University Hospitals Birmingham NHS Foundation Trust

3. Miss G complains the Trust did not document the family’s questions about her mother’s care when she was a patient of the Trust between April and August 2024.

4. Specifically, Miss G says the Trust often denied her family had asked questions when her or her father requested a response from staff.

5. Miss G says this lack of clear and provable communication meant her mother experienced avoidable pain, distress and suffering. She also says the family’s distress, frustration and their bereavement process were badly affected.

6. Finally, she says she feels had the communication been better a lengthy and distressing complaint process could have been entirely avoided. Miss G wants service improvement in this area with an audit trail showing who asked the question and who answered.

7. Late April/early May 2024, the Trust occupational health (OH) team recommended a sleep system for Mrs F. This would assist with Mrs F’s compacted legs. This is a non-medical term used to describe legs which that have become shortened, stiffer, and weaker due to reduced muscle strength, movement, and normal circulation.

8. Miss G said the OH team told her the Trust district nurse team would need to order the system. Early July, Miss G began to ask the Trust every day about the delay in the sleep system.

9. Early August, the Trust told Miss G a senior member of the district nursing team would telephone her. She was not contacted.

10. Mid August, Miss G complained to the Trust in writing. She told them she had been asking for updates on Mrs F’s care since early July. She said had also raised questions separately before July.

11. Also in mid August, the sleep system was delivered to Mrs F by the Trust.

12. Sadly, at the end of August Mrs F died.

Miss G says the Trust did not document the family’s questions about Mrs F’s care and often denied her family had asked questions when the family requested a response from staff.

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has now done enough to put right the impact of these events.

16. Miss G was the named carer for her mother, Mrs F. Mrs F was being cared for at home by the Trust between April and August 2024. Miss G said the Trust did not respond to questions asked by her or her father about her mother’s care and treatment.

17. She told us the Trust did not have a system in place to reassure her the questions were being taken to the daily huddle, or for receiving answers back once asked. This meant she was left concerned important aspects of her mother’s care were not being adequately considered or addressed.

18. In its response to Miss G the Trust apologised and said it had identified shortfalls in relation to its communication with Miss G.

19. It did not explain how it was going to improve documenting patient and relative’s questions and resulting answers from the daily huddle.

20. In a further response to us, the Trust apologised it did not correctly evidence how daily safety huddle responses are communicated back to families and carers. It also confirmed it has taken immediate steps to improve this communication.

21. The Code requires nurses to communicate appropriately with the patient’s carer. It also says nurses must share with people, their families and their carers, as far as the law allows, the information they want, or need, to know about the patient’s health, care and ongoing treatment. They must do this sensitively and in a way it can be understood.

22. The Trust has identified shortcomings in its communication with Miss G. We cannot see there is evidence her questions and concerns were taken to the huddle as she believed at the time.

23. Mrs F was nonverbal. Communication was through her daughter, in her role as her mother’s carer. This was a reasonable and obvious way of communication. It meets the NMC requirement of meeting communication needs and acting openly with carers where appropriate.

24. We can see there was an issue in the Trust’s communication with Miss G. It did not consistently acknowledge, record or respond to questions she raised by her. This was not in line with professional expectations set out in the Code, which requires nurses to communicate openly and appropriately with patients and their carers. Based on this, we believe there is an indication of a failing.

25. Miss G said the impact of her questions not being answered meant Mrs F experienced avoidable pain, distress and suffering. The situation also caused her and her father a great deal of frustration and grief, at not being able to help Mrs F’s situation.

26. Their bereavement process has also been badly affected. Miss G said if the Trust’s communication had been better, a lengthy and distressing complaint process could also have been entirely avoided.

27. We recognise the strength of her belief that better communication could have reduced her mother’s suffering and eased the family’s bereavement. There is a linked injustice.

28. We believe this caused Miss G and her family avoidable distress, frustration and uncertainty. We cannot see evidence the Trust has taken action to remedy this.

29. We consider the injustice caused by poor communication remains unremedied.

30. We highlighted the outstanding issue to the Trust and asked it to clarify what action had been taken because of Miss G’s complaint. The Trust told us it was sorry it had not clearly addressed this issue in the original response.

31. It explained it had immediately taken steps to address this. It explained it is completing work to address the underlying cause, by developing a servicewide guidance document for daily safety huddles.

32. It told us this includes clear requirements for capturing questions raised by families and carers, allocating responsibility for responding, and confirming when and how responses are communicated back.

33. The Trust have said the guidance document will specifically focus on how: • questions raised by families and carers are captured by clinical teams • questions are escalated and discussed within the daily huddle • an identified response and responsible individual are agreed • when, and by whom the outcome is communicated back to the family or carer.

34. The Trust has provided us with evidence to show this work is being led at senior and governance level. The improved guidance will be presented to its Quality and Safety Committee for approval. It will then be implemented across district nursing teams, supported with local team briefings.

35. Our principles for remedy say appropriate remedies include an apology, explanation, acknowledgement of responsibility and appropriate remedial action. We are satisfied these actions are proportionate and directly address the failings identified in this complaint in line with guidance.

36. On that basis, we consider Miss G’s outstanding injustice to be remedied and the complaint resolved.

1. We have carefully considered Miss G’s complaint about her mother’s care and treatment at University Hospitals Birmingham NHS Foundation Trust (the Trust). We were very sorry to hear about her experience. It was clearly a difficult time.

2. Having considered the case in detail we have decided the Trust has now taken appropriate steps to demonstrate service improvements around its communication of family questions and answers. For this reason, there is nothing further we can add.