The Dudley Group NHS Foundation Trust

4. Mr B complains about the care the Trust provided his father, Mr J, in March 2024. He specifically complains the Trust: • failed to tell him his father was end-of-life in his last few days • refused the chance to stay with him overnight before he died • failed to provide information about his enlarged lymph nodes.

5. Mr B says the impact of these communication failures were lost opportunities to spend time with his father at the end of his life. He says this has significantly impacted him and his family’s mental health. This has caused a loss of trust in the healthcare system.

6. As an outcome, Mr B is seeking an acknowledgement of the failings that took place, lessons to be learnt and a financial remedy.

7. This brief background is only intended to place the key events in context, not provide a full account of everything that happened.

8. ​​Mr J was in his seventies and developed gangrene of two of his toes. The Trust admitted him in February 2024 for amputations. During his admission, he developed fevers with no known cause and staff treated him for sepsis.

9. He had a CT scan which showed enlarged lymph nodes. The scan said the cause may have been lymphoma or prostate cancer. Staff sent off blood tests and planned to perform a biopsy. Mr J and his family decided not to go ahead with this procedure as he had become too frail.

10. Staff explained to Mr J’s family that he would not be suitable for a lot of potential treatments. Staff decided to continue to provide supportive care to him and he sadly died on 13 March.

Telling the family Mr J was end of life

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.

15. Mr J had a CT scan showing enlarged lymph nodes on 2 March. Over the next few days, he had tests to try to determine the cause. Staff planned to perform a biopsy and Mr J decided he did not want this on 11 March.

16. On 12 March, at 12.22, the medical records show a clinician spoke to Mr J’s family (son and wife). They noted Mr J was looking more fatigued despite treatment. They noted he was too frail for a biopsy and would not be suitable for lots of treatment options. They documented the family understood Mr J was likely in the final stages of life. They discussed a plan to provide ongoing conservative and supportive care to Mr J. This meant it would not be appropriate to give him invasive treatments or CPR if he deteriorated.

17. Later the same day, a doctor spoke to the family, but it is not clear which family members were present. The doctor documented the family were accepting he was approaching the end of his life.

18. Mr B says he feels the Trust knew his father was approaching the end of his life for a few days and there was a delay in informing the family about this.

19. Our adviser signposted us to a study that explains clinicians predicting a patient’s death can vary widely in its accuracy. They explained that each patient responds to illness differently and the speed of their deterioration can vary. For this reason, doctors do not usually provide an exact timeline for when death may happen.

20. Our adviser explained that despite the seriousness of Mr J’s condition, he seemed to be stable and there was no indication he was imminently at the very end of his life. Mr J’s medical records show the Trust continued to provide treatment with fluids and antibiotics on the night of 12 March.

21. GMC guidance says doctors should share information about a patient’s condition and likely progression. We consider there was no indication the Trust knew Mr J was nearing the end of his life prior to the discussions that took place on 12 March. On this day, it shared information with the family and so, acted in line with guidance.

Overnight stay

22. Mr B told us the family asked to stay after visiting hours on 12 March. Mr J sadly died in the early hours of the morning.

23. The Trust’s open visiting policy says visitors may be able to visit outside of usual times, if agreed with ward staff in advance. The policy says the circumstances in which this may apply include deteriorating and end of life patients.

24. On 12 March, Mr J’s notes show staff had conversations with his family indicating he was approaching end of life.

25. The Trust acknowledged in its response that it did not offer open visiting, and this would have allowed the family precious time with Mr J. In response to Mr B’s complaint, it apologised for this and explained the service improvements it has made. These include ward staff working with the Trust’s palliative care team and working towards accreditation for end-of-life care.

26. As an outcome, Mr B is seeking an acknowledgement of the failings that took place, learning and a financial remedy.

27. Our service model guidance sets out how we consider cases. It says ‘resolution means delivering an answer or outcome for a complainant that resolves the complaint they have brought to us.’

28. We can see the Trust has acknowledged the failings and learnt lessons in its response. We approached it to see if it would consider a financial remedy. To assist us in considering an appropriate level of financial remedy, as well as casework policy and guidance, we use our severity of injustice scale (our scale). We also review similar cases where the person has experienced similar injustice.

29. Level two on our scale includes cases in which failures in communication caused distress or worry against a background of bereavement. This includes cases in which the opportunity was lost to be with the deceased at the time of death.

30. In line with this, the Trust has agreed to provide a financial remedy of £500. We consider this appropriately reflects the impact on Mr B.

31. Our service model guidance, it says ‘it is for us, and not the person bringing the complaint to us, to decide whether the actions taken have resolved the complaint.’ We consider the above actions from the Trust are sufficient to resolve this part of Mr B’s complaint.

Information on enlarged lymph nodes

32. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so we have not found any indication that these issues had a negative impact on Mr B.

33. The Trust referred Mr J to haematology on 4 March. The haematology team advised doctors to perform blood tests and a biopsy to obtain more information. On 11 March, Mr J decided not to have the biopsy.

34. On 12 March, Mr J’s family asked ward staff for more information about his diagnosis and prognosis. Staff asked the haematology team to speak to the family in person.

35. The haematology team provided a remote review. This means they reviewed Mr J’s notes and results and provided advice but did not see him. They explained that as Mr J had not had a biopsy, he did not have a confirmed diagnosis. Without this, it would not be possible to provide any information on his diagnosis or prognosis. The ward doctor explained this to Mr J’s family.

36. GMC guidance says doctors should be responsive in giving support and information to those close to a patient. In line with this, our adviser explained the haematology team would be expected to see the family if this they requested this. However, this is subject to their clinical commitments and is not always possible.

37. We note the haematology team were unable to provide any further information to Mr J’s family due to him not having a diagnosis. We therefore consider that even if the haematologist had spoken to Mr J’s family, they would not have been able to provide any additional information on his condition or prognosis.

38. The Trust apologised for the lack of haematology review and discussed this with the team for reflection.

39. We recognise Mr B’s frustration that the haematology team did not speak to his family. We consider it would not have been able to provide any additional information the family did not already have from the ward staff.

40. Our NHS Complaint Standards say organisations should take action to make sure any learning is identified and used to improve services. The Trust has apologised and taken steps to learn from this. We consider it has acted in line with our complaint standards and done enough to put right this impact on Mr B.

1. We have carefully considered Mr B’s complaint about the care The Dudley Group NHS Foundation Trust (the Trust) provided his father, Mr J. We were sorry to hear of his father’s illness, and we extend our sincere condolences to Mr B.

2. We have considered all the available evidence. We have seen no indication the Trust did anything wrong when telling the family Mr J was nearing the end of his life. We have seen indications the haematology team failed to speak to the family, but cannot link this to an impact on Mr B.

3. On refusing to let the family stay with Mr J overnight, the Trust has agreed to take steps to put right the impact on Mr B and his family. We consider the Trust’s actions will resolve this aspect of Mr B’s complaint.