ‘Urinary tract infection (lower): antimicrobial prescribing’, 2018, states: ‘Consider … an immediate antibiotic prescription (see the recommendations on choice of antibiotic) for women with lower UTI’.

22. The records show the first concerns of a suspected UTI were raised on 21 June 2024 and dealt with promptly. Mrs A was prescribed an antibiotic within 24 hours of the concerns first being raised.

23. We understand it is very concerning to feel more treatment could have been provided for a loved one. We have found Mrs A was treated appropriately by the Hospice. We will not take further action on this element of Mr A’s complaint.

Safeguarding referral

24. Mr A complains a safeguarding referral was made on 20 June 2024 regarding his behaviour. He states this was ultimately not substantiated and this has caused his mental health to suffer.

25. The Hospice says staff focus on the needs of the individual and those close to them, although this is guided and led by the patient. If the individual has concerns, the hospice will work with the patient to respect their wishes and keep them safe in their care. The Hospice apologised Mr A felt his needs were disregarded during this contact with the team, and it was never the intention to cause any distress.

26. Southend, Essex, and Thurrock (SET) Safeguarding Adults Guidelines, ‘stage 1- raising concerns’, states:

‘A safeguarding adult concern is when there is a suspicion that an adult at risk is experiencing or has experienced, abuse or neglect, or there is a concern that the adult at risk is neglecting to look after their home, personal care, health or social requirements and it is having a negative effect on their quality of life and or safety.

An adult at risk is someone who: 1) has or appears to have care and support needs 2) may be subject to, or may be at risk of, abuse and neglect and 3) may be unable to protect themselves against this’

27. Our adviser said Mrs A met the threshold as an adult at risk in line with these guidelines. She required palliative care from nurses, and she raised concerns about Mr A, stating she feared he would taint her food or adjust her medication.

28. The national safeguarding policy states it is important for public services work together to take action to support the prevention of abuse or neglect. The Office of the Public Guardian Safeguarding Policy states: ‘4.2. Safeguarding is about protecting certain people who may be in vulnerable circumstances. These people may be at risk of abuse or neglect due to the actions (or lack of action) of another person. In these cases, it is vital that public services work together to identify people at risk, and put steps in place to help prevent abuse or neglect’.

29. On 20 June 2024, Mrs A contacted the Hospice nursing team. She is reported to have been very upset on this call, and she was with her chiropodist. She said she had to make the call when someone else was in the house, otherwise her husband would take her phone away from her.

30. Nurses visited her home immediately after this call. Mrs A said she was afraid her husband may taint her food or add medication, as she has not felt right over the last few days. Mrs A said she was worried the Hospice staff would not think she had capacity with these claims. It was recorded she repeated the date, and she was able to have a rational conversation. The nurses reassured her she is deemed to have capacity unless there was evidence to suggest otherwise.

31. The discussion included Mr A. According to the records, Mrs A did not feel heard by her husband, and she felt Mr A needed support. Mr A said he was tired, and the conversation was brought to a close as all parties agreed this conversation was not resolving anything.

32. As a solution, Mrs A made the choice to go to her friend’s house on 20 June 2024. She was then admitted to the Hospice on 21 June 2024. Mrs A had the capacity to make these decisions. The records on 21 June 2024 state ‘doesn’t appear confused. … She is able to give a clear history of her cancer and no concerns about capacity.’

33. The safeguarding guidance was followed (stage 1 – raising concerns), because there were clear indications raised by Mrs A that she was at risk of abuse or neglect (husband ‘would take the phone from her’ and ‘may taint her food or add medication’). This quantifies her, according to the SET Safeguarding Adult Guidelines, as a person at risk.

34. We recognise this has been extremely stressful and difficult for Mr A. We know the safeguarding concern was ultimately not substantiated, but it is important for all concerns such as this to be taken seriously, and for appropriate action and intervention to be taken.

35. We have seen the Hospice acted in line with the relevant SET guidelines and has taken appropriate action when concerns were raised. We therefore will take no further action.

Mrs A stayed at a property unknown to the Hospice

36. Mr A complains his wife slept in a chair overnight in a property with four other males present on 20 June 2024. He states this property was in the catchment area of the Hospice, but it was not visited by Hospice staff, and his wife had never been there before.

37. The records state initially the Hospice was going to provide a bed for Mrs A as a temporary measure, which she initially agreed to do. However, she changed her mind and decided to go and stay with a friend.

38. Mrs A had the capacity to make this decision and could stay where she chose to on 20 June 2024. In the records it notes there were no concerns regarding her capacity. The Mental Capacity Act 2005 ‘Code of Practice’ sets out capacity must be assumed unless demonstrated otherwise. In line with the safeguarding guidance above, she was able to make this decision, and the Hospice could not have prevented her from doing this. The Hospice is not responsible for Mrs A staying at another property.

39. We know this has been a very difficult process for Mr A, and we do not wish to diminish his concerns. We have not identified any failings in the care and treatment provided by the Hospice. We thank Mr A for bringing his complaint to our attention.

1. We have carefully considered Mr A’s complaint about St. Luke's Hospice (the Hospice).

Having carefully considered this complaint, we have seen no indication anything went seriously wrong.

2. We understand this has been a stressful and difficult experience for Mr A, and we were sorry to hear about his concerns. We hope our report can provide him with reassurance that appropriate action was taken for his wife’s care.