Trust failed to handle complaint well which added to family's distress

What happened

Ms T's elderly father, Mr D, had been in hospital locally to where he lived, which was in a different part of the country to his daughter. A plan was in place to transfer him to hospital close to Ms T in preparation for a stay with her while he recuperated. However, not long after his transfer between hospitals, Mr D had a fall in hospital, that caused a head injury. He remained in hospital and died a few days later.

Ms T had first complained to both hospitals about his care and treatment before her father's death, sending them a joint letter of complaint. Each Trust sent a separate response, but Ms T was dissatisfied with both responses. She sent a further joint letter to both Trusts and they eventually responded jointly.

In the meantime, an inquest was opened to establish the cause of Mr D's death. The coroner raised concerns, which he said if left unaddressed, could lead to future deaths. The coroner's concern related to record keeping and communication about Mr D's transfer between hospitals and his fall.

What we found

We investigated responses from one of the Trusts, because Ms T was satisfied with the response received from the other.

Our investigation only considered the Trust's complaint handling and did not address Mr D's care and treatment, because an inquest had already looked at this in detail.

There were a number of failings in how the Trust we investigated handled the complaint. We saw inconsistencies in its responses, and it had no evidence to support its account of events. This contradicted the other Trust, which had evidence to support what it said. The Trust based its response on the account of one staff member, instead of gathering evidence from all the people involved, and some information in that response was misleading. The Trust also gave the complainant an initial response before it had completed an internal root cause investigation. It did not then take the findings from the investigation into account when it provided Ms T with further responses.

These failings led to a protracted complaints process for Ms T, causing her additional distress and frustration at a time when she was mourning her father.

Putting it right

After receiving our findings, the Trust gave us information that demonstrated it had already identified failings in its complaint handling processes and had taken action to put them right. This included better communication with complainants, improved management of the investigation, shorter response times, taking more staff statements and completing a root cause analysis (where one is required) before responding to a complaint. We also saw that the Care Quality Commission had inspected the Trust and seen improvements in complaint handling. We therefore did not make any further recommendations.