Taunton and Somerset NHS Foundation Trust

6. Ms B complains Taunton and Somerset NHS Foundation Trust mismanaged the treatment of a groin abscess in July 2023. Specifically, she complains the Trust: • failed to get her consent to touch a groin abscess when on the ward • attempted to drain the abscess under local anaesthetic despite a failed attempt the previous day • removed her wound packing too early following surgery • did not respond to her complaint in a timely manner

7. She says the Trust’s actions caused her an immense amount of pain and distress. She explained the experience impacted her sleep due to nightmares and her ability to work due to anxiety and panic attacks. She told us she had multiple infections following her surgery because the Trust removed the wound packing too early.

8. Ms B explained the prolonged complaints process meant she did not get closure for more than two years. She wants an acknowledgement of what went wrong, service improvements, and a financial remedy.

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

10. Ms B has a phobia of needles. The Trust admitted Ms B at the beginning of July 2023 as she had a right groin abscess (a collection of infected fluid). It attempted an incision and drainage under local anaesthetic on the ward, but Ms B could not tolerate the procedure. An incision and drainage procedure is when a cut is made in the skin over the abscess and the pus inside the abscess is washed out. A dressing is then used to pack the space where the abscess was. Local anaesthetic is medication that numbs an area of body and leaves the patient conscious during a procedure.

11. The Trust arranged for her to be re-admitted the following day so it could carry the procedure out under general anaesthetic. General anaesthetic is a combination of medications that cause controlled unconsciousness allowing patients to undergo surgical procedures without awareness or pain. Ms B discharged herself from the Trust the same day.

12. The following day, Ms B attended the Trust for her procedure, and it reviewed her. Later that day, the Trust carried out an incision and drainage procedure under general anaesthetic to treat her right groin abscess. Following her procedure but before it discharged Ms B, the Trust changed her wound dressing. It discharged Ms B a few hours after her procedure.

15. 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.

Consent 16. Ms B complains the Trust attempted to touch and drain an abscess in her groin when she was on the ward at the beginning of July 2023 without getting her consent to do so. She explained that she was due to go to theatre to have the abscess drained under a general anaesthetic because she could not tolerate the procedure under local anaesthetic. She told us the Trust’s attempt to touch and drain the abscess on the ward were traumatic for her.

17. We were sorry to hear Ms B’s concerns about how the Trust managed the procedure to remove and drain her abscess and the distress and pain this caused her. From our conversations with Ms B, it is clear this was a very stressful situation for her, and she continues to be concerned about the Trust’s actions and how the experience impacted her ability to work and sleep.

18. The medical records document that the Trust admitted Ms B at the beginning of July as she had an abscess in her groin that needed draining. The Trust arranged for her to be re-admitted the following day to have the procedure under general anaesthetic in theatre as she could not tolerate it under local anaesthetic.

19. It appears the Trust reviewed Ms B on the ward when she attended the next day, and it spoke with her about the groin abscess. From the evidence we have considered, we cannot see any documentation to suggest it attempted to touch or drain the abscess when she was on the ward during her second attendance to the Trust.

20. In its response to the complaint, the Trust says it gained verbal consent from Ms B when she was on the ward to examine whether the abscess was suitable to manage under local anaesthetic. It says it decided the abscess was suitable to drain under local anaesthetic and it discussed this treatment option with Ms B who agreed to the plan to attempt this.

21. The Trust explained Ms B became distressed when it attempted to inject her with local anaesthetic, so it abandoned the procedure. It attempted it again a second time with Ms B’s consent, but she asked the Trust to stop so it did.

22. It appears there are conflicting accounts about what happened when Ms B attended the Trust for the second time to have the abscess drained under general anaesthetic. Ms B says the Trust got consent to look at the abscess but not touch it or attempt to drain it and the Trust says it got verbal consent and Ms B agreed with its plan to drain the abscess under local anaesthetic. As the medical records do not fully explain what happened, and we only have a version of events from Ms B and the Trust, we cannot reach a conclusion about what happened or whose version of accounts is more accurate.

23. It is unlikely that we would be able to provide any further information to Ms B about what happened and why, through an investigation. Therefore, we will decline to investigate this aspect of the complaint and take no further action as it is unlikely that we would be able to reach a satisfactory decision about what happened, or why it happened based on the conflicting information available.

24. It is understandable that this will be disappointing for Ms B and we are sorry we cannot reach a conclusion about what happened on the ward when Ms B attended the Trust for the second time.

Wound management 25. Ms B complains the Trust removed the packing from her wound too early following the procedure to drain the abscess in her groin under general anaesthetic. She says this meant she experienced infections following her procedure. We were sorry to hear her concerns that this could have been avoided with different action from the Trust.

26. There are no specific guidelines that instruct clinicians how long to leave wound packing in place for following surgery. However, NICE guidelines on the prevention and treatment of surgical site infections says offer patients and carers clear, consistent information throughout all stages of their care.

27. This information should include the risk of infections, how patients should care for their wound after discharge, how to recognise a surgical site infection, and who to contact if they are concerned.

28. As we explain above, the Trust carried out a procedure to drain Ms B’s abscess under general anaesthetic as she could not tolerate it under local anaesthetic. The operation notes document the Trust packed Ms B’s wound with Kaltostat packing. The information leaflet on Kaltostat packing explains this wound dressing is designed to create a moist environment that assists wound healing. Although it can be left in place for up to seven days, there is no guidance to say the minimum amount of time it should be left in the wound for as this decision is a clinical one.

29. The Trust’s discharge summary following Ms B’s procedure contains advice about how she should care for her wound to avoid infections, what to expect post operatively including what to do and who to contact if she had concerns or experienced any deterioration following her procedure. The discharge summary states the Trust shared this information with Ms B. It also advised her to complete the course of antibiotics her GP prescribed to her. These actions appear to be in line with the NICE guidance above about giving patients information about the risks of infection and wound care.

30. The discharge summary says the Trust removed Ms B’s wound packing before her discharge and it replaced this with a simple dressing. We cannot see any documentation in the medical records about what the wound was like before the Trust removed the wound packing. This means we cannot say if it should have replaced the wound packing with another Kaltostat dressing or if the wound was suitable to be dressed with a simple dressing. The NICE guidance does not say the Trust must document this information either so we cannot say it should have done this.

31. Based on the evidence we have seen, it appears the Trust followed relevant NICE guidance when it gave Ms B instructions on how to care for her wound and who to contact if she had any concerns. As this guidance or the information leaflet on Kaltostat dressings does not specify the minimum amount of time wound packing should be left in place for, we cannot say the Trust’s decision to remove Ms B’s packing when it did, was the wrong decision.

32. For this reason, we have seen no indications that anything went wrong, and we will decline to investigate this part of the complaint for this reason. From what Ms B told us, it is clear she went through a difficult time following her procedure as she experienced infections. We hope our explanations about her wound packing helps to reassure her that it appears the Trust followed relevant guidelines when it managed her wound during her admission.

Complaint handling 33. Ms B complains the Trust handled her complaint poorly as it did not respond to her concerns in a timely manner. She says this delay meant she did not get satisfactory closure to her concerns for over two years.

34. We were sorry to hear Ms B’s concerns about how the Trust handled her complaint, its delays in responding to her concerns, and how this impacted and prolonged her ability to get satisfactory closure. From what she told us, it is clear this was a frustrating time for her.

35. The NHS Complaints Regulations say the organisation must provide a response within six months from the day the official complaint was received. It goes on to say that organisations should keep the complainant informed, as far as reasonably practicable, as to the progress of the investigation.

36. Ms B told us she raised her concerns about her care to the Trust at the end of July 2023, and the Trust told us she initially contacted it with her complaint at the beginning of August. It appears there are differing versions of accounts about when Ms B first raised her complaint to the Trust, however, the difference of opinion amounts to approximately five days.

37. The Trust provided its first response to the complaint in the beginning of February 2024, approximately six months after Ms B told us she complained to it. The response appears to be ten days outside of the six months timeline suggested by the NHS complaints regulations which is longer than expected. As we consider this is a short amount of time, we have therefore considered if the Trust kept Ms B informed of any delays during its investigation of her complaint.

38. From the information the Trust provided, it appears it spoke with Ms B (via her representative) seven times during its initial investigation of her complaint to update her on its progress. Although we do not know what was discussed during these updates, it appears the Trust had the intention of regularly updating Ms B during the six months it took to provide the initial response to her complaint. Based on this information, it did take slightly longer than expected for the Trust to provide Ms B with its initial response, but we are satisfied it kept her updated with its progress.

39. Ms B raised further concerns about her care towards the end of March. The Trust responded to these concerns at the beginning of September, within six months of receiving the second complaint and therefore in line with the NHS complaints regulations. Although it responded to this complaint within the six-month time frame, the Trust explained that Ms B also raised her concerns with the Police and this delayed its ability to provide a response sooner.

40. Based on the evidence we have considered, it appears that although the Trust took slightly longer than the six month time frame set out in the NHS complaints regulations to respond to Ms B’s initial complaint, it appears it kept her updated on its progress. We are also satisfied it responded to her second complaint within the necessary six month timeframe. We will therefore take no further action on this aspect of the complaint as we have not seen any indications that something went seriously wrong.

41. From what she told us, it is clear Ms B found the complaints process frustrating and we were sorry to hear this. We hope our findings above clearly explain how we have considered her concerns about the Trust’s actions and helps to clarify any information she is unsure about.

Conclusion 42. Overall, we are sorry we cannot reach a decision on Ms B’s concerns that the Trust did not get her consent to attempt to drain her groin abscess when she attended it for the second time. This is because there is a lack of objective evidence for us to reach a view about what happened.

43. From the evidence we have considered, it appears the Trust followed relevant guidelines, and we have seen no indications anything went wrong when it removed Ms B’s wound packing following her procedure to drain the abscess.

44. Although it appears the Trust took slightly longer than the six months set out in the NHS complaint regulations to initially respond to Ms B’s complaint, we are satisfied it kept her updated on its progress throughout its investigation and therefore nothing serious went wrong. We will take no further action on this complaint for this reason.

45. From our conversations with Ms B, it is clear she found her experience at the Trust very difficult, and we were sorry to hear this. We hope how explanations above clearly explain our decision and our reasons not to consider her complaint further.

1. We have carefully considered Ms B’s complaint about Taunton and Somerset NHS Foundation Trust (the Trust). We were sorry to hear her concerns about how the Trust managed her care in July 2023 when it admitted her to treat an abscess in her groin. From what she told us, this has clearly been a difficult time for her and concerns about her care continue to cause her ongoing distress.

2. Ms B is understandably concerned the Trust did not get her consent to touch or attempt to drain an abscess in her groin during her admission. Sadly, we are not able to carry out a further meaningful investigation into this part of the complaint, as there is no evidence available to be able to fully explain what happened that we can take a view on. Therefore, we will not investigate this aspect of Ms B’s complaint any further. It is understandable that this may be disappointing for Ms B and we are sorry we have not been able to do more to address this.

3. Ms B also complains the Trust removed the packing from her wound too soon after her procedure. Based on the information we have considered, it appears the Trust followed relevant guidelines when it managed Ms B’s wound care and we have seen no indications that anything went wrong. We have decided to take no further action on this aspect of the complaint for this reason.

4. We also considered Ms B’s concerns about the time it took for the Trust to respond to her complaint. It appears the Trust followed relevant guidelines when it managed Ms B’s complaint. We have decided to take no further action on this aspect of the complaint for this reason.

5. We recognise how important this complaint is to Ms B, and we would like to take this opportunity to thank her for bringing her complaint to our attention. We hope our explanations below show how we have considered this complaint and provides her with some reassurance that the Trust followed relevant guidelines when it managed her care in July 2023.