The Newcastle Upon Tyne Hospitals NHS Foundation Trust

3. Mrs P complains the Trust did not manage her father, Mr P’s, nutrition adequately during admissions between December 2024 and February 2025. It failed to plan for his future care properly because family did not have the opportunity to discuss his care with a multi-disciplinary team (MDT), and it did not complete his emergency health care plan (EHCP) in a timely manner.

4. Mrs P says that her father lost a significant amount of weight during January 2025, and this contributed to his frailty. She explains this means he died in hospital in May 2025, sooner than family expected, and not at the care home where he lived as he preferred. If advance planning had been in place, she says his GP and care home would have been better prepared when he deteriorated and he may have had a better outcome.

5. Mrs P would like the Trust to acknowledge what went wrong and make service improvements.

6. Mr P became unwell with pneumonia on 28 December 2024 and the Trust admitted him for treatment. It discharged him on 16 January 2025, but he became unwell again with delirium and the Trust readmitted him on 18 January. It discharged him on 5 February and readmitted him on 10 February when he developed increasing confusion and a fast, irregular heartbeat. It suspected this was caused by fluid overload, when the body retains too much water. Mr P was well enough for the Trust to discharge him again on 25 February.

7. In April 2025 Mr P had a seizure and fall at the care home where he lived. The Trust admitted him for care and treatment. Mr P sadly died in hospital, less than two weeks’ later, at the age of 83.

Nutrition

10. The Trust gave Mrs P detailed information about how it managed her father’s nutrition in its response to her original complaint. It weighed Mr P weekly while he was an inpatient. He weighed 65.4kg on 29 December 2024, then 64kg on 4 January 2025, then 63.7kg on 12 January. Mr P was discharged on 16 January.

11. The Trust weighed him again on 19 January, the day after it readmitted him. Mr P weighed 53.5kg, around 10kg less than he was the previous week representing a significant loss of weight. On 23 January he weighed 53.4kg. The Trust admitted Mr P again in February and his weight increased from 52.1kg on 10 February to 52.9kg on 24 February. Mrs P is concerned about the significant weight loss in January.

12. We do not know what Mr P weighed at the point the Trust first discharged him, we only know that a few days before his discharge he weighed 10kg more than he did after the Trust readmitted him the following week. During this week Mr P was both in hospital and at home. The Trust said it did not use food charts until February, when Mr P’s risk of malnutrition increased. However, it said its records showed Mr P was regularly encouraged to eat and was offered snacks in addition to meals. The Trust also noted that Mr P was dehydrated on his readmission which would make his weight appear lower than usual. Mr P’s GP record shows his GP also questioned whether the dramatic weight change was in part due to resolving fluid overload. Mr P’s regular prescriptions included furosemide, a medication which helps the body remove excess water.

13. There is no further evidence available for us to decide exactly when the significant weight loss happened or to know how much could be potentially attributed to poor nutrition in hospital, rather than nutrition at home, or a potential reduction in fluid overload. For the periods when we know the Trust was the sole provider of Mr P’s nutrition, there is only a nominal fluctuation in his weight.

14. Even if we were to investigate further and found failings in the way the Trust managed Mr P’s nutrition, we do not think we could robustly link this to his weight loss. We do recognise Mrs P was worried when her father dramatically lost weight and we hope she finds this explanation helpful.

EHCP and MDT

15. Our Principles of Remedy say we expect organisations to acknowledge failures and apologise for them, to make amends, and to use the opportunity to improve their services.

16. Before this complaint reached us, the Trust had apologised to Mrs P for not putting an EHCP - a personalised plan to help guide health and care professionals if an emergency happens - in place for Mr P in a timely manner. On 25 April Mr P had a fall and apparent seizure at his residential home which required him to return to hospital. His EHCP was not yet in place when this happened.

17. The Trust reviewed its processes around EHCPs and decided it needed to make improvements. This included putting time-bound steps in place for action within the EHCP process. If these time limits had been in place at the time Mr P’s EHCP was discussed on 17 April, it should have shared available for carers and medics by 19 April, before Mr P fell at home.

18. An EHCP is intended to include any emergencies that are likely to occur, including the action to be taken by the lay person and the information needed by front line health workers to give the best care to the individual. It takes into account the views of the patient, their family, and professionals involved in their care.

19. Mr P’s GP records record a 17 April conversation between Mrs P and a home care specialist about her father’s EHCP. She was keen for this to focus on managing his chronic obstructive pulmonary disease (COPD – a progressive lung condition). She wanted a clear plan to manage this, and they discussed a plan for effective use of his inhalers and an antibiotic ‘rescue pack’. Mrs P wanted her father to be admitted to hospital if he needed antibiotics and these were not effective. If he fell, the specialist said hospital admission would be advised if there were concerns about heart failure. They also said Mr P appeared to currently be stable and the plan should be revisited if he started to deteriorate. The EHCP is unlikely to have included a plan for a suspected seizure, as Mr P had no history of this.

20. The Trust wrote to Mr P about a respiratory review which took place on 17 April. It reminded him about an improved technique he was shown for using his inhaler and to regularly use his Aerobika device for chest physiotherapy. Two days before his fall on 25 April, Mr P started a ‘rescue pack’ of antibiotics and steroids for an exacerbation of his COPD. A rescue pack includes medication which is available for urgent use if a chronic or variable health condition worsens. The Trust admitted Mr P after he fell because to investigate a head injury and because his residential home’s carers had witnessed him having an apparent seizure. Sadly, Mr P died during this admission.

21. We understand why Mrs P was concerned to get the EHCP in place, as it can help people like Mr P get the right type of care for them at the right time. We think an EHCP is unlikely to have changed the course of events for Mr P. The rescue pack was already in use and Mr P had been shown the best techniques for inhaler use, which he may have needed some support to continue at home. Even with an EHCP in place it is likely the Trust would still have admitted Mr P to hospital in April to investigate his head injury and potential seizure. We are sorry Mr P did not return home again.

22. The Trust did not carry out an MDT discussion of Mr P’s care in respect of his frailty. This is when clinicians from different specialisms discuss the care of a patient with complex needs. Mrs P was keen to be involved in such a discussion. The Trust apologised this discussion did not happen with family, although suggested it was not needed in Mr P’s case as family had been kept up to date. It said the ward team would reflect on Mrs P’s complaint and be more proactive in offering an MDT discussion if this would be helpful in future.

23. Mrs P’s main concerns about her father’s health centred around his nutrition, which we addressed above, and management of his COPD and general frailty. Even without the MDT discussion with family, there were plans in place to manage Mr P’s COPD. The Trust also investigated his low iron levels, and asked his GP to refer him for cognitive tests once his delirium had resolved. We understand Mrs P’s view that family would have found an MDT discussion beneficial, but we do not see an indication that it would have altered or significantly altered Mr P’s care.

24. We think that the steps the Trust has taken in response to Mrs P’s complaint are in line with our Principles for Remedy. This is because the Trust has apologised for what happened and used the complaint as an opportunity to improve its services.

25. We recognise Mrs P felt her father’s care was disjointed and there should have been better coordination between disciplines within the Trust and between the services supporting her father. We are sorry she remains concerned her father could have had a different outcome. By making her complaint directly to the Trust she has already achieved the appropriate service improvements, and we think it is unlikely our consideration could add to this. Therefore, we have decided not to take further action about her concerns.

1. We have carefully considered Mrs P’s complaint about the Trust. We have decided the not to take further action. This is because we do not think we would be able to robustly say her father’s weight loss happened while he was in hospital. We think the Trust has already done enough to put right any impact linked to her other concerns.

2. We are sorry to learn Mrs P’s father died in hospital instead of in his care home, as he and his family had hoped. We hope she finds our consideration helpful and is reassured by our view that the Trust took appropriate action to try to improve its services following her complaint.