Guy's and St Thomas' NHS Foundation Trust

4. Ms F complains about the care and treatment she received for bilateral frontal hyperostosis (BFH) since 2019. Specifically, she complains the organisations listed failed to provide transparency, access to timely diagnosis and treatment. Further, she complains the organisations failed to provide reasonable adjustments and her care was spread across multiple hospitals.

5. Ms F says these failings have left her without a care plan, proper treatment and consistent medical oversight. Ms F says her health has deteriorated as a result and is now living with daily pain, alongside cognitive difficulties. Ms F is no longer able to work as a result of her condition.

6. Ms F is seeking financial remedy, a meeting with a specialist clinician regarding BFH, transparency and for a comprehensive health care plan to be established.

9. The law 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. We have discussed this with Ms F to understand the reasons why she could not do so. We have also considered the time the organisation has taken to respond to Ms F.

10. Ms F complains that the organisations failed to provide adequate care and treatment for BFH since 2019.

11. Ms F claims the organisations failed to provide transparency, access to timely diagnosis and treatment. Further, she states the organisations failed to provide reasonable adjustments and her care was spread across multiple hospitals. Ms F claims that had her concerns been listened to and properly investigated, this would have led to more timely diagnosis and treatment.

12. We first considered when Ms F became aware of her reason to complain. Ms F first complained regarding these failings in 2019 to her GP. Ms F evidences through her complaint to her GP in 2019 that she suspected failings in care. Ms F became aware in October 2023 following an MRI scan that she had a cognitive condition (BFH) on her frontal lobe. This diagnoses further supported Ms F’s belief that there had been failings in her care and treatment.

13. As such, we consider October 2023 to be a reasonable date of knowledge for Ms F to have suspected the claimed failings in care for the entirety of her complaint.

14. This means we would expect the complaint to have been brought to us by October 2024 to be considered in time. The complaint was brought to us in December 2025 and is therefore one year and two months out of time.

15. We have spoken with Ms F to clarify the timeline of events and her reasons for not brining the complaint to us within out one-year time limit. These reasons have been considered when determining if we are able to set aside out time limit in this instance.

16. Ms F has detailed the impact and nature of the claimed failings. Ms F states that these failings are ongoing as the misdiagnosis and the lack of treatment has been persistent over several years. Ms F claims that without recognition of BFH she could not reasonably raise a complaint regarding missed opportunities of care. We were very sorry to hear of Ms F’s trauma and the impact she experienced. We do not underestimate what a difficult time this must have been for her.

17. Ms F has also told us she was unable to bring her complaint to us sooner as her condition has impacted her ability to meet deadlines as she has a restricted capacity to pursue complaints promptly. Further, she explained that she spent time pursuing resolution through the NHS complaints process prior to escalating the complaint to the Parliamentary and Health Service Ombudsman (PHSO). Her complaint was brought to PHSO in December 2025.

18. We acknowledge Ms F’s explanation for the delay in coming to the PHSO and appreciate the gravity of the impact her experiences have had. As previously stated, this complaint has been brought to us one year and two-months out of time. We must carefully consider this period of delay to assess if there are reasons to exercise discretion.

19. We appreciate Ms F’s circumstances surrounding her diagnosis and the adjustments she had to make in her life because of this. After taking this into consideration, we cannot see that Ms F has provided us with barriers which prevented her from bringing her complaint to us for the entirety of this period. Ms F was able to raise and pursue multiple complaints with the named organisations between January 2024 and June 2025. Further, Ms F was able to engage with her local MP during this period who submitted a complaint to SHA on her behalf.

20. We consider that this evidences Ms F’s ability to pursue her concerns and meaningfully engage with the local resolution process.

21. The organisations issued final responses to Ms F between April 2024 and October 2025 which signposted her to PHSO should she have remained dissatisfied with their response. Ms F did not submit a complaint to PHSO until December 2025.

22. Ms F tells us she was unaware of the option of obtaining support through an advocate. We recognise that complainants may not always be aware of all sources of support available to them. Despite this, individuals remain responsible for taking reasonable steps to pursue concerns they wish to raise. We have not seen evidence that a lack of awareness of advocacy services prevented Ms F from exploring how to make a complaint.

23. We do not consider that the reasons provided account for the entirety of this period. We consider Ms F had reasonable opportunity to pursue a complaint with PHSO regarding her concerns at an earlier point.

24. We recognise these events have profoundly impacted Ms F. We can see that Ms F has attempted to find resolution with the organisations before bringing the complaint to us, and we are sorry these have not been successful for her. We are unable to put aside the time limit on this case as the time elapsed is too long for us to be able to exercise our discretion without reasonable cause for the entirety of the period. As such, we will be closing this case as out of time.

1. We have carefully considered Ms F’s complaint about a Special Health Authority (SHA), an NHS Hospital (the Trust), an Integrated Care board (the ICB) and a Practice in the Tower Hamlets area (GP). The complaint falls outside of our time limit, and we have decided there is no good reason for us to put our time limit aside to consider it further.

2. We recognise the profound affect these events have had on Ms F and we are very sorry to hear this. We have taken Ms F’s concerns seriously and carefully considered them. Having done so, we do not consider there is sufficient evidence to show Ms F’s circumstances prevented her from bringing her complaint to us sooner than she did.

3. We acknowledge our decision will be disappointing for Ms F. We are sorry for any further distress our decision may cause, and we hope our explanation set out below shows clearly how we have considered her complaint and the reasons she has provided to us.