Sherwood Forest Hospitals NHS Foundation Trust

3. Mr V complains about aspects of the care and treatment of his late father, Mr I, by Sherwood Forest Hospitals NHS Foundation Trust in September 2023. He specifically complains the Trust did not:

• take adequate action to prevent Mr I’s unwitnessed fall, treat him afterwards, or address his blood loss with his family on 18 September • respond to Mr V’s complaint appropriately.

4. Mr V says the fall and the lack of appropriate treatment afterwards contributed to his father’s death. He says he is left with unanswered questions and does not know the full circumstances of his father’s death as the Trust suspended his complaint, did not provide answers and kept conflicting records. Mr V says both he and his mother were left devastated by Mr I’s death, and that dignity was taken away from his father as a result of the lack of care and treatment.

5. As an outcome to his complaint, Mr V seeks further information from the Trust and service improvements.

6. Mr I was in his eighties at the time of his death. He was admitted to the Trust on 13 September 2023 after a fall at home. He was kept in due to an electrolyte imbalance and moved to a ward.

7. Mr I fell from his bed on 18 September. The fall was unwitnessed and he was found on the floor. The Trust called his family and told them he was ok. The Trust called again the next morning and told his family to come in, as Mr I’s heart rate was high, his blood pressure had dropped, and he had been vomiting blood. Mr V says Mr I was very different and seemed distressed when he saw him.

8. Mr V says there was a large blood stain at the end of the bed and believes his father lost a lot of blood due to the fall. He says the Trust did not acknowledge this and believes they downplayed the issue.

9. Mr I self-discharged the next day. He died at home on 21 September.

10. Mr V complained to the Trust in August 2024 and says the Trust suspended his complaint in November 2024 without addressing his concerns.

Fall on 18 September

13. The law (Health Service Commissioners Act 1993) says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. If the complaint is outside our time limit, we consider the reasons for this and whether the reasons for the delay in coming to us were reasonable in the circumstances.

14. Mr V complains the Trust did not acknowledge Mr I lost a lot of blood or treat him appropriately following a fall from his bed on 18 September 2023.

15. Mr I’s wife, Mrs I, submitted an initial complaint to the Trust. Mr V has since taken over as the complainant.

16. Mr I sadly died at home on 21 September. Mrs I submitted a subject access request on 18 October. Mr V told us he and Mrs I were aware they had reason to complain about Mr I’s care and treatment in February 2024, after reviewing his medical records. This means a complaint should have been brought to us by February 2025 at the latest.

17. Mrs I complained to the Trust on 28 August 2024, and it responded with an acknowledgement letter on 2 September which included a list of points summarising the complaint.

18. Mrs I and Mr V contacted the Parliamentary and Health Service Ombudsman (PHSO) on 6 September. A case was opened however a complaint form was not submitted. Therefore, the complaint was not properly made at this time.

19. Further correspondence continued between Mrs I, Mr V and the Trust as they did not feel the Trust’s summary of the complaint addressed all the issues they had raised. The Trust sent a letter to Mrs I and Mr V on 29 November explaining it would be suspending the complaint, as it included more than 200 points. It explained the request was not proportionate to its resources and was unreasonable. Mr V contacted the Trust again, and the last correspondence from it was on 19 December 2024.

20. We can see in both letters dated 29 November and 19 December, the Trust told Mr V if he had any concerns regarding its decision, he could contact PHSO. Mr V submitted a complaint form to us on 21 August 2025.

21. We have seen Mr V knew he had reason to complain by February 2024. Mr V should have complained to us by February 2025. We received our complaint form in August 2025. This means he is approximately six outside the statutory time limit.

22. For us to waive the time limit we must be satisfied the explanation given for the delay is reasonable.

23. In his complaint form, Mr V explained he did not bring his complaint to us sooner because sadly his mother, Mrs I, died on 2 February 2025. He also explained he had only recently completed probate.

24. We discussed the reasons for the delay further in a phone call with Mr V and subsequent emails. He explained he had spent significant time putting together the complaint, as he wanted it to be thorough regarding what happened to Mr I.

25. He also explained he thought the year he had to make the complaint to us would begin from when the Trust suspended its complaint.

26. Mr V explained he and Mrs I spent time reviewing Mr I’s medical records in depth in early 2024, as they wanted to cover everything in their complaint to the Trust, which was submitted in August 2024.

27. We can see Mr V was in correspondence with the Trust regarding which parts of his complaint it would address from August 2024 until December 2024. A letter from the Trust in November 2024 explained it would be suspending his complaint. It is reasonable to accept Mr V was waiting for a response from the Trust between August and November, and we consider there is justification to set aside this part of the delay.

28. We mentioned earlier the Trust told Mr V he could contact PHSO in the letters sent in November and December 2024. We know Mr V was aware of PHSO prior to this, as he had made initial contact with us on 6 September 2023. Our website explains there is a 12-month time limit for making a complaint to us. We therefore think it is reasonable Mr V could have submitted a complaint form to us from November 2024 when the Trust directed him to us.

29. We understand Mr V’s mother died in February 2025. We were very sorry to hear this and offer our sincere condolences. This must have been a difficult time for Mr V. We take into consideration people experience grief differently, and it will always make complaining difficult.

30. Whilst we can and do allow some flexibility when a complainant is experiencing grief, we must also consider whether they could have progressed their complaint to our service sooner.

31. Mr V also told us he spent time putting together the complaint as he wanted it to be thorough. We have seen Mrs I and Mr V submitted a comprehensive complaint to the Trust in August 2024, six months after they knew they had reason to complain.

32. A complaint to us is often largely the same complaint that has already been made to an organisation. It is our view this is significantly different to beginning to draft and write a complaint from the beginning and the preparation needed to first get it ready. As such, the process of bringing a complaint to us should be relatively easier irrespective of the complexity to that of first complaining to an organisation as usually the information has already been collated.

33. It is reasonable to expect if Mr V was unhappy with the Trust’s response in November 2024, Mr V could and should have brought the complaint to us much sooner than August 2025.

34. We acknowledge the reasons Mr V says he was not able to complain to us within the time limit. We do not think he has provided a clear reason to persuade us to set our time limit aside. On that basis, we have decided not to consider this part of his complaint further. We understand our decision may be disappointing for Mr V and we do not wish to undermine what he has told us about the events and their impact on him.

Complaint handling

35. Mr V says the Trust did not respond to his complaint appropriately and did not address his concerns. He says he is left with unanswered questions and does not know the full circumstances of his father’s death.

36. Mrs I and Mr V submitted a complain to the Trust on 28 August 2024. The complaint contained over 200 points which Mr I and Mr V wanted the Trust to address. The Trust responded with an acknowledgement letter on 2 September. In the letter, the Trust summarised the complaint in 26 points. It explained it would be forwarded for investigation, and a response would be provided within 60 working days of the date the complaint was received.

37. Mr V responded by email on 16 September explaining the points set out by the Trust did not cover everything he had raised, and requested the original complaint be sent to those providing information at the Trust. In a further email on 16 September, he explained he would appreciate a response to each of the bullet pointed sections in the original complaint.

38. The Trust sent a further acknowledgement letter on 24 September with an updated list of 42 points it would investigate.

39. Mr V emailed the Trust on 26 September explaining it was still not clear what the Trust could answer from his initial complaint. Mr V again asked if the Trust could let him know if it could answer all his questions and points.

40. The Trust sent a third updated acknowledgement letter on 9 October with 48 points. Mr V responded on 10 October and 25 October acknowledging the changes to the questions, noting some points were still not included, and expressing he would like his own questions answered, not an interpretation of them.

41. On 8 November the Trust apologised Mr V did not feel the acknowledgement letter was clear. It explained due to the volume of questions Mr V had raised, this was not proportionate to the Trust’s resources. It explained the questions it had originally set out had been done so in a way that would enable the team to address Mr V’s questions.

42. It explained Mr V had declined the option to have a meeting to discuss the complaint and acknowledged although Mr V had suggested a compromise of having core questions be addressed with a view to raising a complaint at a later date with secondary questions, this again would not be proportionate and was deemed unreasonable. It explained it had also sought advice from PHSO regarding the decision.

43. Mr V sent a further email on 11 November. The Trust sent a letter on 29 November explaining it would be suspending Mr V’s complaint on the grounds his behaviour and requests were unreasonable. Mr V sent a further email on 9 December, and the Trust’s final response was an email on 19 December directing Mr V to PHSO.

44. The Trust’s complaint policy defines habitually demanding or unreasonable behaviour as ‘displaying unreasonable demands or expectations and failing to accept that these may be unreasonable’.

45. We can see the Trust engaged with Mr V between September and December 2024. We have seen it acknowledged all correspondence in a timely and polite manner, clearly explained the reasons it was unable to address all points raised in the original complaint, and repeatedly amended its acknowledgement letter in response to Mr V’s concerns. We have also seen it offered Mr V a meeting and sought advice from PHSO on how to handle the complaint.

46. Based on the evidence we have seen, we consider it was reasonable for the Trust to suspend the complaint in line with its complaints policy.

47. We acknowledge Mr V has not received a formal response from the Trust and is left with unanswered questions. We understand this may have compounded his distress at an already difficult time.

48. We consider the Trust engaged with Mr V and made attempts to address his complaint in a proportionate manner. We have seen no indications of failings regarding the Trust’s complaint handling. We have decided not to consider this part of the complaint further.

1. We have carefully considered Mr V’s complaint about Sherwood Forest Hospitals NHS Foundation Trust (the Trust). We were very sorry to hear about the circumstances of Mr V’s complaint and offer our sincere condolences on the death of his father, Mr I.

2. We have decided Mr V’s complaint about the care and treatment of Mr I falls outside of our time limit, and we have not seen a good reason for us to put our time limit aside to consider it further. Regarding the Trust’s complaint handling, we have not seen anything went seriously wrong.