Imperial College Healthcare NHS Trust

The Trust

3. Mr H complains between November and December 2024 the Trust did not:

• Diagnose him or correctly treat signs of pneumonia and bacterial sepsis • Give him pain management while in hospital or discharged • Admit him when he was unwell.

4. Mr H says as a result, his health was allowed to deteriorate causing him pain, emotional distress, and a period of hospitalisation. Mr H also said this has had a long-term effect on his physical health.

5. Mr H wants an apology, service improvements and a financial remedy.

Ambulance Trust

6. Mr H complains that London Ambulance Service NHS Trust (the Ambulance Trust) did not recognise or treat his condition correctly on 3 December 2024. He specifically said the Ambulance Trust did not: • Take him to hospital when he had chest pain and breathing difficulties • Give him pain relief to ease his symptoms • Correctly record information about refusing to go to hospital.

7. Mr H said as a result, his health deteriorated and left him with daily effects to his life meaning he was unable to work and was later hospitalised. He told us if he had been taken to hospital sooner this could have been avoided.

8. Mr H wants service improvements.

9. Mr H went to the emergency department in late November 2024 with symptoms of a temperature, sore throat, dry cough. He complained of feeling faint with aches and pains.

10. Mr H was diagnosed with flu and called the emergency services for help for pain and difficulties breathing on 3 December 2024.

11. Mr H had two further visits to the Trust and was admitted to a ward in early December for flu, pneumonia, and sepsis. Mr H was discharged mid December 2024.

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation 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.

The Trust

16. Mr H complains the Trust did not diagnose or correctly treat signs of pneumonia and bacterial sepsis and did not focus on him as a patient between November and December 2024. He says his health was allowed to deteriorate causing him pain, emotional distress, and a period of hospitalisation.

17. The Trust said it gave Mr H an appropriate examination, care, and advice for his presenting symptoms of suspected flu.

18. The records show Mr H went to the Trust in late November 2024, as he felt generally unwell and weak. He explained to the Trust he had congestion, a temperature, loss of appetite and felt faint but had not lost consciousness.

19. The Trust assessed Mr H in its urgent care department and noted his observations were normal and had no temperature at the time. NHS symptoms of flu say ‘ flu symptoms can come on very quickly and can include: a sudden high temperature, aching body, feeling tired and exhausted, headache, difficulty sleeping, and loss of appetite

20. We can see the Trust reviewed Mr H and considered the symptoms he presented with in line with NHS flu advice information. The Trust gave Mr H advice on staying well and discharged him the same day.

21. NICE, Chest infections- adult: How should I assess an adult with a suspected chest infection? says, ‘Clinical judgement must always be used to assess people with suspected community acquired pneumonia (an infection caught outside of a healthcare setting) as no combination of symptoms or signs is definitively diagnostic. Cough is the predominant symptom in both acute and community acquired pneumonia.

22. In early December 2024, Mr H went to the Trust again with flu like symptoms which had worsened. The Trust recorded Mr H’s observations and noted his temperature was 36.7°C (a normal temperature is 36.1°C to 37.2°C) and his oxygen level was 97% (A normal oxygen saturation level for most healthy adults is between 95% and 100%).

23. The Trust wrote although Mr H appeared well, he had a dry cough, pain all over his chest and upper abdomen. The Trust took blood and urine tests and gave Mr H intravenous IV fluids and a chest X-ray.

24. The Trust wrote Mr H’s white cell count which is an indicator the body is fighting infection was within the normal range at 10. The range for this test to be considered normal is 4.2 to 10.6.

25. The Trust noted Mr H’s chest X-ray results were read and reported on 3 December after Mr H was discharged with flu. The X-ray shows a little patchy airspace shadowing at the left base extending behind the left heart border. This could represent a focus of infection’.

26. Our emergency medicine adviser told us the diagnosis of flu and the interpretation of the X-ray was reasonable because there were no clinical signs of infection to support a diagnosis of pneumonia or sepsis.

27. Mr H went to the Trust by ambulance on 4 December for left sided sharp pain moving to the neck which worsened when breathing. The Trust took blood and organised a chest X-ray.

28. The Trust recorded Mr H’s observations such as his oxygen level, which was 97% breathing room air, his temperature of 36.8° and blood pressure. These actions are in line with NICE, Sepsis: recognition, diagnosis and early management, NG51, section 1.3, Face to face assessment of people with suspected sepsis which says: ‘assess temperature, heart rate, blood pressure, level of consciousness and oxygen saturation in young people and adults with suspected sepsis.

29. The Trust noted Mr H’s white cell count had gone up from 10 on 2 December to 18 which was outside the normal range limit. The Trust organised a computerised tomography CT pulmonary angiogram. This means dye is injected into a vein allowing a detailed view of the lungs to take place. The scan showed Mr H had consolidation (air sacs of the lung filled with fluid) of the lungs, diagnosed pneumonia and influenza A. The Trust admitted Mr H for further investigations and treatment on 4 December 2024.

30. Our emergency medicine adviser said as we found in the records the Trust manged Mr H’s care appropriately in line with NICE chest infection guidelines and NHS Flu in late November and 2 December and admitted him to its care when necessary on 4 December 2024.

31. We acknowledge Mr H said pneumonia and sepsis should have been considered sooner and a hospital stay may have been avoided.

32. Based on the evidence we have seen, the Trust acted in line with NICE guidelines for suspecting chest infections and recognising and considering sepsis and admitted Mr H once appropriate.

33. We understand and acknowledge the distress Mr H experienced. We hope our explanation goes some way to explain how the Trust acted appropriately with its care it gave.

Pain

34. Mr H says the Trust did not give him pain management during his visit or after his discharge between 29 November and 3 December 2024.

35. The Trust said Mr H’s care and treatment was appropriate for each presentation to its departments.

36. Royal College of Emergency Medicine (RCEM), Management of Acute Pain in adults in the Emergency Department tells clinicians, a patients pain should be assessed from zero to ten. Zero being no pain, one to three mild pain, four to six moderate pain and seven and above as severe pain.

37. RCEM algorithm for treatment of undifferentiated acute pain in the ED guidance, says mild pain can be treated with paracetamol and or ibuprofen, non-steroid anti-inflammatory drugs (NSAID), moderate pain with NSAID or a weak opioid and severe with strong IV opioids or rectal NSAIDs.

38. The records show the Trust did not document a pain score for Mr H in November but as it diagnosed him with symptoms of flu, Mr H was given advice to take over the counter pain relief and other advice to stay well and hydrated. The Trust’s advice was given in line with the NHS Flu advice for people to ‘take paracetamol and ibuprofen to lower your temperature and treat aches and pains’.

39. On 2 December 2024 the Trust gave Mr H IV fluids to rehydrate him and while doing this he told the Trust he was in pain. The Trust gave Mr H co-dydramol which is a combination of dihydrocodeine and paracetamol.

40. On 4 December when Mr H was admitted to the Trust he gave his pain level as a 5. The Trust during his admission gave Mr H oral morphine, paracetamol, ibuprofen and co-codamol which is a mixture of paracetamol and codeine.

41. Our emergency medicine adviser confirmed as we had seen from the evidence, the Trust acted in line with RCEM treatment of acute pain. It considered the level of Mr H’s pain that was documented and what was described verbally and it appropriately prescribed pain relief.

42. We acknowledge Mr H said he was not given pain relief when discharged with flu symptoms.

43. We have seen the Trust follow NHS Flu advice for self-medicating to take place at home to support Mr H’s recovery and pain relief treatment was given in line with RCEM guidelines.

44. We understand and acknowledge the pain and distress Mr H experienced and his concern about not getting the care and treatment he needed. We hope our explanation goes some way to explain how the Trust acted appropriately with the care and treatment it completed.

The Ambulance Trust

45. Mr H complains the Ambulance Trust should have taken him to hospital on 3 December 2024 when he had chest pain and difficulties breathing. He said a paramedic from the Ambulance Trust recorded his acceptance to not go to the hospital incorrectly.

46. The Ambulance Trust said its paramedic assessed Mr H and was satisfied he was not at risk by remaining at home and his symptoms were likely from the flu.

47. It also said Mr H declined to go to the hospital and the paramedic left worsening advice and made an appointment for a GP to contact Mr H within 24 and 48 hrs.

48. Joint Royal Colleges Ambulance Liaison Committee (JRCALC), Medical Emergencies in Adults says, ‘…a clear focus on the patient’s presenting complaint and ongoing concerns, medical history and a primary survey must be taken’.

49. The records show Mr H called the Ambulance Trust to his home on 3 December reporting breathing difficulties with pain in the chest.

50. The Ambulance Trust paramedic wrote Mr H was alert, orientated but appeared uncomfortable. The paramedic documented Mr H’s medical history and his resent history of flu symptoms. This is in line with JRCALC guidelines as the paramedic completed and documented a medical history and primary review of Mr H’s health.

51. Mr H’s temperature was 37.9°C (a normal temperature is 36.1°C to 37.2°C), he had a dry cough, his oxygen level breathing in room air was 97% (A normal oxygen saturation level for most healthy adults is between 95% and 100%). The paramedic noted Mr H’s pain was six out of ten specifically left sided and when breathing in deeply. Mr H had no loss of consciousness, confusion or activity of having a fit.

52. The Ambulance Trust paramedic completed an echocardiogram (ECG), this checks for abnormal heart rates to check for potential heart related conditions such as stroke or a heart attack. Mr H’s ECG showed no heart related concerns.

53. These actions are in line with Resuscitation Council UK, The ABCDE Approach, as the paramedic checked Mr H was taking in oxygen appropriately (A), respiratory, breathing distress was checked for (B), his heart rate and blood circulation were checked (C).

54. The records show the Ambulance Trust paramedic advised Mr H to return to the emergency department but noted Mr M declined to do so. The paramedic told Mr H about any underlying concerns for the symptoms he was experiencing such as a heart problem or pulmonary embolism (PE) which is a sudden blockage a lung artery caused by a blood clot, and how ruling these out would mean going to the hospital.

55. The paramedic noted Mr H had a clear understanding of what he was being told and declined to go to hospital. The paramedic noted the clinical impression for Mr H’s symptoms were of flu and talked to Mr H about his ongoing plan to take pain relief and keep hydrated.

56. The Ambulance Trust paramedic made a referral for Mr H’s own GP to check on his progress within 24 and 48 hrs following the visit.

57. Our paramedic adviser told us, as we saw in the records, Mr H was assessed to see if he needed urgent medical attention at the hospital and advice was given to take Mr H to the emergency department to rule out any life threatening conditions.

58. Our paramedic adviser also said as Mr H described his pain as a level six which is moderate pain, the Entonox gas or morphine medication paramedics carry was considered too strong for the pain Mr H was experiencing.

59. We acknowledge Mr H says he was not given pain relief and disputes the paramedics documentation of his refusal to return to the hospital.

60. Based on the evidence we have seen, the Ambulance Trust acted in line with JRCALC guidelines and the ABCDE approach for assessing his medical need to go to hospital. The paramedic confirmed continuing with the pain relief paracetamol and ibuprofen, and health supportive advice from Mr H’s previous hospital visit. It also gave safety worsening advice and organised for his own GP to contact him.

61. We understand and acknowledge the pain and distress Mr H experienced. We hope our explanation goes some way to explain how the Ambulance Trust acted appropriately with the care and investigations it completed.

1. We have carefully considered Mr H’s complaint about Imperial College Healthcare NHS Trust (the Trust) and London Ambulance Service Trust (the Ambulance Trust). We are sorry to hear about the difficulties Mr H experienced before being hospitalised with pneumonia and sepsis. We understand how frustrating it is to feel you are not getting the care you need.

2. Having considered his complaint, the evidence suggests the Trust and the Ambulance Trust treated Mr H in line with relevant guidance. We hope he is reassured by what we have seen.