University Hospitals Sussex NHS Foundation Trust

3. Miss Mr R complains that when Mr B, was a patient at the Royal Sussex County Hospital between June and July 2023, the Trust did not properly consider the reasons for his swallowing problems. She says it assumed the cause was alcohol related and did not rule out a physical cause. She says it should have considered and tested for throat cancer.

4. She says if these mistakes had not happened, her partner may have been able to have some treatment for throat cancer, and he may have lived longer. If he had been diagnosed, he may have received care and support, rather than struggling at home before he was readmitted to hospital.

5. She says it was horrific to see her partner at home suffering and unable to eat or drink. She has lost her partner of 36 years.

6. In bringing this complaint she wants the Trust to make service improvements and provide a financial payment to her.

7. On 13 June 2023, Mr B saw his GP due to having repeated collapses or falls, poor mobility, weight loss and being very lethargic. His GP referred him directly to the hospital.

8. He was admitted under the care of the gastroenterology team, doctors who are focused on the digestive system and its disorders. Various teams assessed Mr B and they completed tests such as blood tests, X-rays and brain imaging. A feeding tube was inserted to ensure Mr B received adequate nutrition.

9. Doctors concluded that there was no acute cause for his issues and considering the imaging felt he had chronic and irreversible cognitive impairment due to alcohol use.

10. Mr B remained in hospital whilst staff attempted to increase his intake of food and drink and whilst discharge planning took place. They discharged him home on 11 August with a package of care in place.

11. On 12 September, Mr B saw his GP who referred him to hospital for suspected cancer. However, a few days later, Mr B was readmitted to hospital by ambulance and was found to have a tumour in his throat. Sadly, Mr H died later that month.

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

16. GMC guidance says doctors must adequately assess a patient’s conditions, taking account of their history and where necessary examine the patient. They should promptly provide or arrange suitable advice, investigations or treatment where necessary. They should refer a patient to another practitioner where this serves the patient’s needs.

17. The records show that during his admission, Mr B was reviewed regularly by gastroenterology. They had the referral from the GP, took the history from Mr B and Miss Mr R and physically examined him. They referred him to specialties and completed several tests.

18. Neurologists, who specialise in the nervous system including the brain spinal cord and peripheral nerves, assessed Mr H and concluded his problems were not caused by a focal brain issue. This means they considered he did not have an acute issue affecting one part of the brain, such as a stroke. The frailty team and the older person’s mental health team also reviewed Mr B.

19. Doctors completed blood tests, X-rays, infection screening, CT and MRI scans. These did not show any acute cause for his issues but showed cerebral atrophy. This is the progressive loss of brain cells, causing the brain to shrink and affecting how it works.

20. Speech and language therapists (SALT) saw Mr B regularly. Although they were initially unable to assess his ability to swallow, as he declined food and drink, they were later able to do so to a limited extent. They found he did not have an obvious swallowing difficulty, which is known as dysphagia.

21. We can see the records show that during his admission his oral intake was variable, with him sometimes tolerating more food and varying textures than at other times. This suggests his limited food intake was not due to a physical inability or difficulty swallowing.

22. Doctors concluded that Mr B had chronic and irreversible cognitive impairment due to alcohol use. The charity Dementia UK says that alcohol related brain damage can cause decreased oral intake. Our adviser said the diagnosis of alcohol related dementia was sound, considering the history and investigation results.

23. In our view, there is evidence in the records of a thorough assessment during the admission to try to identify the cause of Mr B’s limited oral intake. We consider this was in line with the GMC guidance.

24. We acknowledge Miss Mr R says doctors should have considered and tested Mr B for throat cancer. NICE guidance for upper gastrointestinal tract cancers says to refer people for suspected cancer if they have dysphagia or if they have persistent and unexplained hoarseness or a lump in the neck.

25. As set out in paragraph 20, an assessment by SALT did not identify any obvious swallowing difficulty. By the time Mr B’s GP referred him on the suspected cancer pathway in September, Miss Mr R reported he had been having difficulty swallowing for a few days, as well as a painful swelling on his neck. This indicates those symptoms only developed after Mr B’s discharge from hospital.

26. Looking at the other symptom to consider in the NICE guidance, hoarseness is where the voice is sounding rough or harsh. We can see there is some evidence from SALT on 19, 20 and 22 June that Mr B was hoarse.

27. However, these occasions were early in his admission and at time when he had a chest infection. Due to him having difficulty managing his secretions (saliva), staff suspected the chest infection may be due to aspiration. This is when something other than air, such as food or secretions, enters the airway. Our adviser said aspiration can cause hoarseness.

28. This means although Mr B had hoarseness, it was only short term over four days, and it was not unexplained as he had aspiration. Considering this, along with the history and investigation results, we do not consider it a failing that the Trust did not suspect Mr B had cancer. This means we do not need to investigate this further.

29. This decision in no way minimises how difficult it was for Miss Mr R that her partner was diagnosed only shortly before his sad death. We recognise the lasting impact these events have had on her.

1. We have carefully considered Miss Mr R’s complaint about the timing of her partner’s diagnosis of throat cancer. We acknowledge how distressing it was for Miss Mr R that his diagnosis came only shortly before he died. We recognise these events continue to be upsetting for her.

2. We understand how important it is for her to know whether more could have been done. Having considered the complaint, we have seen the Trust adequately assessed Mr B’s condition and considered whether there was a physical cause for his symptoms. We have not found the Trust should have suspected he had throat cancer.