Barking, Havering and Redbridge University Hospitals NHS Trust

5. Mrs B complains about the care and treatment her daughter, U, received from the Trust starting in August 2024. She specifically says the Trust:

• dismissed U’s symptoms as ‘not a real UTI’ despite foul-smelling and abnormal looking urine • relied solely on urine culture results and did not explore other diagnostic possibilities she suggested via email • failed to provide timely advice on Movicol maintenance levels until November 2024.

6. Mrs B says as a result of the Trust’s actions: • U was admitted to hospital on New Year’s Eve 2024 with chronic UTI pain • she found it traumatic seeing U in distress, staying overnight in hospital, and being misdirected toward appendicitis • she suffered months of stress and uncertainty about U’s health.

7. Mrs B is seeking: • service improvements in managing chronic UTIs • acceptance that the Consultant did not properly respond to or acknowledge her emails.

8. U had been experiencing ongoing urinary and bowel symptoms throughout 2024. Her mother, Mrs B, repeatedly raised concerns with U’s Consultant about foul-smelling and abnormal looking urine, which she believed indicated a UTI.

9. During an appointment in August 2024, Mrs B says the Consultant dismissed these concerns and relied solely on urine dipstick results.

10. Following this appointment, Mrs B emailed the Consultant to reiterate her concerns and to seek advice on Movicol (a medication used to treat constipation) maintenance levels for U. She reports she did not receive this advice until November 2024, after following up several times and booking another appointment.

11. On 31 December 2024, U developed severe abdominal and urinary pain. Her GP suspected appendicitis and advised attending A&E. U was taken to Queen’s Hospital, where she underwent ultrasound and X-ray investigations. The clinicians diagnosed a UTI, and they admitted her overnight for  pain management.

15.

Dismissal of U’s symptoms

16. 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 anything has gone wrong.

17. Mrs B complains about the care U received in August 2024 relating to a UTI. She states the Trust dismissed U’s symptoms and did not consider them to be ‘real symptoms’. She says U’s urine looked abnormal and was foul-smelling, yet the Trust did not view this as a concern. Mrs B says this approach caused further distress for her and especially for U as her illness progressed. We understand how upsetting this was for Mrs B and her daughter.

18.  To show their approach in examining U and her symptoms, the Trust provided consultation and clinical notes from the August 2024 appointment, along with the detailed complaint response to Mrs B on 14 April 2025. At the time, U was experiencing constipation, soiling, and smelly urine. She attended the appointment with her father and older sister, and the Trust took the relevant samples for examination.

19. The Trust stated that as U had normal baseline blood test results and recent urine culture results showed no issues, they were happy to discharge her. After the appointment, they also assured U’s family they would be happy to see her if needed in the future.

20. NICE UTI guidance states clinicians should test the urine of babies and children if their symptoms indicate a possible UTI. Similarly, NICE constipation guidance advises carrying out an appropriate physical examination.

21. Having discussed this case with our adviser, we are satisfied the evidence indicates the Trust followed the relevant standards and guidelines when assessing and managing U’s symptoms. The doctor examined U, measured her height and weight, and tested her urine. The Trust had been treating U’s constipation and the doctor noted it was improving. The doctor gave advice about how good water intake and avoiding using bubbles in the bath could increase her risk of infection.

22. We understand the bladder symptoms were concerning for the family. Our adviser said they did not necessarily indicate an infection. As the urine culture did not show evidence of a UTI, our adviser said there was no indication the Trust’s investigations or treatment were inappropriate.

23. As the evidence shows the Trust carried out U’s investigations and treatment in line with the relevant NICE guidance, we have not seen any indications of failings in this matter.

24. We hope we have clearly explained our findings and reassured Mrs B that the Trust considered the appropriate factors when treating U.

Not considering other diagnostic methods led to U’s hospitalisation

25. Mrs B says the Trust relied solely on urine culture results and did not explore other possible diagnostic options for U’s symptoms, including those she raised in her emails. She believes the Trust did not acknowledge her concerns in these emails. Mrs B also states the Trust’s failure to consider different diagnostic methods led to U’s hospital admission in December 2024. We understand how concerning this was for her.

26.  Mrs B emailed the Trust on 25 September 2024, stating the Kass criteria (a diagnostic benchmark used in clinical microbiology to diagnose a UTI) were set too high. She said that even though U’s urine tests did not indicate infection, she believed a UTI was still possible. She asked whether the Trust would consider any further tests or investigations. On 26 September, the Trust responded to arrange another clinic appointment and to test U’s urine sample again for a possible UTI.

27. Our principles of good administration say organisations should take reasonable decisions, respond to people’s needs flexibly, and ensure decisions and actions are proportionate, appropriate and fair. We consider the Trust acted in line with this by responding to Mrs B the next day and arranging an appointment and further testing.

28. We discussed with our adviser whether the Trust should have done any further testing. NICE UTI guidance recommends urine dipstick testing where the patient has symptoms of a UTI. The guidance sets out circumstances when it is recommended to send a urine sample to the laboratory. This includes certain dipstick results, if the child is under three months old or at risk of serious illness, or if a UTI is not responding to treatment. The guidance goes on to recommend imaging tests in certain situations, such as then a child has an atypical UTI or they are baby under six months.

29. Our adviser explained that, in line with NICE UTI guidance, the Trust would not do further investigations into simple UTIs unless there were other concerns. They said the Trust’s use of imaging and reliance on urine cultures was appropriate in managing U’s symptoms and in line with NICE guidance.

30. U later presented with abdominal and urinary pain and was admitted to hospital on 31 December 2024. Our adviser explained there is no evidence episode was related to the Trust’s earlier management, but instead to U’s ongoing issues with constipation, which can contribute to UTI’s.

31. We recognise how distressing this experience was for Mrs B, particularly the hospitalisation of U. It is understandable this caused confusion and concern. We are sorry for her experiences. We hope our decision reassures Mrs B about why we believe the Trust has done enough to explain their approach in treating U in the best possible way.

Lack of timely advice on Movicol maintenance levels

32. If we see indications something has gone wrong, we then consider the impact this had. We will not take further action on a complaint if we see a failing may have occurred, but this did not have a negative impact.

33. Mrs B also complains the Trust did not provide timely advice about Movicol maintenance levels at the time of U’s discharge in August 2024. She states she had to follow-up regularly until the Trust advised her on maintenance levels in November 2024. We understand this caused uncertainty, and we are sorry to hear this added to an already difficult situation.

34. We discussed with our adviser whether the Trust should have given U’s family more information about Movicol maintenance levels. NICE constipation guidance recommends maintenance treatment with laxatives (medication to treat constipation) for several weeks after regular bowel habit is established. It says some children may require laxative therapy for several years.

35. The clinical records show the Trust gave general advice about managing U’s constipation at the August appointment. Our advisor explained that constipation in children is a common issue usually handled by General Practitioners and their primary care team, so paediatrics do not usually provide specific detailed clinical advice. However, given the Trust was reviewing U’s constipation and decided to discharge her, it would be in line with NICE guidance to give advice on maintenance treatment.

36. While the Trust did not provide specific information about Movicol maintenance levels at the time, we have also not seen evidence that Mrs B made repeated requests for this information between August and November 2024. The email correspondence provided to us does not show followup messages about Movicol dosing during this period.

37. The first documented discussion about maintenance dosing took place during a telephone consultation in November 2024. During this call, Mrs B explained U had taken paediatric Movicol for seven days before switching to the adult version, but U continued to soil her underwear. She also said she had been giving U food supplements instead. The Trust then advised restarting paediatric Movicol at four sachets once daily for seven days, followed by a reduction to two sachets once daily until U’s outpatient review in December.

38. At the December appointment, the Consultant noted U was refusing to take the paediatric Movicol. Here they provided further advice, suggesting chocolate‑flavoured paediatric Movicol and recommending four sachets once daily for five days, then reducing to two sachets daily until stools were soft and regular.

39. Based on the evidence, we consider the impact of any delay in providing specific maintenance dosing advice to be low. U’s symptoms did not significantly change between August and November, and when the Trust did give maintenance advice, U did not take the Movicol as recommended. This means the delay did not materially affect U’s condition or the course of her treatment.

40. As we can see no evidence the lack of advice about Movicol maintenance levels had a negative impact, we have decided to take no further action.

41. We appreciate the time and effort involved in raising these concerns and we thank Mrs B for bringing her complaint to our attention. We hope our explanation brings some reassurance that the care and treatment provided by the Trust to U was in line with the relevant standards, and that the lack of information about Movicol maintenance levels did not have a significant impact on her.

1. We have carefully considered Mrs B’s complaint about the care and treatment her daughter, U, received from Barking, Havering and Redbridge University Hospitals NHS Trust (the Trust).

2. We are very sorry to hear Mrs B is upset the Trust dismissed U’s urinary tract infection (UTI) symptoms during an appointment in August 2024. We understand why this caused her concern. Based on the evidence we have reviewed, we have not seen any indication the Trust acted outside relevant standards. We explain this in more detail below.

3. Mrs B also believes the Trust relied solely on urine culture results and did not explore other possible diagnostics for U’s symptoms, including those she raised in her emails. She feels this contributed to U’s later hospital admission. Having reviewed the available evidence, we have not seen signs the Trust acted incorrectly. We explain the reasons for our decision below.

4. Mrs B also complains the Trust did not provide timely advice about Movicol (laxatives to treat constipation) maintenance levels at the time of U’s discharge. We are sorry to hear this situation was distressing. We have not seen indications of a significant impact on U or on the overall management of her condition. We explain them in more detail below.