Improving healthcare through better patient engagement

In a recent case (ref: 202003667) a patient’s daughter complained that medical staff did not tell her or her family that it had imposed a DNACPR order on her late father, who had dementia and was being treated in hospital.

Doctors tried to contact the family three times within a half hour period but they were unsuccessful.  Despite this they made no attempt to try again. 

While we recognised the pressure clinicians faced at the time, we found it was unreasonable to expect the family to answer within such a short timescale and not follow up on the contact, particularly given the significance of the matter.

By not being told about the decision, the family didn’t have the opportunity to provide their views or to request another clinical opinion. We emphasised the importance of such discussions being handled appropriately, and asked the Trust to provide training to all relevant clinicians to ensure in future they make reasonable attempts to contact a patient’s family about DNACPR when the patient lacks the capacity to consent.

In another case (ref: 202002121) we found that a Health Trust performed an endoscopy on a cancer patient without giving her enough time to think about the procedure or to discuss it with her family. We also found the Trust should have done more to ease her discomfort during the procedure.

These failures caused both the patient and her family significant upset and distress.

We asked the Trust to remind clinical staff of the importance of following guidelines on pain management, obtaining consent, and on communicating with patients and their families.

In another investigation into the actions of a Health Trust (case ref: 202002533), we asked the Trust to make sure patients who have difficulties relaying their medical histories are accompanied when they are assessed in hospital Emergency Departments.

This followed a complaint from a woman who visited the Emergency Department with an ill relative.  She said a nurse had agreed that she should accompany him to the doctor’s assessment due to his memory difficulties. However the doctor subsequently assessed the patient without her being present. 

Although ultimately there was no impact to the patient’s care and treatment, he was distressed at not being accompanied by someone he trusted.

During our investigation we identified a lack of an appropriate and effective procedure for staff to ‘flag’ patients who required assistance with communication and to provide medical history. 

We recommended the Trust should continue to provide further staff training to identify and assist patients with poor memory and communication difficulties.

We asked the Chief Executive of another Health Trust to apologise to a mother after we found opportunities were lost for health professionals to understand how best to care for her daughter when she turned 18 (case ref: 202001744). We recommended that the Trust develop policy and procedures to govern the transition between child and adult services to ensure the change is managed sensitively, empathetically, and as effectively as possible for service users and their families.

When family members are unhappy about the care their loved ones have received it’s also vital their complaints are dealt with properly. The poor management of complaints has been highlighted in many of the reports and inquiries that have examined the care of people with a learning disability in hospitals. In our investigation into the care of a man who had Downs Syndrome and dementia (case ref: 21912943), we found that the family’s distress over how their brother was treated was made worse by the Trust’s poor handling of their complaint.

Our report said that better communication with the family, and more empathetic and timely responses may have helped resolve their concerns and prevented them having to use time and energy in approaching the Public Services Ombudsman. 

And finally, in another recent case (ref: 202001941) we investigated a complaint from a woman who said that medical staff should have asked her late sister whether she wanted her loved ones to have a say in her care.

Her sister attended a hospital Emergency Department following an overdose of paracetamol tablets. She was referred to the care of the Trust’s Community Addictions Team and the Self-Harm Intervention Programme. She later took her own life.

We found that the Trust’s assessment of the patient was based on information solely provided by her, and that it would have benefitted from the wider views of those closest to her. We believed this caused the complainant an injustice as she continued to question whether the outcome for her sister may have been different if this input had been provided.

We asked the Trust to apologise to the complainant, and to highlight to staff the importance of incorporating the views of patients and their loved ones when developing care plans.