University Hospitals of North Midlands NHS Trust

6. Mrs A complains University Hospitals of North Midlands NHS Trust failed to manage her mother, Mrs N’s care correctly during her critical care admission in mid-April 2024. She says specifically, the nursing staff asked her mother to reposition herself when she was experiencing a sudden onset of paralysis and did not support her with eating. She says at the end of her mother’s life, the Trust removed oxygen support before it provided her with pain relief that considered her mother's weight. She also says that following her mother's death, the Trust did not provide the family with the correct bereavement care and how it managed the complaint made a distressing time much worse as lacked humanity in its response.

7. Mrs A says seeing her vulnerable mother in so much upset and distress in her final days has had a lasting impact on her and her immediate family. She says she struggles to sleep and is now on anti-depressants and has a diagnosis of post-traumatic stress disorder (PTSD).

8. She wants an acknowledgement of failings, an apology, service improvements and financial remedy.

9. Mrs A, who was 66 at the time of events and had pre-existing medical conditions including a body mass index (BMI) of 50, chronic obstructive pulmonary disease (COPD) and diabetes. The Trust admitted Mrs A into the emergency department (ED) on 12 April after suddenly experiencing weakness and numbness in her limbs. It then transferred her to critical care on 13 April. She sadly died on 16 April of hypercarbic respiratory failure (also called hypercapnic respiratory failure) is a medical condition where the lungs are unable to remove enough carbon dioxide (CO₂) from the blood.

Repositioning

12. Mrs A complains the Trust failed to manage her mother, Mrs N’s care correctly during her critical care admission in mid-April 2024. She says specifically, the nursing staff asked her mother to reposition herself when she was experiencing a sudden onset of paralysis.

13. We have looked at Mrs A’s concerns that nursing staff asked her mother to reposition herself during her first night despite her not being able to do this herself due to weakness and numbness in her limbs. She says when her mother could not do this, the nursing staff were abrupt and rude to her.

14. Mrs A says her mother’s experience was distressing for her and her mother was still upset the following day when she visited her by the interaction.

15. Our Principles for Remedy says where failings have had an impact, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. An appropriate range of remedies will include an apology, explanation, and acknowledgement of responsibility.

16. In its final response, the Trust has apologised to Mrs A for this interaction and her mother’s experience. The Trust advised it had spoken to the nurse involved and asked them to reflect on their clinical practice and how they could improve this going forward.

17. We recognise how difficult it can be to bring forward concerns during such a challenging time, and we appreciate the time and effort Mrs A has taken to do so. After careful evaluation, we consider that the actions taken by the Trust in its final response are sufficient to address the distress Mrs A has highlighted regarding her mother’s experience.

18. As Mrs A also wants a financial remedy, we have considered the impact the experience had on her. She told us it was distressing to see her mother so upset during an already difficult time.

19. We have considered our severity of injustice scale and feel that the added distress Mrs A experienced at what was already a very challenging and overwhelming time is remedied through the apology and action already taken by the Trust.

20. Based on this we are satisfied an acknowledgement, apology and service improvements would be enough to address the impact caused by the failing outlined above. We will therefore take no further action on this part of the complaint.

Nutrition and Hydration

21. Mrs A has also raised concerns the Trust did not support her mother with eating. Mrs A says the nursing team left her mother’s food on the side when it was clear she could not help herself.

22. NICE guidance on nutrition support for adults: oral nutrition support says states that healthcare professionals must ensure people receive appropriate support with food and fluids.

23. The Trust admitted Mrs N into critical care in mid-April following an ED attendance. We have seen evidence it the records, the nursing staff noted she had a very poor appetite and needed encouragement to eat and drink.

24. We have seen evidence in the medical records, the nursing team continued to note Mrs N’s need for full assistance to take diet and fluids alongside information on the ongoing encouragement and support they provided during her short admission.

25. Our clinical adviser explained despite the interventions from the nursing team, Mrs N’s oral intake remained limited due to her reduced level of alertness and physical weakness. They go on to say the Trust had also started intravenous fluids (IV) to supplement Mrs N’s hydration in line with her clinical need from admission. We were sorry to see Mrs N’s condition deteriorated and on the third day of her admission she sadly died.

26. It appears the Trust acted in line with NICE guidance in that the records support that it considered and acted to give Mrs N nutrition and hydration during her admission while considering her deteriorating health. We have seen evidence that although she did find it difficult to eat and drink, the Trust did support her while she was able to do so and then gave her IV fluids when she was not able to.

27. We were sorry to hear of Mrs A’s experience of her mother’s food not being accessible to her and recognise how upsetting and distressing this would have been to see. We hope our findings will give her reassurance we have not found the Trust got anything wrong in its actions relating to her mother’s nutrition and hydration support. We will therefore take no further action on this part of the complaint.

End of Life

28. Mrs A complains at the end of her mother’s life, the Trust removed her oxygen support before it provided her with pain relief that considered her weight.

29. In the early hours of the morning on her third day of admission, Mrs N’s condition, which had been deteriorating over time worsened further. The Trust therefore made the decision to make her comfortable and to inform her family to attend as they thought she was approaching the end of her life.

30. NICE guidance on caring for dying adults says a clinician should consider using a syringe driver (a small, portable medical device used to deliver a continuous and controlled dose of medication under the skin), to deliver medicines for continuous symptom control. It says clinicians should not routinely use oxygen to manage breathlessness in a person in the last days of life. It says to consider managing breathlessness with pain relief medication such as an opioid, a benzodiazepine or a combination of the two.

31. The Trust prescribed her with morphine (opioid painkiller) and midazolam (benzodiazepine) via a syringe driver. It started this medication once her family arrived. Following this it removed oxygen support.

32. Our clinical adviser explained the Trust removed the oxygen as part of transitioning to comfort‑focused end‑of‑life care for Mrs N as it was no longer providing meaningful benefit.

33. The medication prescribed for Mrs N started at five millilitres (ml) per hour with additional single, concentrated doses of the medication prescribed in response to her individual symptoms.

34. Our clinical adviser explained weight-based dosing is not standard practice for end-of-life medication instead the emphasis is on starting with small doses and adjusting the dose of a medication to achieve the desired effect while minimising side effects, according to the individual’s response and needs.

35. We therefore consider the Trust acted in line with NICE guidance when managing Mrs N’s medication and the removal of her oxygen support during the transition to end-of-life care as it started her pain-relieving medication before it removed her oxygen.

36. We recognise Mrs A’s experience of her mother’s final hours was a difficult and distressing one, we hope that our finding will give her reassurance that there was no delay in her mother receiving pain relief before her oxygen was removed or that her weight was a factor in the relief, she received from her pain medication.

Communication

37. Mrs A complains that following her mother's death, the Trust did not provide the family with the correct bereavement care. Mrs A says after her mother had died, the nursing team moved both her and her family to a room that staff were using to sleep which she says caused much distress to an already grieving family. She says she then had to wait two hours to receive a memory box.

38. Our Principles for Remedy says where failings have had an impact, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. An appropriate range of remedies will include an apology, explanation, and acknowledgement of responsibility.

39. In its final response, the Trust have acknowledged Mrs A’s experience was an unacceptable one and has apologised for the distress caused to both her and her family. It has also taken action to learn from the complaint and has made improvements to ensure a better patient experience for future families.

40. We recognise Mrs A’s experience of the Trust’s bereavement care lacked emotional support and empathy for a grieving family and understand how this continues to impact her. After careful evaluation, we consider that the actions taken by the Trust in its final response are sufficient to address the distress Mrs A has highlighted regarding her experience.

41. As Mrs A also wants a financial remedy, we have also considered this. As explained earlier in our decision, we are satisfied an acknowledgement, apology and service improvements are enough to address the impact caused by the failing outlined above. We will therefore take no further action on this part of the complaint.

Complaint Handling

42. Mrs A has told us her concerns about the Trust’s management of her complaint as she says its responses lacked humanity and made an already distressing time much worse.

43. While a humane response is an essential aspect of communication in complaint handling, it is important to recognise that it can be subjective to the reader and not something we can measure in an objective way.

44. We recognise how the responses made Mrs A feel and how this added to the distress she was already feeling at such a difficult time. We were pleased to see in its response in December 2024 the Trust apologised to Mrs A if any of its responses lacked empathy and understanding as this was not its intention

45. As there is no objective evidence to measure this part of the complaint, we would not be able to reach a decision, and we will therefore not take any further action on this part of the complaint.

46. We were sorry to hear of Mrs A’s experience and recognise how upsetting and difficult it has been for her to raise her concerns with our service while grieving her mother. We hope our explanation gives her some reassurance that we have carefully considered her concerns. However, we have not found that the Trust got anything wrong in its actions relating to Mrs N’s nutrition and hydration and the management of her end of life.

47. We are also satisfied it has done enough to address the impact caused by the failings in the nursing care and the Trust’s communication with the family. We will therefore take no further action on the complaint.

1. We have carefully considered the complaint about the University Hospitals of North Midlands NHS Trust (the Trust). We were sorry to hear of Mrs A’ experience, and we would like to express our sincere condolences for the sad loss of her mother.

2. We have looked at all the evidence provided to us by Mrs A and the Trust. We have seen that the Trust followed relevant guidance in relation Mrs N nutrition and hydration during her admission and in its management of her end-of-life care.

3. We have also looked at the nursing care provided to Mrs N on her first night on the ward and the Trust’s communication with the family following their mother’s death and have found that this was not in line with NHS guidance. We have seen that the Trust has acknowledged and apologised to Mrs A for Mrs N’s and her family’s experience and took learning to improve, in line with the Ombudsman’s Principles for Remedy. We are satisfied this is enough to remedy this part of complaint.

4. We have not seen any evidence to support us in making an impartial decision about Mrs A’s concerns about how the Trust managed her complaint and will therefore take no further action on the complaint.

5. We are sorry for any additional upset this may cause, and we hope our explanations below explain how we have fully considered this.