East Sussex Healthcare NHS Trust

4. Mrs O complains about aspects of care provided to her husband, Mr O, by the Trust in December 2024. Specifically, she complains:

• the Trust failed to keep Mr O’s family adequately informed about his condition • while at the Trust, Mr O suffered an injury to his rib and bruising • the Trust failed to provide adequate reasoning for Mr O’s rib injury and bruising.

As a result of this, Mrs O says Mr O had no family with him whilst he was severely ill and dying. She says this would have made him feel scared and lonely, thinking none of his family came to be with him. Mrs O says the family has been severely traumatised from having Mr O attend the Trust for a routine appointment, then to seeing him at the end of his life in a very short period time. Mrs O says the family were unprepared as to what to expect when they went to see Mr O and were taken to a full ward in the early hours.

Mrs O says they were left with only minutes to spend with Mr O before he died. The family were left to themselves afterwards with no information as to the next steps or given any space to come to terms with his loss. Mrs O says her and the family still have feelings of guilt and trauma. Mr O’s family have been left distressed due to Mr O’s rib injury and bruising, and the Trust’s explanation about this.

As an outcome to the complaint, Mrs O would like service changes and a financial remedy at a minimum of £3,750.

5. Mr O had chronic myelogenous leukaemia (cancer affecting bone marrow and white blood cells) and empyema (accumulation of infected fluid or pus) of the lung.

6. In December 2024, Mr O presented to the Trust due to shortness of breath. The Trust admitted Mr O for further tests.

7. The next day, at around 2am, Mr O’s condition deteriorated and he sadly died.

Communication of Mr O’s condition

11. 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 decided we are unable to make a decision on this part of the complaint with the evidence available.

12. Mrs O complains the Trust failed to keep Mr O’s family adequately informed about his condition.

13. There is no specific guidance which outlines when a Trust should contact a patient’s family in relation to their condition. The GMC guidance says doctors must be considerate to those close to the patient and be sensitive about giving them information and support. Our adviser said it is good practice for a clinician to inform a patient’s family if their condition deteriorates.

14. We can see from the records the Trust documented Mr O’s family was contacted by the resident doctor following his admission. The doctor noted they informed Mr O’s family he was ‘very unwell’, he was being ‘treated for multi organ failure’ and when the family asked him if Mr O was going to die that evening, the family were told ‘things could go either way’.

15. Our adviser has said this is the type of information that should be shared with the family in communicating the gravity of a situation such as in Mr O’s case. Our adviser highlighted it is not always possible to give a precise prognosis, and decline and death can often be rapid and unpredictable.

16. Mrs O has explained the Trust did not tell them Mr O had multiple organ failure. She says if it did, Mrs O and the family would have come to the hospital to be by Mr O’s side and spend as much time with him as possible. We recognise Mrs O’s frustration and anxiety around this issue.

17. We recognise there is a disparity between how the doctor noted the conversation occurred, and Mrs O’s recollection of the call, particularly in relation to the communication of Mr O’s multiple organ failure.

18. Our Service Model Guidance says there will be times when an investigation will not be practical, or would not reach a satisfactory conclusion, and there would be no value in providing that response through an investigation.

19. As an independent organisation we need to consider Mrs O’s and the Trust’s recollections. In this case, we have conflicting evidence. We are unable to put more weight on Mrs O’s recollection or the Trust’s evidence. We do not think there is any way for us to be able to reach a view, even on the balance of probabilities, about what was said, and, just as importantly, what was understood. This is because of how contradictory the recollections are.

20. We can see the Trust has apologised for its communication and have said in the future once a doctor has provided an update to relatives, the nursing team will make a follow-up call. This is to ensure families have understood the information provided or if they have any further questions.

21. We acknowledge how distressed Mrs O is by not having longer to spend with Mr O when he was dying. We hope the Trust’s actions provides Mrs O with some reassurance but we understand she may find our decision disappointing and we are very sorry about this.

Rib injury and bruising

22. Mrs O complains while at the Trust, Mr O suffered an injury to his rib and bruising. She has provided us with photographs of the bruising. We understand why seeing Mr O like this has been deeply upsetting for Mrs O.

23. From Mr O’s records, we cannot see any evidence to suggest something traumatic happened while he was at the Trust which could explain reasoning for his injury and bruising. We recognise Mrs O will disagree with this.

24. Our adviser explained it is impossible to say where Mr O’s bruising definitively occurred from. Mr O had bone marrow failure due to his advanced cancer resulting in him having low platelets. Our adviser explained this can lead people to be susceptible to bruising.

25. From the records, we can see Mr O also presented to the Trust with a fall two weeks earlier which could be an explanation for his bruising. We recognise here that Mrs O would likely have noticed any bruising caused by the fall prior that existed prior to this admission.

26. Mr O also had a recent history of a pus collection in his lung (empyema) which would have needed been drained. Our adviser said inserting a drain could also explain his injury. If this was the cause of the bruising, it would not necessarily indicate a failing in how this was done.

27. Given the evidence available, we do not think we would be able to come to a robust decision on if Mr O’s injury and bruising occurred while he was at the Trust. Even if we were able to say it did occur while he was at the Trust, we do not think we could say whether the bruising was caused by a failing in the Trust’s actions.

28. There are a number of possible reasons for why the bruising may have occurred. We cannot say which is more likely to have occurred, or whether this was due to a failing or a known complication. We understand Mrs O may find this decision disappointing.

29. Mrs O also complains the Trust failed to provide adequate reasoning for Mr O’s rib injury and bruising.

30. GMC guidance states clinicians must be considerate to those close to the patient and be sensitive and responsive in giving them information and support.

31. As explained above, we think it is not possible to say what the likely cause of Mr O’s rib injury and bruising was. We therefore cannot say if it occurred due to any failing by the Trust.

32. From the Trust response, we can see the Trust explained the rib fracture and the haematoma were in different places, with the fracture was towards the front/side of the chest and the haematoma towards the back. Because they are not close to each other, the Trust thought they were likely unrelated.

33. The Trust also explained there had been no issue with Mr O’s chest drain insertion it did not feel his hematoma was caused by this. It also explained it is possible for people to suffer from a rib fracture by coughing and Mr O had a cough. The Trust said it could not be sure what caused his hematoma.

34. Our adviser said the reasoning the Trust provided Mr O’s family was adequate. They said Mr O’s bruising was likely due to a number of factors including his bone marrow failure and low platelets.

35. We acknowledge how distressing it was for Mrs O to learn of Mr O’s injury and bruising, and we understand this has left her very concerned. We have seen no indication of failing in the Trust’s reasonings in relation to Mr O’s rib injury and bruising. As we have explained above, we do not think it is possible to say, even on the balance of probabilities, what the likely cause of Mr O’s bruise was.

36. Because we have not seen any indication something has gone wrong here, we will not be considering her complaint further. We understand Mrs O may be disappointed with our consideration but hope we have explained our decision clearly.

1. We have carefully considered Mrs O’s complaint about East Sussex Healthcare NHS Trust (the Trust). We acknowledge how stressful the events she has shared with us were for her and we extend our condolences for the loss of Mr O.

2. Given the evidence we have seen, we have been unable to reach a robust decision on whether the Trust adequately kept Mr O’s family informed about his condition. We have also been unable to come to a robust decision whether Mr O’s rib injury and bruising occurred due to a failing by the Trust.

3. We have seen no indication the Trust did anything wrong in its communication around the possible reasoning provided as to why Mr O had sustained a rib injury and bruising. We have explained our decision below.